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Development of the York Angina Beliefs Questionnaire
Abstract
It is known that people who have suffered a heart attack can hold misconceived or maladaptive beliefs and that these can have a deleterious effect on quality of life and functioning. It has also been noted that clinicians do not routinely elicit these maladaptive beliefs. It is probable that angina sufferers also hold such beliefs. As angina is a great burden in the western world, with over two million people with angina in the UK alone, there may be large numbers of people who suffer from these frightening and unhelpful misconceptions. We believe that there is a need for a simple questionnaire that could assist the delivery of tailored education directed at dispelling common misconceptions. This article details the development and psychometric properties of just such a brief questionnaire, designed for use both in research and in clinical practice.
... Estas crenças são conhecidas na literatura como illness misconceptions. Passando muitas vezes despercebidas aos profissionais de saúde, podem resultar em comportamentos que afetam negativamente a saúde global e cardíaca dos indivíduos (Furze, Bull, Lewin, & Thompson, 2003;Furze, 2007). ...
... Num estudo exploratório de levantamento das crenças erróneas e estratégias de coping não adaptativas destes pacientes, Furze at al. (2001) identificaram o stress como a atribuição causal mais frequente e o evitamento de atividades como a estratégia não adaptativa mais referida pelos participantes. Os resultados deste estudo deram lugar ao desenvolvimento de um questionário onde são listadas as crenças potencialmente desadequadas sobre a angina -o York Angina Beliefs Questionnaire (Furze et al., 2003). A sua aplicação revelou que indivíduos com mais equívocos sobre a sua angina eram mais propensos a ficar ansiosos, deprimidos e/ou fisicamente limitados. ...
... Os coeficientes de consistência interna medidos através do alfa de Cronbach foram de 0,73 para os cônjuges e 0,68 para os pacientes. (Furze et al., 2003). Esta escala é composta por 22 itens, com uma escala de resposta de cinco pontos (tipo Likert) variando de (0) "discorda completamente" a (4) "concorda completamente". ...
Objetivo: O presente estudo de caráter exploratório procurou caraterizar e comparar as perceções de doença e as crenças erróneas sobre a doença cardíaca em pacientes portugueses e nos seus cônjuges. Método: A amostra foi composta por 46 pacientes com doença cardíaca e 32 cônjuges. Foi utilizada uma metodologia combinada (qualitativa e quantitativa), com recurso a instrumentos de autorrelato e, no caso das perceções de doença dos pacientes, também a desenhos do coração. Resultados: Verificou-se que as perceções de doença do paciente diferem consoante o sexo, a idade e a situação profissional e estão relacionadas com traços de personalidade. Os cônjuges dos pacientes parecem reportar níveis mais elevados de preocupação com a doença. A análise dos desenhos efetuados pelos pacientes sugere ainda que a altura e a área dos mesmos podem estar associadas com dimensões específicas das perceções de doença. Conclusão: Em termos gerais consideramos que o presente estudo contribui de forma modesta mas significativa para descrever o tipo de crenças erróneas sobre as doenças de coração dos pacientes e cônjuges, assim como para analisar de que forma a perceção da doença influencia outras crenças relacionadas com diferentes aspetos da fase de ajustamento e gestão da doença.
... Cardiac misconceptions were first described and studied in post-MI patients, in whom a higher number of misconceptions was found to be associated with worse indicators of recovery (Maeland & Havik, 1988. Later, this area of research was extended to angina patients with the development of the York Angina Beliefs Questionnaire (YABQ; Furze, Bull, Lewin, & Thompson, 2003). Furze and collaborators found the most frequently held maladaptive beliefs about angina consisted in causal attributions to stress and overexertion, placement of the problem inside the heart rather than in the coronary arteries, and coping strategies based on avoidance (Furze, Lewin, Roebuck, & Thompson, 2001). ...
... Furze and collaborators found the most frequently held maladaptive beliefs about angina consisted in causal attributions to stress and overexertion, placement of the problem inside the heart rather than in the coronary arteries, and coping strategies based on avoidance (Furze, Lewin, Roebuck, & Thompson, 2001). Patients with higher misconceptions reported greater levels of anxiety and depression and more physical limitations (Furze et al., 2003). Also, in a prospective study with angina patients, a reduction in misconceptions was the best 2 M.J. Figueiras et al. predictor of more physical limitations (Furze, Lewin, Murberg, Bull, & Thompson, 2005). ...
... This result is congruent with previous literature, showing cardiac misconceptions are associated with poorer coping strategies (e.g. Furze et al., 2003). This result fits within the self-regulation model, as after a sudden MI both the patients' emotional responses to and their representations of the MI, including cardiac misconceptions, would be activated (Leventhal et al., 2003). ...
... Estas crenças são conhecidas na literatura como illness misconceptions. Passando muitas vezes despercebidas aos profissionais de saúde, podem resultar em comportamentos que afetam negativamente a saúde global e cardíaca dos indivíduos (Furze, Bull, Lewin, & Thompson, 2003;Furze, 2007). ...
... Num estudo exploratório de levantamento das crenças erróneas e estratégias de coping não adaptativas destes pacientes, Furze at al. (2001) identificaram o stress como a atribuição causal mais frequente e o evitamento de atividades como a estratégia não adaptativa mais referida pelos participantes. Os resultados deste estudo deram lugar ao desenvolvimento de um questionário onde são listadas as crenças potencialmente desadequadas sobre a angina -o York Angina Beliefs Questionnaire (Furze et al., 2003). A sua aplicação revelou que indivíduos com mais equívocos sobre a sua angina eram mais propensos a ficar ansiosos, deprimidos e/ou fisicamente limitados. ...
... Os coeficientes de consistência interna medidos através do alfa de Cronbach foram de 0,73 para os cônjuges e 0,68 para os pacientes. (Furze et al., 2003). Esta escala é composta por 22 itens, com uma escala de resposta de cinco pontos (tipo Likert) variando de (0) "discorda completamente" a (4) "concorda completamente". ...
... Sabe-se ainda existir uma associação, embora questionável, entre diagnóstico de TP e prolapso da válvula mitral 22 . Pacientes que sofrem de angina também tendem a superestimar a periculosidade dos sintomas 23 . Desta forma, indivíduos que sobreviveram a um evento cardiovascular agudo, ou mesmo que possuem condições cardiovasculares menos complexas, até mesmo sem risco de letalidade, podem vir a constituir um grupo de risco para o desenvolvimento de TP, em função de suas crenças disfuncionais acerca de seus sintomas físicos 20 . ...
... Indivíduos que sofreram um infarto do miocárdio podem desenvolver crenças distorcidas e/ou desadaptativas -como, por exemplo, "Quando eu tenho desconforto no peito ou quando meu coração está acelerado, eu penso que posso estar tendo um ataque cardíaco" ou "Mesmo que os exames estejam normais, eu ainda me preocupo com meu coração" -, que geram efeitos deletérios em sua qualidade de vida e funcionamento. Estes pacientes se tornam mais ansiosos e apresentam limitações físicas clinicamente significativas quando comparados com indivíduos que não as desenvolvem 23 . Além disso, tais pacientes são freqüentemente mais ansiosos e fisicamente limitados do que aqueles com menos crenças desta natureza, sendo as diferenças clínicas significativas entre os dois grupos. ...
... Além disso, tais pacientes são freqüentemente mais ansiosos e fisicamente limitados do que aqueles com menos crenças desta natureza, sendo as diferenças clínicas significativas entre os dois grupos. Tal atitude pode, ainda, produzir efeito negativo sobre a adesão do paciente ao tratamento cardiológico 23,24 . ...
OBJETIVO: Estresse e depressão já são considerados fatores de risco para o desenvolvimento e o agravamento de doenças cardiovasculares. Os transtornos de ansiedade têm sido fortemente associados às cardiopatias nos últimos anos. O transtorno de pânico em cardiopatas representa um desafio em termos de diagnóstico e tratamento. Atualizar o leitor quanto ao status da associação entre transtornos de ansiedade, especialmente transtorno de pânico, e cardiopatias. MÉTODO: Foi realizada uma busca nas bases de dados ISI e Medline, com as palavras-chave: "heart disease", "coronary disease", "anxiety", "panic disorder" e "autonomic function". Foram selecionados os artigos publicados a partir de 1998. DISCUSSÃO: O padrão autonômico encontrado em pacientes com transtorno de pânico, em particular a redução da variabilidade cardíaca, é apontado como o provável fator mediador do impacto cardiovascular do transtorno de pânico. CONCLUSÕES: Apesar de a associação entre transtornos de ansiedade e doenças cardiovasculares estar atualmente bastante estabelecida, existem ainda diversas lacunas no estado atual do conhecimento. São recomendadas a terapia cognitivo-comportamental e a prática de exercícios físicos supervisionados como potenciais coadjuvantes na intervenção terapêutica.
... Despite the well established benefits of risk factor modification CHD individuals often fail to change adverse behaviours ( Fernandez et al., 2006;Goulding et al., 2010) and there is a reciprocal relationship between risk perception and adaptive behaviours (Brewer et al., 2004). A failure to accurately perceive risk or acknowledge consequences of behaviour can alter an individual's actions ( Furze et al., 2003;Smith et al., 2006). ...
... The rationale for this is how people represent their medical conditions influences behaviour and is likely related to perception of risk. The York Angina Beliefs Questionnaire consists of 16 statements about angina with answers scored on a five-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree), with ''I don't have any idea about this'' scoring 2. The internal reliability of this scale is 0.803 ( Furze et al., 2003). ...
... This study confirms the observations of other investigators who describe poor congruence between actual and perceived cardiovascular risk ( Goldberg et al., 2002;Weinstein, 1989). Further, many individuals commonly hold erroneous beliefs regarding their health conditions ( Furze et al., 2003;Furze et al., 2002). Of note there was an increased congruence between actual and perceived risk in those admitted to hospital following an ACS suggesting that this is an optimal time for patient education. ...
An individual's perception of the risk of, and their susceptibility to, future cardiovascular events is crucial in engaging in effective secondary prevention.
To investigate the perception of a cardiovascular event by examining the level of agreement between individuals with CHD views of their actual and perceived risk.
This study examined the individual's perception of the risk of a subsequent cardiac event among 220 patients hospitalised for a percutaneous coronary intervention (PCI) at a metropolitan, tertiary referral hospital in Sydney, Australia. Baseline clinical and demographic characteristics were collected, and actual risk (Personal Risk Score) calculated based on the presence or absence of nine cardiovascular risk factors: diabetes, hypertension, high cholesterol, cigarette smoking, previous history of CHD, family history of CHD, depression, overweight or obesity, and physical inactivity. Perception of risk was determined using an investigator-developed 4-item, 11-point Likert scale instrument (Perceived Heart Risk Questionnaire--PHRQ) which measured two dimensions of health threat: perceived seriousness, and perceived susceptibility. The correlation between the Personal Risk Score and the PHRQ was assessed using the Pearson product-moment correlation coefficient.
The calculated mean Personal Risk Score was 4.63±1.71 and the PHRQ was 25.5±7.04. The correlation between the Personal Risk Score (actual risk) and the PHRQ (perceived risk) was r=0.26 (p<0.01).
The weak relationship between actual and perceived risk is of concern, particularly in a population at higher risk for future cardiovascular events. Implementing strategies to personalise risk should be explored to improve the accuracy of risk perception, and facilitate tailoring of behaviour change strategies.
... Patients' beliefs about their condition can influence their symptoms and effective rehabilitation 2 . In particular, cardiac misconceptions have a detrimental effect on the frequency of angina, functional status [3][4][5][6][7] , uptake of cardiac rehabilitation 8 and adherence to medications 9 . The classic example of a cardiac misconception is that exercise which brings on angina is 'bad' for the heart. ...
... While there has been work published on the cardiac misconceptions of patients 3,6,7,11,15,16 , there is limited data relating to the cardiac misconceptions of healthcare workers 11,12 with the exception of a recent study which compared cardiac misconceptions among nurses, nursing students and patients with heart disease in Taiwan 17 . This study found that nursing students had fewer cardiac misconceptions than registered nurses and that there were no significant differences in the number of misconceptions between cardiac and general nurses. ...
... Subjects were asked to complete a demographic data sheet including details of occupation, grade, place of work and years qualified and were also requested to complete the York Cardiac Beliefs Questionnaire (2007 version) (YCBQ). The YCBQ is based on previous questionnaires including the York Angina Beliefs Questionnaire which has been shown to be sensitive and reliable for eliciting an individual's cardiac misconceptions 6,16 . The YCBQ is designed to elicit beliefs regarding causation and coping with heart disease that may be misconceived and/or potentially maladaptive. ...
BACKGROUND: Cardiac misconceptions are common and may have a detrimental effect on patients. Such misconceptions may be introduced or reinforced by vague and inconsistent advice from healthcare staff and can adversely affect health outcomes. AIM: To assess whether level of cardiac misconceptions significantly differs between groups of healthcare staff based on occupation. METHODS: The 22-item York Cardiac Beliefs Questionnaire (YCBQ) was administered to a convenience sample of healthcare staff (n=263) in direct contact with cardiac patients. Data was also collected on the occupation of healthcare staff and years worked. RESULTS: Medical staff had the lowest mean score (17.5, CI 15.6-19.4), indicating fewest misconceptions, and unqualified healthcare workers had the highest mean score (32.1, CI 28.4-35.7). Analysis by ANOVA indicated differences between staff groups to be statistically significant (F=17.66, p<0.001). Length of time worked was found to be significantly associated with cardiac misconception score (Pearson's r=-0.243, p<0.001). Further analysis demonstrated that significant differences between mean group scores remained when years worked was defined as a covariate, F=15.68, p<0.001). CONCLUSION: There is significant variability in cardiac misconceptions in different groups of healthcare staff. Education to correct cardiac misconceptions should be particularly targeted at unqualified healthcare staff. The importance of maintaining appropriate ratios of qualified to unqualified healthcare staff in the care of cardiac patients is supported by this study.
... Sabe-se ainda existir uma associação, embora questionável, entre diagnóstico de TP e prolapso da válvula mitral 22 . Pacientes que sofrem de angina também tendem a superestimar a periculosidade dos sintomas 23 . Desta forma, indivíduos que sobreviveram a um evento cardiovascular agudo, ou mesmo que possuem condições cardiovasculares menos complexas, até mesmo sem risco de letalidade, podem vir a constituir um grupo de risco para o desenvolvimento de TP, em função de suas crenças disfuncionais acerca de seus sintomas físicos 20 . ...
... Indivíduos que sofreram um infarto do miocárdio podem desenvolver crenças distorcidas e/ou desadaptativas -como, por exemplo, "Quando eu tenho desconforto no peito ou quando meu coração está acelerado, eu penso que posso estar tendo um ataque cardíaco" ou "Mesmo que os exames estejam normais, eu ainda me preocupo com meu coração" -, que geram efeitos deletérios em sua qualidade de vida e funcionamento. Estes pacientes se tornam mais ansiosos e apresentam limitações físicas clinicamente significativas quando comparados com indivíduos que não as desenvolvem 23 . Além disso, tais pacientes são freqüentemente mais ansiosos e fisicamente limitados do que aqueles com menos crenças desta natureza, sendo as diferenças clínicas significativas entre os dois grupos. ...
... Além disso, tais pacientes são freqüentemente mais ansiosos e fisicamente limitados do que aqueles com menos crenças desta natureza, sendo as diferenças clínicas significativas entre os dois grupos. Tal atitude pode, ainda, produzir efeito negativo sobre a adesão do paciente ao tratamento cardiológico 23,24 . ...
Psychosocial stress and depression have already been established as risk factors for developing and worsening cardiovascular diseases. Anxiety disorders are been strongly associated to cardiac problems nowadays. Panic disorder in cardiac patients represents a challenge for diagnose and treatment. Update the reader on the status of the association between anxiety disorders, particularly panic disorder, in cardiac patients.
Were retrieved papers published at ISI and Medline databases since 1998. Key-words used were: 'heart disease', 'coronary disease', 'anxiety', 'panic disorder' and 'autonomic function'.
The characteristic autonomic pattern found in patients with panic disorder, particularly the reduction in heart rate variability, are discussed as potential mediators of the cardiovascular impact of panic disorder.
Despite de established association between panic disorder and cardiac diseases, current literatures data points to a knowledge gap on treating and diagnosing the comorbidity between panic disorder and cardiovascular diseases. Cognitive-behavioral therapy and regular supervised exercise are recommended as potential adjunct therapeutic interventions.
... Individuals' beliefs about their condition are derived from many sources in addition to medical ones (eg family, cultural group, media). [263][264][265] Information from healthcare professionals may be adapted to fit existing beliefs or ignored, thereby influencing behaviour. 266 Peers, including partners, have greater misconceptions than patients, which may reinforce the network of misconceptions held by patients with angina. ...
... 267,268 The York Angina Beliefs questionnaire is a reliable and valid tool to measure misconceptions and beliefs in angina patients, which may lead to disability, anxiety and avoidance of activity. 265 ...
... Individuals' beliefs about their condition are derived from many sources in addition to medical ones (eg, family, cultural group, media). 233,282,283 Information from clinicians may be adapted to fit existing beliefs or ignored, thereby influencing behaviour. 279 Commonly found beliefs such as 'angina is like a mini-heart attack' or 'every time I get angina I am damaging my heart', influence mood and degree of disability. ...
... It was demonstrated to be a reliable and valid tool to measure misconceptions and beliefs in angina patients, which may lead to avoidance of activity, disability and anxiety. 283 A study of 40 patients examined causal attributions of patients awaiting PCI. Stress, family history and cholesterol are cited as causes of CHD prior to PCI by more females than males. ...
In 2005-6 I was surgical senior editor of the SIGN Guidelines. This guideline was superseded by guideline 151. The recorded prevalence of angina varies greatly across UK studies. The Scottish Health Survey (2003) reports the prevalence of angina, determined by the Rose Angin questionnaire to be 5.1% and 6.7% in males aged 55-64 and 65-74 respectively. For the same age groups in women the equivalent rates were 4% and 6.8%. This compares with general practitioner (GP) record data in the British Regional Heart Study from across the UK of 9.2% and 16.2% for men in the same age groups. The average GP will see, on average, four new cases of angina each year. Practice team information submitted by Scottish general practices to Information Services Division (ISD) Scotland allows the calculation of an annual prevalence rate for Scotland (the proportion of the population who have consulted their general practice because of a definite diagnosis of angina based on ISD’s standard morbidity grouping). In the year ending March 2005 the annual prevalence rate is given as 8.3 for men and 7.6 for women per 1,000 population. This equates to an estimated number of patients seen in Scotland in that year for angina of 42,600 with 68,200 patient contacts. A diagnosis of angina can have a significant impact on the patient’s level of functioning. In one survey, angina patients scored their general health as twice as poor as those who had had a stroke. In another survey, patients had a low level of factual knowledge about their illness and poor medication adherence. A Tayside study showed that in patients with angina, symptoms are often poorly controlled, there is a high level of anxiety and depression, scope for lifestyle change and an ongoing need for frequent medical contact.
... A meta-analysis of seven trials of psychoeducational interventions for people with stable angina reported that such programmes reduced symptoms, improved quality of life and physical limitations (McGillion et al. 2008a). It has also been suggested that a number of common misconceptions about angina are associated with reduced physical and psychological functioning and quality of life in people with angina (Furze et al. 2003Furze et al. , 2005). Guidelines recommend that misconceptions about living with angina are dispelled [Scottish Intercollegiate Guideline Network 2007, NICE 2011. ...
... The Seattle Angina Questionnaire scales and the angina diary were found to be reliable in the original Angina Plan study (Lewin et al. 2002 ). The YABQ was developed among angina populations in the UK and reported good internal consistency (Cronbach's alpha 0AE79–0AE82) and stability (test–retest Pearson's r = 0AE79) (Furze et al. 2003). ...
furze g., cox h., morton v., chuang l.-h., lewin r.j.p., nelson p., carty r., norris h., patel n. & elton p. (2012) Randomized controlled trial of a lay-facilitated angina management programme. Journal of Advanced Nursing68(10), 2267–2279.
Aims. This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP).
Background. Previously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes.
Design. A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist.
Methods. Participants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation.
Results. There was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: Anxiety; Depression; and angina misconceptions. The intervention was considered cost-effective.
Conclusion. The angina management programme produced some superior benefits when compared to advice from a specialist nurse.
... The theories of HBM and TPB have been used in the development of instruments measuring attitudes and beliefs across various conditions including diabetes, 19 angina, 20 coeliac disease 21 and in suicide prevention. 22 Furthermore, the integration of these two social psychological theories has been found to be particularly useful for development of effective communication campaigns that aim to change people's intentions to engage in a health behaviour. ...
Background:
Health practitioners' values, attitudes and beliefs largely determine their referrals to cardiac rehabilitation (CR).
Objective:
To develop and test the Recommending Cardiac Rehabilitation scale (ReCaRe), designed to assess health professionals attitudes, values and beliefs to CR referral.
Methods:
ReCaRe was appraised for: content validity (Delphi method, expert panel); interpretability and face validity (interview, health professionals); factor structure and internal consistency (survey, health professionals); and test-retest reliability (survey, health professionals). Normative scores were collated.
Results:
ReCaRe initially comprised 75 items. Initially, a Content Validity Index (CVI) was calculated for ratings of item relevance (CVI range; 0.27-1.0), which resulted in the removal of 19 items. After preliminary validation and psychometric testing, 34 items were factor-analysed (n = 24) providing a 17-item, four-factor scale: perceived severity and susceptibility (α = 0.93, κ = 0.37); perceived service accessibility (α = 0.91, κ = 0.67); perceived benefit (α = 0.97, κ = 0.47); perceived barriers and attitudes (α = 0.82, κ = 0.49). ReCaRe normative scores (n = 75) are reported.
Conclusions:
This psychometric analysis found ReCaRe to demonstrate good face validity, internal consistency and fair to substantial test-retest reliability. The next step is to validate these initial findings on a larger sample size to confirm whether ReCaRe can enable identification of factors impacting CR referral.
... Fruit and vegetable consumption was measured using two items from the South Australian Monitoring and Surveillance System (SAMSS) [24]. To gain insight into the participant's health literacy, knowledge and beliefs around heart disease and its treatment, we included the York Cardiac Beliefs Questionnaire [25]. ...
Background:
Cardiotoxicity from anticancer therapy affects heart function and structure. Cardiotoxicity can also lead to accelerated development of chronic diseases, especially in the presence of risk factors.
Methods:
This study aimed to develop and pilot a combined cardiovascular disease and cardiotoxicity risk assessment questionnaire to quantify the potential extent of risk factors in breast cancer patients prior to treatment. The questionnaire underwent content and face validity evaluation by an expert panel followed by pilot testing in a sample of breast cancer patients (n = 36). Questionnaires were self-administered while attending chemotherapy clinic, in the presence of a research assistant.
Results:
Mean age of participants was 54.8 years (range 36-72 years). Participants reported CVD risk factors including diabetes 2.8%, hypertension 19.8%, hypercholesterolaemia 11% and sleep apnoea 5%. Lifestyle risk factors, included not eating the recommended serves of vegetables (100%) or fruit (78%) per day; smoking (13%) and regularly consuming alcohol (75%). Twenty five percent reported being physically inactive, 61%, overweight or obese, 24%, little or no social support and 30% recorded high to very high psychological distress. Participants were highly (75%) reluctant to undertake lifestyle changes; i.e. changing alcohol consumption; dietary habits; good emotional/mental health strategies; improving physical activity; quitting smoking; learning about heart-health and weight loss.
Conclusion:
This study is an important step towards prevention and management of treatment-associated cardiotoxicity after breast cancer diagnosis. We recommend that our questionnaire is providing important data that should be included in cancer registries so that researchers can establish the relationship between CVD risk profile and cardiotoxicity outcomes and that this study revealed important teaching opportunities that could be used to examine the impact on health literacy and help patients better understand the consequences of cancer treatment.
... Previous research has found cardiac misconceptions to be associated with higher levels of emotional distress and invalidism in ischemic heart disease (Wynn, 1967), slower recovery and reduced rate of return to work (Havik & Maeland, 1987), more re-hospitalizations (Maland & Havik, 1989), and poor attendance at cardiac rehabilitation (French, Cooper, & Weinman, 2006) in MI patients. Also, angina patients holding stronger misconceptions were more likely to be anxious, depressed and/or physically limited (Furze, Bull, Lewin, & Thompson, 2003). Another study found that change in angina misconceptions was the most significant predictor of patients' physical limitations at one-year follow-up (Furze, Lewin, Murberg, Bull, & Thompson, 2005). ...
... The scale demonstrates good content validity, good internal reliability, and test-retest stability. It was derived from two previous versions of misconception questionnaires and the items were drawn from statements made by patients living in Britain regarding their journey of living with a heart condition [25,26]. The YCBQv1 has been translated into Chinese and used among different patient groups, including cardiac patients and people with chronic illnesses [7]. ...
Background
Cardiac misconceptions are common among healthcare professionals. The development of professional knowledge is considered an essential component of nursing education. Nurses, regardless of their grade, skills, and experience, should be updated with information so as to be able to rectify their misconceptions, as these could affect patient health outcomes. As the literature evaluating the cardiac knowledge and misconceptions of nursing students is sparse, a study of the subject seems warranted. MethodsA cross-sectional sample survey was used to study the cardiac knowledge and cardiac misconceptions of nursing students in Hong Kong. The study sample included 385 senior nursing students from three universities. Their level of knowledge of cardiac disease was assessed using the modified Coronary Heart Disease Knowledge Test. The York Cardiac Beliefs Questionnaire (YCBQv1) was used to examine cardiac misconceptions. ResultsThe scores for the nursing students’ level of knowledge were diverse. Their mean score in the Cardiac Knowledge Test was 12.27 out of 18 (SD 2.38), with a range of 2–17. For cardiac misconceptions, their mean score in the YCBQv1 was 6.98 out of 20 (SD 2.84), with a range of 0–14. A negative correlation, r = −0.33 was found among students with more knowledge and fewer misconceptions. (p < 0.001). The Chi-square tests found some associations between the students’ experiences of caring for cardiac patients and misconceptions about stress and physiology. Conclusions
The results of our analyses indicate a diversity in levels of knowledge among the nursing students. Students with higher scores in cardiac knowledge did not necessarily have fewer misconceptions. There were associations between the students’ misbeliefs and their caregiving experiences with cardiac patients. This study presents a framework for designing the contents of cardiac nursing programmes and is a starting point for promoting research on misconceptions held by undergraduate nursing students. A new paradigm of teaching should include inputs from both perspectives to help students to make critical use of theoretical knowledge to rectify their misconceptions and pursue excellence in the working world.
... Previous research has found cardiac misconceptions to be associated with higher levels of emotional distress and invalidism in ischemic heart disease (Wynn, 1967), slower recovery and reduced rate of return to work (Havik & Maeland, 1987), more re-hospitalizations (Maland & Havik, 1989), and poor attendance at cardiac rehabilitation (French, Cooper, & Weinman, 2006) in MI patients. Also, angina patients holding stronger misconceptions were more likely to be anxious, depressed and/or physically limited (Furze, Bull, Lewin, & Thompson, 2003). Another study found that change in angina misconceptions was the most significant predictor of patients' physical limitations at one-year follow-up (Furze, Lewin, Murberg, Bull, & Thompson, 2005). ...
There is converging evidence that changing beliefs about an illness leads to positive recovery outcomes. However, cardiac misconceptions interventions have been investigated mainly in Angina or Coronary Heart Disease patients, and less in patients following Myocardial Infarction (MI). In these patients, cardiac misconceptions may play a role in the adjustment or lifestyle changes. This article reports a randomized controlled trial of an intervention designed to reduce the strength of misconceptions in patients after a first MI. The primary outcome was the degree of change in misconceptions and the secondary outcomes were: exercise, smoking status, return to work and mood (anxiety and depression). Patients in the intervention condition (n = 60) were compared with a control group (n = 67) receiving usual care. Both groups were evaluated at baseline and 4, 8 and 12 months after hospital discharge. There was a significant time-by-group interaction for the total score of cardiac misconceptions. Patients in the intervention group significantly decreased their total score of cardiac misconceptions at 4 months compared with the control group and this difference was sustained over time. Patients in the intervention group were also more likely to exercise at the follow-up period after MI than the control group. This intervention was effective in reducing the strength of cardiac misconceptions in MI patients and had a positive impact on health behaviour outcomes. These results support the importance of misconceptions in health behaviours and the utility of belief change interventions in promoting health in patients with Myocardial Infarction.
... The Space from Heart Disease intervention builds on a generic online intervention for depression and anxiety that is currently used within the NHS. Space from Heart Disease includes a module on distress, which patients may or may not select, which highlights CVD-related dysfunctional thinking (ie, "catastrophizing"-assuming that chest pain is always serious, leading to panic and inappropriate responses such as avoidance of activity, which can lead to worse health and unnecessary health service use) [45]. However, the impact of low mood and anxiety is stressed throughout the intervention; feedback from the cross-sectional study of participants suggests that people who are not currently experiencing distress may not consider the intervention relevant to them. ...
Poor self-management of symptoms and psychological distress leads to worse outcomes and excess health service use in cardiovascular disease (CVD). Online-delivered therapy is effective, but generic interventions lack relevance for people with specific long-term conditions, such as cardiovascular disease.
To develop a comprehensive online CVD-specific intervention to improve both self-management and well-being, and to test acceptability and feasibility.
Informed by the Medical Research Council (MRC) guidance for the development of complex interventions, we adapted an existing evidence-based generic intervention for depression and anxiety for people with CVD. Content was informed by a literature review of existing resources and trial evidence, and the findings of a focus group study. Think-aloud usability testing was conducted to identify improvements to design and content. Acceptability and feasibility were tested in a cross-sectional study.
Focus group participants (n=10) agreed that no existing resource met all their needs. Improvements such as "collapse and expand" features were added based on findings that participants' information needs varied, and specific information, such as detecting heart attacks and when to seek help, was added. Think-aloud testing (n=2) led to changes in font size and design changes around navigation. All participants of the cross-sectional study (10/10, 100%) were able to access and use the intervention. Reported satisfaction was good, although the intervention was perceived to lack relevance for people without comorbid psychological distress.
We have developed an evidence-based, theory-informed, user-led online intervention for improving self-management and well-being in CVD. The use of multiple evaluation tests informed improvements to content and usability. Preliminary acceptability and feasibility has been demonstrated. The Space from Heart Disease intervention is now ready to be tested for effectiveness. This work has also identified that people with CVD symptoms and comorbid distress would be the most appropriate sample for a future randomized controlled trial to evaluate its effectiveness.
... There is a widespread misconception among patients, some health professionals and the general public that physical activity should be limited after a myocardial infarction to avoid recurrence (NHS Centre for Reviews 1998). This and other misconceptions about heart disease are related to cardiac patients' symptoms, and there is some evidence that changing these beliefs is helpful (Furze et al. 2003). The Scottish Intercollegiate Guideline Networks (SIGN) Clinical Guideline for Cardiac Rehabilitation makes correcting misconceptions a central part of cardiac rehabilitation (SIGN 2002). ...
... Studies that examined the relationship between patients' perceived and actual risk of cardiovascular disease (CVD) reported a tendency towards inappropriate optimism [44]. An accurate risk perception is central to shaping appropriate responses to a health threat [45][46][47]. The term optimistic bias is sometimes used to describe an unrealistic health-risk perception, whereby individuals tend to Table 2 Characteristics of trial participants by group and those lost to follow-up at 12 months. ...
... Positive associations were observed between angina misconceptions and symptom load, poor functional and poor psychological status. In regression models that included baseline demographic variables, change in angina beliefs was the most significant predictor for physical limitations at one-year follow-up, whereas change in symptom severity did not make a significant contribution to the model (Furze, Bull, Lewin, & Thompson, 2003;Furze, Lewin, Murberg, Bull, & Thompson, 2005) This finding has been replicated in a further recent longitudinal study of 434 people with CAD who completed questionnaires at baseline and three months. Measures included: demographics, disease severity, York Cardiac Beliefs Questionnaire (YCBQ), Godin Leisure-time Exercise (GLE) and Vigorous Activity (GVA) questionnaires, Hospital Anxiety and Depression Scales (HADS). ...
Stable angina (a symptom of heart disease) is very common across the world. Cardiac rehabilitation reduces cardiac mortality by up to 26%, but is not routinely offered to people with angina. In addition, common misconceptions about living with angina are stronger predictors of future physical and psychological functioning than severity of the underlying condition. As people with angina have higher risk of anxiety and depression, exercise-based rehabilitation is not enough – there is a need for angina rehabilitation that includes psychological treatments and counselling to dispel misconceptions. This paper discusses the effects on outcome of such cognitive behavioural angina rehabilitation programmes.
... If branch of industry, sociodemographic, or other individual characteristics indeed have a profound effect on specific knowledge and beliefs, this could provide clinicians with suggestions for well-targeted risk education. Although several studies investigated people's knowledge and beliefs about diabetes and CVD 8,[23][24][25][26][27][28][29] this research has tended to focus on individual diseases, rather than on disease risk as a consequence of unhealthy lifestyle. Because more and more emphasis is placed on the shared risk factors of cardiometabolic diseases as well as the interplay of detrimental physiological processes, 30 it is important to assess how workers themselves think about cardiometabolic risk. ...
Investigate workers' knowledge and beliefs about cardiometabolic risk.
A survey on the risks of diabetes, cardiovascular disease, and chronic kidney disease was disseminated among Dutch construction workers and employees from the general working population.
We had 482 respondents (26.8%) among construction workers and 738 respondents (65.1%) among the general working population. Employees showed reasonable basic knowledge, especially about cardiovascular disease risk factors and risk reduction. Nevertheless, they also had knowledge gaps (eg, specific dietary intake) and showed misconceptions of what elevated risk entails. Employees having lower education, being male, and having lower health literacy demonstrated less adequate knowledge and beliefs.
To improve the potential effect of health risk assessments in the occupational setting, physicians should explain what it means to be at elevated cardiometabolic risk and target their messages to employee subgroups.
... Demonstrou-se que pessoas que tiveram um ataque cardíaco apresentam crenças mal adaptadas ou mal concebidas que podem ter um efeito deletério sobre a qualidade de vida e funcionamento 10 . Também se observou que os clínicos não obtêm rotineiramente essas crenças mal adaptadas 11 . ...
INTRODUÇÃO: É crescente a produção científica brasileira na adaptação de instrumentos internacionais para avaliar ansiedade. A tradução e adaptação transcultural de escalas é um primeiro passo na obtenção de instrumentos válidos que permitam a comparação de diferentes populações. O objetivo do presente estudo foi traduzir e avaliar a equivalência semântica do Cardiac Anxiety Questionnaire, realizando um estudo piloto na população brasileira de diferentes níveis de escolaridade. MÉTODO: O processo de adaptação transcultural envolveu duas traduções e retrotraduções realizadas por avaliadores independentes, avaliação das versões e elaboração de uma versão síntese. Também examinamos os comentários dos participantes sobre a versão preliminar do questionário, os quais foram usados no desenvolvimento da versão final. RESULTADOS: Para cada item do instrumento, apresentam-se os resultados das quatro etapas. Os participantes com maior grau de escolaridade não apresentaram dificuldades na compreensão do instrumento, tendo apenas apresentado sugestões controversas acerca do item 5. Entretanto, os participantes apenas com escolaridade em nível fundamental relataram dificuldades com os itens 2, 4, 6, 7, 10, 11 e 14. Algumas alterações semânticas foram realizadas com o intuito de facilitar a compreensão do instrumento. CONCLUSÃO: A utilização de duas versões de tradução e retrotradução, discussão sobre a versão síntese e a interlocução com a população-alvo proporcionaram maior segurança ao processo de equivalência semântica da versão final brasileira.
... In a study of 133 people drawn from general practice and diagnosed with angina, the questionnaire was found to be valid and reliable. People with more misconceptions about their angina were more likely to be anxious, depressed and/or physically limited 6 . ...
People with heart disease have specific beliefs about what caused it and how they should modify their behaviour to cope with the condition. Unfortunately, some of these beliefs are misconceptions that can result in behaviours that adversely affect overall and cardiac health, and long-term outcome. This article looks at the research into cardiac misconceptions, why they matter and what healthcare professionals can do about them. Questionnaires that can be completed by patients in a few minutes have been found to be valid and reliable tools with which to elicit and dispel specific misconceptions about coping with heart disease.
... Knowledge and misconceptions were assessed using the 14-item York Angina Beliefs Questionnaire [22]. This uses a Likert scale response format ranging from "strongly agree" to "strongly disagree" and has been reported to be reliable and valid in this client group. ...
... Knowledge and misconceptions were assessed using the 14-item York Angina Beliefs Questionnaire [22]. This uses a Likert scale response format ranging from "strongly agree" to "strongly disagree" and has been reported to be reliable and valid in this client group. ...
... These findings suggest that a 'mixed' support approach involving both lay-workers and nurses may offer patients the opportunity to ask treatment or medicationspecific questions. Misconceptions about living with angina and their effect on health outcomes have been highlighted previously in the literature (Furze et al. 2003Furze et al. , 2005). A positive element of the management programme for intervention participants and their family/carers was the opportunity to be better informed about angina. ...
Aim:
This paper is a report of a qualitative study conducted as part of a randomized controlled trial comparing a lay-facilitated angina management programme with usual care. Its aim was to explore participants' beliefs, experiences, and attitudes to the care they had received during the trial, particularly those who had received the angina management intervention.
Background:
Angina affects over 50 million people worldwide. Over half of these people have symptoms that restrict their daily life and would benefit from knowing how to manage their condition.
Design:
A nested qualitative study within a randomized controlled trial of lay-facilitated angina management.
Method:
We conducted four participant focus groups during 2008; three were with people randomized to the intervention and one with those randomized to control. We recruited a total of 14 participants to the focus groups, 10 intervention, and 4 control.
Findings:
Although recruitment to the focus groups was relatively low by comparison to conventional standards, each generated lively discussions and a rich data set. Data analysis demonstrated both similarities and differences between control and intervention groups. Similarities included low levels of prior knowledge about angina, whereas differences included a perception among intervention participants that lifestyle changes were more easily facilitated with the help and support of a lay-worker.
Conclusion:
Lay facilitation with the Angina Plan is perceived by the participants to be beneficial in supporting self-management. However, clinical expertise is still required to meet the more complex information and care needs of people with stable angina.
... The incorrect belief that total rest is good for people with CHD while physical activity could be dangerous is one of several common misconceptions. Other examples include 'angina is a small heart attack', 'angina is caused by worry, stress or work', 'it is dangerous for people with heart problems to argue' (Furze et al. 2003), 'after a heart attack, a patient should not fly for 6 months', 'I've smoked for 20 years, it's too late now' and 'hard work causes heart disease' (Lewin et al. 2002a). These examples of incorrect beliefs are by no means exhaustive but demonstrate that a range of misconceptions about causation, physiology and coping exist. ...
This paper is a report of a systematic review of randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease, and was conducted to determine whether such interventions were effective in changing maladaptive beliefs, and to assess any consequent change in coping and outcome.
An increasing body of evidence suggests that faulty beliefs can lead to maladaptive behaviours and, in turn, to poor outcomes. However, the effectiveness of interventions to change such faulty illness beliefs in people with coronary heart disease is unknown.
Multiple data bases were searched using a systematic search strategy. In addition, reference lists of included papers were checked and key authors in the field contacted.
The systematic review included randomized controlled trials with adults of any age with a diagnosis of coronary heart disease and an intervention aimed at changing cardiac beliefs. The primary outcome measured was change in beliefs about coronary heart disease.
Thirteen trials met the inclusion criteria. Owing to the heterogeneity of these studies, quantitative synthesis was not practicable. Descriptive synthesis of the results suggested that cognitive behavioural and counselling/education interventions can be effective in changing beliefs. The effects of changing beliefs on behavioural, functional and psychological outcomes remain unclear.
While some interventions may be effective in changing beliefs in people with coronary heart disease, the effect of these changes on outcome is not clear. Further high quality research is required before firmer guidance can be given to clinicians on the most effective method to dispel cardiac misconceptions.
... Knowledge and misconceptions were assessed using the 14-item York Angina Beliefs Questionnaire [22]. This uses a Likert scale response format ranging from "strongly agree" to "strongly disagree" and has been reported to be reliable and valid in this client group. ...
The aim of this trial was to evaluate the Angina Plan (AP), a cognitive-behavioral nurse-facilitated self-help intervention against standard care (SC). A randomized controlled trial of 218 patients hospitalized with angina assessed participants predischarge and 6 months later. Data were collected during a structured interview using validated questionnaires, self-report, and physiological measurement to assess between group changes in mood, knowledge and misconceptions, cardiovascular risk, symptoms, quality of life, and health service utilization. The intention-to-treat (ITT) analysis found no reliable effects on anxiety and depression at 6 months. AP participants reported increased knowledge, less misconceptions, reduced body mass index (BMI), an increase in self-reported exercise, less functional limitation, and improvements in general health perceptions and social and leisure activities compared to those receiving SC. Sensitivity analysis excluding participants with high baseline depression revealed a statistical significant reduction in depression levels in AP compared to the SC participants. Analysis excluding participants receiving cardiac surgery or angioplasty removed the ITT effects on physical limitation, self-reported exercise and general health perceptions and the improvements seen in social and leisure activities, while adaptive effects on knowledge, misconceptions and BMI remained and between-group changes in depression approached significance. Initiating the AP in a secondary care setting for patients with new and existing angina produces similar benefits to those reported in newly diagnosed primary care patients. Further evaluation is required to examine the extent of observed effects in the longer term.
... Many people with heart disease have misconceptions about their illness and how to cope with it. It has been found that people with heart disease who hold a number of common misconceptions are more anxious, depressed and physically limited [15,27], and that change in the number of misconceptions that people with angina hold is a greater predictor of physical functioning one year later than change in the frequency of angina.[14] These relationships between beliefs and outcome can be explained by Leventhal's Common Sense Model of Illness Behaviour [28], in which it is theorised that people build cognitive representations of their illness which engenders an emotional response. ...
Many patients demonstrate psychological distress and reduced physical activity before coronary artery bypass graft surgery (CABG). Here we evaluated the addition of a brief, cognitive-behavioural intervention (the HeartOp Programme) to routine nurse counselling for people waiting for CABG surgery.
Randomised controlled trial comparing nurse counselling with the HeartOp programme to routine nurse counselling in 204 patients awaiting first time elective CABG. Primary outcome measures were: anxiety and length of hospital stay; secondary outcome measures were: depression, physical functioning, cardiac misconceptions and cost utility. Measures were collected prior to randomisation and after 8 weeks of their intervention prior to surgery, excepting length of hospital stay which was collected after discharge following surgery.
100 patients were randomised to intervention, 104 to control. At follow-up there were no differences in anxiety or length of hospital stay. There were significant differences in depression (difference=7.79, p=0.008, 95% CI=2.04-13.54), physical functioning (difference=0.82, p=0.001, 95%CI=0.34-1.3) and cardiac misconceptions (difference=2.56, p<0.001, 95%CI=1.64-3.48) in favour of the HeartOp Programme. The only difference to be maintained following surgery was in cardiac misconceptions. The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of pound 288.83 per Quality-Adjusted Life Year.
Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy.
... A longitudinal study which includes the York Angina Beliefs Questionnaire (YABQ) is underway, in order to discover whether such beliefs predict illness experience and quality of life in a cohort of people with angina, as this work has not been undertaken previously. Early results show significant correlations between scores on the YABQ and anxiety, depression and physical limitation [20]. The results of the longitudinal study will be published in a separate report in the future. ...
What people believe about their illness may affect how they cope with it. It has been suggested that such beliefs stem from those commonly held within society. This study compared the beliefs held by people with angina, regarding causation and coping in angina, with the beliefs of their friends who do not suffer from angina.
Postal survey using the York Angina Beliefs Questionnaire (version 1), which elicits stress attributions and misconceived beliefs about causation and coping. This was administered to 164 people with angina and their non-cohabiting friends matched for age and sex. 132 people with angina and 94 friends completed the questionnaire.
Peers are more likely than people with angina to believe that angina is caused by a worn out heart (p < 0.01), angina is a small heart attack (p = 0.02), and that it causes permanent damage to the heart (p < 0.001). Peers were also more likely to believe that people with angina should take life easy (p < 0.01) and avoid exercise (p = 0.04) and excitement (p < 0.01).
The beliefs of the peer group about causation and coping in angina run counter to professional advice. Over time this may contribute to a reduction in patient concordance with risk factor reduction, and may help to create cardiac invalids.
... The results are consistent with previous research showing that negative patient perceptions of their MI are related to a slower recovery and return to work [1,7]. The results also support recent work showing erroneous beliefs about the heart leading to poorer long-term functioning and quality of life [8]. Given the significant relationship between peak troponin-T and damage drawing, clearly, patients base their ideas about what has happened to their heart, to some degree, on the information that they are given or that they pick up from staff in hospital. ...
The aim of this study was to examine whether myocardial infarction (MI) patients' drawings of their hearts predict subsequent return to work, exercise, distress about symptoms and perceptions of recovery at 3 months.
Just prior to hospital discharge, 74 consecutive patients aged under 70 admitted with an acute MI drew pictures of their hearts. Patients' recovery was assessed at 3 months by postal questionnaire.
Patients who drew damage on their heart while in the hospital perceived that their heart had recovered less at 3 months (P = .005), that their heart condition would last longer (P = .01) and had lower perceived control over their heart condition (P = .05) than did patients who drew no damage. The amount of damage drawn on the heart was also associated with a slower return to work (r = .37, P < .05). While patients' peak troponin-T in the hospital was associated with the amount of damage drawn (r = .41, P < .001), it was not associated with the speed of return to work or other 3-month outcomes, apart from perceived duration of heart condition (r = .26, P < .05).
Patients drawings of damage on their hearts after a MI predict recovery better than do medical indicators of damage. Drawings offer a simple starting point for doctors to assess patients' ideas when discussing their heart condition and an opportunity to counter illness negative beliefs.
Behandlungsmanual und Behandlungsmaterialien für die psychologische Kurzintervention zur Erwartungsoptimierung von Patienten vor herzchirurgischen Eingriffen im Rahmen der randomisiert-kontrollierten mulitzentrischen PSY-HEART-II-Studie.
This study was conducted to assess the effect of an empowerment program on the perceived risk and physical health of patients with coronary artery disease. This randomized clinical trial recruited 84 patients with coronary artery disease admitted to post-cardiac care unit (CCU) wards in Tehran Heart Center in 2017. The study subjects were selected and assessed according to inclusion criteria and assigned to intervention and control groups by block randomization. Both groups completed questionnaires for demographic details and disease history, perceived risk in cardiac patients, and physical health. The Magic Empowerment Program was performed for the intervention group as 3 workshops on 3 successive days. Intervention continued after patients' discharge from the hospital through phone calls once a week for 8 weeks. The perceived risk in cardiac patients and physical health questionnaires were completed for both groups. Postintervention results showed significant differences between the 2 groups in total score of perceived risk (P = .001) and its subscales. The Empowerment Program changed patients' attitudes toward risk-motivating behavior change and improving physical health.
Objective
Despite various efforts, hypertension remains poorly controlled, thus allowing cardiovascular disease (CVD) to impact the health burden worldwide. Patients’ perception of risk may contribute to this scenario. The present study aims to assess the level of risk perception among individuals with hypertension in rural Malaysia.
Methods
This is a community-based study conducted among adults between 2010 and 2011 among a rural population in Raub, Pahang, Malaysia. Blood pressure was measured after 5 min of rest. Measurement was done twice and the average was recorded. Cardiovascular risk perception score (CvRPS) was derived using the Modified Risk and Health Behavior Questionnaire. Higher CvRPS indicates the respondent perceives a poorer prognostic outlook.
Results
A total of 383 respondents who have hypertension participated in this study. The mean age of respondents was 62±10.6 years; men 63.1±9.6 years, women 61.2±11.1 years (p>0.05). Among hypertensives, those who were not on medication had significantly lower CvRPS compared with those who were on medications (115.9±22.1vs 120.9±23.5, p=0.036); those who were not aware of their hypertensive status had significantly lower CvRPS compared with respondents who were aware about their hypertension (116.7±22.5vs 121.7±21.3, p=0.029) and those with uncontrolled hypertension had significantly lower CvRPS compared with those whose blood pressure was controlled (118.2±22.2vs 128.8±25.8, p=0.009).
Conclusions
Our study shows that respondents who were not on medications, unaware of their hypertension status and those who had uncontrolled hypertension tended to underestimate (lower CvRPS) their risk for CVD. Improving their CvPRS through a concerted health education may lead to better therapeutic behaviour and outcomes.
Background and objective: previous studies revealed some angina misconception among patients and health care providers. The aim of this study was to assess the misconceptions about angina held by nurses, nursing students and patients.
Materials and methods: In this cross sectional study, 120 nurses, 120 nursing students, and 120 patients with angina pectoris in Iran participated. Data were gathered by using the York angina belief Questionnaire version 1. The mean of angina misconception were compared by using ANOVA analysis of variance. The correlations between the questionnaire and the variables were calculated by regression. α < 0.05 was considered significant.
Results: Nursing students had a significantly lower misconception than patients and nurses (39.03 ± 6.35 vs. 43.70 ± 7.22 in nurses and 43.78 ± 5.77 in patients, P = 0.001). However, the differences between nurses and patients with angina, regarding the misconception score, were not significant: 43.70 ± 7.22 vs. 43.78 ± 5.77, P = 0.9, and no statically significant association was made between age, sex, education, training and number of misconception in patients, nurses and nursing students.
Conclusion: Nurses have the most pregnant relationship with patients at different stages of their treatment and can play an important role in assessing their misconceptions and intervention to dispel them. It seems that the nursing students and the nurses’ continual professional educations should be emphasized to use the scientific knowledge to dispel the misconceptions in patients.
Chest pain and palpitations, non-malignant pain, breathlessness and fatigue often endure despite the receipt of appropriate nursing and medical care. This is distressing for patients, impacts on their quality of life and ability to function and is associated with high healthcare usage and costs. The cognitive behavioural approach offers nurses a model to understand how people's perceptions and beliefs and their emotional, behavioural and physiological reactions are linked. Common 'thinking errors' which can exacerbate symptom severity and impact are highlighted. Understanding of this model may help nurses to help patients cope better with their symptoms by helping them to come up with alternative more helpful beliefs and practices. Many Improving Access to Psychological Therapy services offer support to people with chronic physical symptoms and nurses are encouraged to sign post patients to them.
Psychological tests and questionnaires are commonly used in personnel recruitment and selection procedures. Because test length has a considerable impact on assessment time and costs, short tests consisting of fewer than 20 items, for instance, are preferable to long tests. Simulated data show that reducing test length can have a substantial impact on the risk of making incorrect selection decisions. However, the impact of shortening tests varies across situations. In this article, I illustrate testing settings in which five items are sufficient to make reliable decisions about individual candidates. I also present scenarios in which 40 items are still insufficient to draw reliable conclusions, even when using an adaptive test. The conclusion is that long tests are preferable to short tests for making personnel selection decisions.
Research about cardiac misconceptions has focused on identifying the most common erroneous beliefs and understanding their impact on patients’ outcomes. However, less is known about the underlying structure of cardiac misconceptions and how they relate to other belief dimensions. The aims of the present study were: (a) to characterize illness perceptions and cardiac misconceptions in a sample of Myocardial Infarction (MI) patients; (b) to analyse the structure of an experimental Portuguese version of the York Cardiac Beliefs Questionnaire (YCBQ); and (c) to examine whether illness perceptions are likely to influence cardiac misconceptions. This cross-sectional study included 127 first-MI patients from both sexes, aged up to 70 years old. Confirmatory factor analysis and structural equation modelling were performed with AMOS. The main results showed that a two-dimension (stress avoidance and exercise avoidance) version of the YCBQ offered the best fit to the data. A significant impact of psychological attributions was observed on cardiac misconceptions, as well as a moderate impact of emotional response explaining 26% of the variance. Although exploratory, this study gives a significant contribution to research in this field, as clarification on the different concepts and the way they relate is needed. Our findings suggest that further investigation into the concepts of cardiac knowledge and cardiac misconceptions may have an important role in understanding health behaviours in the context of heart disease.
In clinical contexts, tests and questionnaires are used to assess change at the level of the individual client. The difference between an individual client's posttreatment and pretreatment scores is used to decide about the degree to which the client benefited from a treatment. Because administration time is limited, clinicians prefer using short tests consisting of, say, at the most 15 items. Simulation research showed that shorter tests produce a higher risk of drawing incorrect conclusions about change in individual clients. Based on the simulation results, the authors provide guidelines for the number of items minimally required to reliably assess individual change. Using item response theory, they also provide guidelines for the minimally required local test information for individual-change assessment.
This study sought to confirm the structure and to investigate the psychometric properties of an experimental Portuguese version of the York Cardiac Beliefs Questionnaire (YCBQ) in a general population sample. It also set out to identify the prevalent misconceptions in the community and to assess the differences according to socio-demographic characteristics. It involved a cross-sectional survey in which both test and validation samples were collected (n = 476), including participants aged between 18 and 40, recruited via e-mail and social networks. The Confirmatory Factor Analysis on both samples suggested a shorter, three factor version of the YCBQ. Also, misconceptions differed significantly according to sociodemographic variables. The validation of the YCBQ for samples in the community constitutes an important starting point to promote research on misconceptions held in the community by specific groups, as well as to provide key points for health promotion.
The routine review of a patient with CVD who is receiving treatment for secondary prevention is described by Amber Cornforth.
To examine published literature investigating the relationship between illness perceptions, mood and quality of life (QoL) in coronary heart disease (CHD) populations.
Key databases were systematically searched (CINAHL, Medline, PsycINFO, Scopus and Web of Science) for studies matching the inclusion criteria between November 2011 and February 2012. References of included studies were examined and key authors contacted. Studies were subject to a quality control check.
21 studies met the inclusion criteria. A synthesis of the results found that illness perceptions were correlated to and predicted QoL and mood across CHD diagnoses. Specific illness perceptions (control, coherence and timeline) were found to be important for patients that had experienced an unexpected medical event, such as myocardial infarction.
The results of this study provide support that illness perceptions are related to outcomes across CHD populations and disease progression, however the results do not selectively support one particular model. Recommendations are consistent with cardiac rehabilitation guidelines. Further research should focus on the systemic impact of illness perceptions.
To efficiently assess multiple psychological constructs and to minimize the burden on respondents, psychologists increasingly use shortened versions of existing tests. However, compared to the longer test, a shorter test version may have a substantial impact on the reliability and the validity of the test scores in psychological research and individual decision making. In this study, we reviewed the psychological literature for recent trends in the use of short tests and examined in depth how and to what extent test constructors and test users addressed the impact on reliability and validity, other potential consequences of using short tests. The sample consisted of shortened tests found in six peer-reviewed psychological journals in the period 2005–2010. Based on our review, we provided recommendations for psychologists considering test shortening.
Cognitive behavioral (CB) disease management programs were developed to help people with chronic back pain and have an extensive
evidence base in that role. The same methods are now being adapted for use in other chronic illnesses.1 Using the example of angina, this chapter will explain how these techniques can be applied in cardiac rehabilitation (CR)
and concludes with a brief description of such a program.
Personnel selection shows an enduring need for short stand-alone tests consisting of, say, 5 to 15 items. Despite their efficiency, short tests are more vulnerable to measurement error than longer test versions. Consequently, the question arises to what extent reducing test length deteriorates decision quality due to increased impact of measurement error. A distinction was made between decision quality at the group level and the individual level. Using simulations, we found that short tests had a large negative impact on individual-level decision quality, in particular for selecting suited candidates when base rates or selection ratios are low. Negative effects on group-level decision quality were smaller than those for individual-level decision quality. Results were similar for dichotomous-item tests and rating-scale tests, and also for top-down and cut-score selection.
Refractory angina patients suffer debilitating chest pain despite optimal medical therapy and previous cardiovascular intervention. Cardiac rehabilitation is often not prescribed due to a lack of evidence regarding potential efficacy and patient suitability. A randomised controlled study was undertaken to explore the impact of cardiac rehabilitation on cardiovascular risk factors, physical ability, quality of life and psychological morbidity among refractory angina sufferers.
Forty-two refractory angina patients (65.1 ± 7.3 years) were randomly assigned to an 8-week Phase III cardiac rehabilitation program or symptom diary control. Physical assessment, Progressive Shuttle Walk test, Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, the York Angina Beliefs scale, ENRICHD Social Support Instrument and SF-36 were completed before and after intervention and at 8-week follow-up.
Following cardiac rehabilitation, patients demonstrated improved physical ability compared with controls in Progressive Shuttle Walk level attainment (p = 0.005) and total distance covered (p = 0.015). Angina frequency and severity remained unchanged in both groups, with the control demonstrating worsening SF-36 pain scale (63.43 ± 22.28 vs. 55.46 ± 23.98, p = 0.025). Cardiac rehabilitation participants showed improved Health Anxiety Questionnaire reassurance (1.71 ± 1.72 vs. 1.14 ± 1.23, p = 0.026) and York Beliefs anginal threat perception (12.42 ± 4.58 vs. 14.35 ± 4.73, p = 0.05) after cardiac rehabilitation. Physical measures were broadly unaffected.
Cardiac rehabilitation can be prescribed to improve physical ability without affecting angina frequency or severity among patients with refractory angina.
The main purpose of the study was to find out whether preoperative education helps in reducing anxiety in patients undergoing coronary artery bypass surgery (CABG), by means of systematic review. About 28,000 CABG surgeries are done in UK every year, but there is variation in terms of number of surgeries from place to place. Patients undergoing CABG faces many psychological issues such as anxiety and depression that may bring the worse outcome of the surgery and even leads to death or another cardiac event. This systematic review brings all these issues into light and 14 relevant studies obtained by search methodology have discussed the issues such as effect of anxiety on coronary heart disease, effect of preoperative patient education on the outcome of the surgery and the different forms of education and their effects. It was reported that anxiety does predict the post operative psychological outcome. Positive association were observed between different forms of education such as support from peer group and music and video information. The systematic review concluded that there is positive effect of education given to the patient prior to surgery, but few more studies need to be performed on large cardiac population to obtained better results for the practical implementation.
INTRODUÇÃO: A busca por subtipos clínicos com melhor resposta terapêutica a tratamentos específicos levou à descrição do transtorno de pânico subtipo respiratório. A qualidade de vida de pacientes com transtorno de pânico (TP) é prejudicada devido a agorafobia, a mais freqüente das conseqüências do TP não tratado. Apesar de ser uma forma de esquiva, há poucos estudos sobre esquiva de atividade física e TP. OBJETIVO: Identificar se uma população com sintomas predominantemente respiratórios apresenta esquiva de atividade física e verificar as diferenças fisiológicas no exame clínico de ergoespirometria desta população, em comparação a pessoas sem transtorno de pânico e com transtorno de pânico subtipo não respiratório. MÉTODOS: Foram selecionados casos novos consecutivos registrados no Ambulatório de Ansiedade do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, que apresentavam diagnóstico de transtorno de pânico. Foram submetidos a diferentes questionários e a um teste ergoespirométrico. Aqueles que preencheram os critérios de inclusão e sem os critérios de exclusão foram dispostos em três grupos: 1) grupo de participantes com transtorno de pânico respiratório (TPR), 2) grupo de participantes com transtorno de pânico não respiratório (TPNR) e 3) grupo de participantes sem diagnóstico psiquiátrico (C). RESULTADOS: 1) Observou-se uma proporção maior de mulheres (63,9%) e uma média de faixa etária de 34,14 anos. 2) Os grupos TPNR e TPR apresentam uma diferença na auto avaliação 3) Para qualidade de vida, o componente físico difere estatisticamente (p 0,001), nos dois grupos, TPNR e TPR em relação ao grupo controle (C). Entretanto entre os mesmos (TPNR e TPR) não houve diferenças, apresentando como médias +- desvio padrão (DP), de 64,94 +- 16,53 e 62,80 +- 17,89 respectivamente, (p = 0,906). 4) A maior diferença à esquiva de atividade física encontra-se entre o grupo C e os outros dois grupos: TPNR e TPR, (p 0,001) principalmente em relação ao medo de praticar exercícios. 5) Ocorreu um consumo máximo de oxigênio (VO2máx.), inferior nos grupos TPNR e TPR em relação ao grupo C, valores de VO2máx. são menores no grupo TPR em comparação ao grupo C, (p = 0,029), com médias +- DP, de 27,47 +- 4,08 e 32,13 +- 5,81 respectivamente, de acordo com o nível de aptidão funcional cardiorrespiratória e metabólica. CONCLUSÕES: Existem evidências da utilidade do conceito de TPR para caracterizar um subgrupo de pacientes com transtorno de pânico. Esquiva de atividade física parece não ser um fator determinante para os subtipos de TP, embora se apresente como característica fundamental nos pacientes com transtorno de pânico. Isto sugere a utilização do exercício como uma alternativa de tratamento ainda a ser estudada, como uma exposição terapêutica. Diferenças fisiológicas de VO2máx. no teste ergoespirométrico entre os grupos TPR e TPNR, não foram significativas, mas em relação a indivíduos sem transtorno de pânico, apresentaram resultados piores no consumo máximo de oxigênio, principalmente por uma questão comportamental de condicionamento ao medo, do que em relação a fisiopatologia do TP. Como uma hipótese: os valores mais baixos de VO2máx., apresentados pelo TPR em relação ao C, devem-se ao fato de um possível aumento do grau de sedentarismo apresentado em TPR, como decorrência do TP e pela má interpretação da escala de Borg utilizada como identificação subjetiva de esforço, determinante na conclusão do teste ergoespirométrico, porém estas conclusões devem ser melhores analisadas em um projeto futuro INTRODUCTION: The search for subtypes with better therapeutic response to specific treatments led to the description of the respiratory panic disorder subtype. The quality of life of patients with panic disorder (PD) is impaired due to agoraphobia, the most frequent consequences of untreated PD. OBJECTIVE: Identify whether a population with mainly respiratory symptoms presents avoidance of physical activity and verify physiological differences in clinical examination of ergoespirometry in this population, in comparison with people who do not have panic disorder and people with non-respiratory panic disorder subtype. METHODS: patients selected consecutive new cases recorded in Anxiety Outpatient Department of Psychiatry Institute at Hospital das Clínicas from University of São Paulo School of Medicine, who presented a diagnosis of panic disorder. They answered to different questionnaires and underwent an ergoespirometric test. Those who met the inclusion criteria and no exclusion criteria were assigned to three groups: 1) group of participants with respiratory panic disorder (RPD), 2) group of participants with non-respiratory panic disorder (NRPD), and 3) group of participants with no psychiatry diagnosis (C). RESULTS: 1) A higher ratio of women was observed (63,9%) and mean age group of 34,14 years old. 2) NRPD and RPD presented a difference in self-evaluation. 3) As regards to quality of life, the physical component statistically differs (p 0,001) in both groups, NRPD and RPD relative to control group (C). However between these groups (NRPD and RPD) there been no differences at all, showing as averages +- standard deviation (SD) 64,94 +- 16,53 and 62,80 +- 17,89 respectively, (p = 0,906). 4) The higher difference in avoidance of physical activity was found among group C and the order two groups: NRPD and RPD, (p 0,001) mainly related to fear of practicing physical activity. 5) It was observed lower maximum oxygen uptake (VO2 máx.) in NRPD and RPD groups relative to group C, VO2 máx. Is lower in RPD group in comparison to group C, (p = 0,029), with averages +- SD 27,47 +- 4,08 and 32,13 +- 5,81 respectively, according to the level of metabolic and cardiorrespiratory performance status. CONCLUSIONS: There are evidences of the utility of RPD concept to characterize a subgroup of patients with panic disorder. Avoidance of physical activity does not seen a determining factor to PD subtypes, although it is presented as an essential characteristic in panic disorder patients. This suggests the use of physical activity as a treatment alternative to be studied, as a therapeutic exposition. Physiological differences in VO2 máx during ergoespirometric test between RPD e NRPD groups were not significant, but as regards to individuals with no panic disorder, they presented worse results in maximum oxygen uptake mainly due to a behavioral reason of being conditioned to fear, rather than PD physiopathology. As a hypothesis: lower VO2 máx values observed in RPD, arising from PD and from misinterpretation of Borg scale, which is subjectively used to identify the effort, and is a determining factor to obtain a conclusion of ergoespirometric test, however such conclusions must be further analyzed in a future project
Women with angina pectoris, a positive exercise electrocardiogram (ECG) for myocardial ischemia and angiographically smooth coronary arteries (cardiac syndrome X), are often characterized by unresolved symptomatology and a poor quality of life. Psychological morbidity and quality of life appear to be related to social support and social isolation. An investigation of group support as an aid to treatment for cardiac syndrome X was therefore undertaken.
Forty-nine women with cardiac syndrome X (mean ± standard deviation 61.8 ± 8 years) were randomized to 12 monthly support group meetings or usual care control. The Health Anxiety Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), SF-36, York Angina Beliefs scale, ENRICHD Social Support Instrument (ESSI) and a demographic information scale, along with hospital admissions, general practitioner (GP) or cardiologist appointments were measured at baseline, 6 months and 12 months.
Support group participants maintained higher levels of social support than controls (ESSI score, 17.18 ± 5.35 vs. 14.45 ± 6.98, p = 0.008). Near significant improvements in health beliefs total score (p = 0.068) and threat perception (p = 0.062) were found among the support group compared to the control; 29% of support patients had made one or more GP visits over the duration of the study, compared with 54% of the control group (p = 0.06).
Support group participation maintains social support and may reduce health-care demands and misconceived health beliefs among patients with cardiac syndrome X.
This paper is a report of a study to examine the misconceived and potentially maladaptive beliefs (cardiac misconceptions) about heart disease held by nurses, nursing students and people with heart disease in Taiwan.
Research suggests that misconceived and maladaptive beliefs about heart disease influence outcomes in people with heart disease, and that eliciting and dispelling incorrect beliefs can reduce disability in this population. However, nurses do not routinely elicit maladaptive beliefs or attempt to dispel them.
Between October 2005 and March 2006, a survey was conducted using version 1 of the York Cardiac Beliefs Questionnaire to measure cardiac misconceptions in 64 hospital-based nurses (13 of whom were cardiac nurses), 134 nursing students and 238 people with heart disease.
Nursing students held fewer cardiac misconceptions than nurses (P = 0.042). There were no statistically significant differences in the numbers of misconceptions between cardiac and general nurses, and no statistically significant associations between level of qualification, years of nursing experience and number of misconceptions. Nurses with higher levels of education were more likely to hold fewer misconceptions (P = 0.24). Patients held statistically significantly more misconceptions about heart problems than nurses (P < 0.001).
Nurses who are involved in the care for people with heart disease have a responsibility to assess and dispel people's misconceptions about their condition, and therefore continuing professional education is required to develop this clinical expertise. Future research should focus on methods of dispelling cardiac misconceptions in both nursing and patient education.
This is the fifteenth edition of Coronary Heart Disease Statistics produced by the British Heart Foundation.
It is divided into 13 chapters.
* The first two chapters on mortality and morbidity deal with demographic trends in CHD and related diseases of the circulatory system.
* Following a section on treatment of CHD there are chapters on the main modifiable risk factors for the disease: smoking, an unhealthy diet, lack of physical activity, a high alcohol consumption, poor psychosocial wellbeing, raised blood pressure, raised blood cholesterol, obesity and diabetes.
* The final chapter provides information about the economic costs of CHD.
The compendium was published by the British Heart Foundation in July 2007.<br /
Short-term and long-term use of physician consultations and rehospitalizations were studied in 383 myocardial infarction (MI) patients in relation to demographic, medical, and psychological factors. Short-term (i.e. within 6 months post-MI) utilization of physicians was only related to patients' health locus of control. In comparison, a higher number of physician consultations 3-5 years after the MI was independently related to female sex, more non-cardiac limitations before the MI, more complications during hospitalization, less cardiac lifestyle knowledge, and higher levels of anxiety and depression short time after the MI. Every second patient was readmitted to the hospital before the 3-5 years follow-up but only 14% suffered a non-fatal reinfarction. More rehospitalizations were independently related to a higer number of previous hospitalizations for heart disease, more pre-MI cardiac limitations, less cardiac lifestyle knowledge, and higer initial level of emotional distress. Discriminant analysis identified female sex and patients' initial expectations of reduced emotional control as the best predictor variables for a rehospitalization caused by chest pain without a new infarction, whereas a reinfarction was best discriminated by the number of previous hospitalizations for heart disease. We conclude that psychological factors influence health services utilization to a comparable extent as medical factors. These findings may indicate a greater need for long-term professional support in patients with less initial cognitive and emotional control.
Short-term and long-term use of physician consultations and rehospitalizations were studied in 383 myocardial infarction (MI) patients in relation to demographic, medical, and psychological factors. Short-term (i.e. within 6 months post-MI) utilization of physicians was only related to patients' health locus of control. In comparison, a higher number of physician consultations 3-5 years after the MI was independently related to female sex, more non-cardiac limitations before the MI, more complications during hospitalization, less cardiac lifestyle knowledge, and higher levels of anxiety and depression short time after the MI. Every second patient was readmitted to the hospital before the 3-5 years follow-up but only 14% suffered a non-fatal reinfarction. More rehospitalizations were independently related to a higher number of previous hospitalizations for heart disease, more pre-MI cardiac limitations, less cardiac lifestyle knowledge, and higher initial level of emotional distress. Discriminant analysis identified female sex and patients' initial expectations of reduced emotional control as the best predictor variables for a rehospitalization caused by chest pain without a new infarction, whereas a reinfarction was best discriminated by the number of previous hospitalizations for heart disease. We conclude that psychological factors influence health services utilization to a comparable extent as medical factors. These findings may indicate a greater need for long-term professional support in patients with less initial cognitive and emotional control.
In a sample of 287 heart attack victims who were interviewed 7 weeks and 8 years after their attack or who were known to have died during follow-up, interrelations among causal attributions for the attack, perceived benefits of the attack, survivor morbidity, and heart attack recurrence were explored. Analyses focused on early cognitive predictors of heart attack recurrence and 8-year morbidity and on the effects of surviving another heart attack on cognitive appraisals. Independently of sociodemographic characteristics and physicians' ratings of initial prognosis, patients who cited benefits from their misfortune 7 weeks after the first attack were less likely to have another attack and had lower levels of morbidity 8 years later. Attributing the initial attack to stress responses (e.g., worrying, nervousness) was also predictive of greater morbidity in 8-year survivors and blaming the initial attack on other people was predictive of reinfarctions. Men who survived a subsequent heart attack were more likely than men who did not have additional attacks to cite benefits and made more attributions 8 years after the initial attack.
What people believe about their illness may affect how they cope with it. It has been suggested that such beliefs stem from those commonly held within society. This study compared the beliefs held by people with angina, regarding causation and coping in angina, with the beliefs of their friends who do not suffer from angina.
Postal survey using the York Angina Beliefs Questionnaire (version 1), which elicits stress attributions and misconceived beliefs about causation and coping. This was administered to 164 people with angina and their non-cohabiting friends matched for age and sex. 132 people with angina and 94 friends completed the questionnaire.
Peers are more likely than people with angina to believe that angina is caused by a worn out heart (p < 0.01), angina is a small heart attack (p = 0.02), and that it causes permanent damage to the heart (p < 0.001). Peers were also more likely to believe that people with angina should take life easy (p < 0.01) and avoid exercise (p = 0.04) and excitement (p < 0.01).
The beliefs of the peer group about causation and coping in angina run counter to professional advice. Over time this may contribute to a reduction in patient concordance with risk factor reduction, and may help to create cardiac invalids.
Antonakoudis C, Aigyptiadou MN, Sarpakis I. On behalf of the Working Group on Exercise Testing and Cardiac Rehabilitation of the Hellenic Cardiology Society. Cardiac rehabilitation: National Guidelines. www.hcs.gr 2001
In a sample of 287 heart attack victims who were interviewed 7 weeks and 8 years after their attack or who were known to have died during follow-up, interrelations among causal attributions for the attack, perceived benefits of the attack, survivor morbidity, and heart attack recurrence were explored. Analyses focused on early cognitive predictors of heart attack recurrence and 8-year morbidity and on the effects of surviving another heart attack on cognitive appraisals. Independently of sociodemographic characteristics and physicians' ratings of initial prognosis, patients who cited benefits from their misfortune 7 weeks after the first attack were less likely to have another attack and had lower levels of morbidity 8 years later. Attributing the initial attack to stress responses (e.g., worrying, nervousness) was also predictive of greater morbidity in 8-year survivors and blaming the initial attack on other people was predictive of reinfarctions. Men who survived a subsequent heart attack were more likely than men who did not have additional attacks to cite benefits and made more attributions 8 years after the initial attack. (37 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Cardiovascular disease is the most important cause of illness in Britain. The focus of the National Service Framework for Coronary Heart Disease (NSF for CHD) is appropriate since the burden of CHD is high in the UK. Interventions for primary and secondary prevention include advice on reducing modifiable risk factors, smoking, maintaining blood pressure < 140/85 mmHg and using statins and dietary advice to lower serum cholesterol. Identification of those at greatest risk will require practice-based registers. Audits will be needed to ensure that the stipulated interventions are offered to those on the disease registers. The biggest implication for primary prevention will be selection of patients at increased risk of CHD. Implementation of the NSF will increase GPs' workload.
Self-evaluated health represents an important aspect of quality of life that may influence the rehabilitation process after a major illness. However, health is a multi-dimensional concept and relatively little is known about the determinants of, and the interrelationships between the separate aspects of health. In a prospective longitudinal study of myocaridal infarction (MI) patients, two indices of self-evaluated health, maximal physical ability (MPA) and perceived global health (PGH), were used. On the average, both ratings were clearly reduced compared with pre-MI levels even as long as 3-5 yr after the MI. Females and older patients indicated lower MPA before and after the MI, whereas PGH was not related to any sociodemographic variable. The severity of the MI appeared to be of relatively limited importance for self-evaluated health. Heart-related symptoms before and after the MI were more strongly related to lower MPA, whereas non-cardiac health problems and psychological distress more clearly influenced PGH. However, initial illness perceptions were of some importance for both health perceptions. The data suggest that to some extent self-evaluated health can be influenced by educational or psychological support in order to faccilitate readaption and recovery after a MI.
Eighty-nine male patients under the age of 60 were studied after admission for their first myocardial infarction (Ml) to the intensive coronary care unit of a medical center in Israel. The subjects were interviewed during hospitalization and after 6 months as to their subjective evaluation of the event. The attending physicians were also interviewed on the same occasions. Patients who attributed the Ml and its possible outcomes at the end of hospitalization to external, uncontrollable causes returned to work and to regular physical and sexual functioning at a significantly lower rate than did patients who cited more internal and controllable causes. Physicians tended to attribute their patients' Ml and rehabilitation solely to physical risk factors (smoking, obesity, hypertension, heredity, etc.), which were poor predictors of the outcome after 6 months. Theoretical and practical implications of these findings are discussed.
The aims of this systematic literature review are to describe the pattern of attributions made for the causes of heart disease, and to determine how this pattern varies with the method by which attributions are elicited, and the respondent group.A search yielded 47 papers and reports, containing 54 datasets. Lifestyle factors and chronic stress were the most common causes cited across all datasets. Attributions to stressors and fate or luck were more likely to be reported in studies that used interval rating scales than in studies that used dichotomous ratings. Cardiac patients were more likely to mention stressors and fate or luck as causes of heart disease; non-patients rated being overweight and hypertensive as more importantThe differences observed between the responses of patients and non-patients may be due to actor - observer differences, or to a methodological difference: patients are often asked to report their own experiences whereas non-patients are asked about the general case.
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Objectives. To assess causal attributions in first-time myocardial infarction (MI) patients and their spouses and to relate these attributions to changes in patients' health-related behaviour at 6 months after the MI. Design. A prospective single cohort design in which baseline attributions were related to health-related behaviour change at 6 months. Patient and spouse attributions were compared using ANOVA and principal components factor analysis. Both sets of attributions were related to behaviour change using correlation and step-wise multiple regression analysis. Method. A sample of 143 first-time MI patients participated in this study. They completed questionnaires assessing their causal attributions and health-related behaviour during their stay in hospital and at 6 month follow-up (N = 115). Spouses (N = 84) completed the attribution questionnaire at 12 weeks post-MI. Results. The most commonly endorsed attributions for both groups were ‘stress’, ‘high cholesterol’, and various health risk behaviours. The overall pattern of patient and spouse attributions was broadly similar but the factor analyses revealed some differences in the factor structures of the two sets of attributions. Most MI patients had made significant changes in health behaviour at 6 months, and those who believed that their MI was caused by their poor health habits were more likely to have made dietary changes at 6 months. Spouse attributions to poor health habits were associated with improvements in patients' exercise level at 6 months. Conclusion. The prospective associations between both patient and spouse causal attributions and subsequent changes in health-related behaviour confirm the importance of specific causal attributions in adjustment to first-time MI.
One-hundred and forty-eight patients, hospitalised for myocardial (MI) infarction, were asked to list those factors which they believed contributed to their present illness episode and then rank them according to their perceived pathogenic potency. Additionally, they were asked to then rate each cited causal factor for degree of control that they perceived themselves as having.One-hundred and two subjects successfully completed the task. Twenty discreet causal categories were identified from a total of 321 causes supplied.The most frequently perceived cause of myocardial infarction in these patients was Overwork. This was followed by Smoking, Worry, Lack of Exercise, Stress, Lifestyle, Overweight and Diet. Lifestyle was seen as the most potent cause for some but for most subjects, Smoking was perceived as the most potent cause. The standard risk factors of smoking, hypertension and serum cholesterol accounted for 20.25% of all cited items with a combined mean potency of 8.7. By contrast, Overwork, Worry and Stress combined to account for 43.0% of all cited causes with a mean potency of 8.6 on a scale of 0–10.Overwork, Worry and Stress together were perceived as significantly less controllable (P < 0.05) than Smoking, Lifestyle, Lack of Exercise, Overweight and Diet.Implications of these data for information giving and treatment compliance where health care workers focus on smoking cessation, dietary control and hypertension control are discussed.
Although there have been a number of studies regarding attributions and misconceptions in people following a heart attack, there have been no comparable studies in people with angina. Semi-structured interviews were held with 20 people suffering from angina to discover their beliefs about angina, particularly those that may be misconceived or associated with maladaptive coping. Nineteen of the 20 participants held such beliefs. Stress was the most frequent causal attribution and misconceived angina avoidance strategies were cited by the majority. The beliefs about angina held by this sample may have implications for their health-related quality of life, if their experience mirrors that found within heart attack populations.
In patients with recent proven or suspected myocardial infarction, understanding of the nature of a heart attack was explored. A wide range of misconceptions, some of them frightening, was revealed; there was a poor understanding of some terms commonly used in discussion with patients; the potential for creation of new misconceptions by doctors and nurses was highlighted.
100 cardiologists were asked for their views on the risk associated with an episode of exertional angina in patients with stable angina. 58% thought that such an episode carried some risk of permanent damage or death, and 78% advised their patients to avoid anginal pain. In contrast, exercise studies done during the evaluation of anti-anginal drugs indicate that exertional angina can be provoked frequently and repeatedly without apparent risk, and other studies have shown that repeated exercise to the onset of angina is not only safe but improves exercise tolerance. Epidemiological investigations suggest that sudden death and myocardial infarction do not commonly occur during exertion, and our knowledge of pathology indicates that both events are usually caused by acute coronary thrombosis. Many physicians seem to treat the symptom of angina because they are unduly motivated by fear of the underlying potentially fatal disease for which angina is a marker. Such an attitude will tend to cause undue anxiety among patients, will lead to unnecessary restriction of patients' activities, and may result in excessive invasive treatment of mild angina.
In a study of 367 patients with myocardial infarction (MI), questionnaires were developed to assess two central aspects of perceived illness: factual and consensual illness knowledge and subjective expectations for the personal consequences of the MI. In a factor analysis, these two aspects of perceived illness were found to load on separate factors, and the patients views of the personal consequences of the MI were only moderately associated with their general cardiac health knowledge. Among a series of sociodemographic, medical, and psychological variables, including a standardized in-hospital patient education programme, the two aspects of perceived illness also proved to have different determinants. Differences in factual and consensual illness knowledge were mainly related to differences in formal education, and this aspect of perceived illness was influenced by the standardized education programme. In contrast, differences in subjective expectations were associated with levels of hopelessness. The implications for psychosocial interventions in the rehabilitation of MI patients are discussed.
The relationships between a return to work (RTW) 6 months after a myocardial infarction and selected personality traits, emotional reactions, health knowledge and beliefs, expectations and global health perceptions have been examined in a prospective study of 249 patients below 67 yr of age. Patients' in-hospital expectations of their future work capacity proved to be a strong predictor for RTW. In addition, level of anxiety and depression during hospitalization and level of cardiac lifestyle knowledge were independently associated with RTW. These effects could not be explained by demographic, work-related, or medical factors. It is concluded that patients' early illness perceptions and affective reactions influence later work resumption. Outcome-specific expectancy measures may be the most effective methods for early identification of patients needing rehabilitation efforts after an acute somatic disease.
A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
This study sought to establish the validity, reproducibility and responsiveness of the Seattle Angina Questionnaire, a 19-item self-administered questionnaire measuring five dimensions of coronary artery disease: physical limitation, anginal stability, anginal frequency, treatment satisfaction and disease perception.
Assessing the functional status of patients is becoming increasingly important in both clinical research and quality assurance programs. No current functional status measure quantifies all of the important domains affected by coronary artery disease.
Cross-sectional or serial administration of the Seattle Angina Questionnaire was carried out in four groups of patients: 70 undergoing exercise treadmill testing, 58 undergoing coronary angioplasty, 160 with initially stable coronary artery disease and an additional 84 with coronary artery disease. Evidence of validity was sought by comparing the questionnaire's five scales with the duration of exercise treadmill tests, physician diagnoses, nitroglycerin refills and other validated instruments. Reproducibility and responsiveness were assessed by comparing serial responses over a 3-month interval.
All five scales correlated significantly with other measures of diagnosis and patient function (r = 0.31 to 0.70, p < or = 0.001). Questionnaire responses of patients with stable coronary artery disease did not change over 3 months. The questionnaire was sensitive to both dramatic clinical change, as seen after successful coronary angioplasty, and to more subtle clinical change, as seen among outpatients with initially stable coronary artery disease.
The Seattle Angina Questionnaire is a valid and reliable instrument that measures five clinically important dimensions of health in patients with coronary artery disease. It is sensitive to clinical change and should be a valuable measure of outcome in cardiovascular research.
More than 200 published studies from most medical settings worldwide have reported experiences with the Hospital Anxiety and Depression Scale (HADS) which was specifically developed by Zigmond and Snaith for use with physically ill patients. Although introduced in 1983, there is still no comprehensive documentation of its psychometric properties. The present review summarizes available data on reliability and validity and gives an overview of clinical studies conducted with this instrument and their most important findings. The HADS gives clinically meaningful results as a psychological screening tool, in clinical group comparisons and in correlational studies with several aspects of disease and quality of life. It is sensitive to changes both during the course of diseases and in response to psychotherapeutic and psychopharmacological intervention. Finally, HADS scores predict psychosocial and possibly also physical outcome.
This article provides a selective review of the effects of psychosocial factors and responses to acute mental stress on the onset of acute coronary syndromes. The literature suggests that the relationship between the anatomical severity of coronary artery disease (CAD) and likelihood of subsequent cardiac events, such as myocardial infarction, is not linear. Furthermore, evidence will be provided that the age-dependent associations between psychosocial factors and risk of cardiac events is at least in part mediated through the severity of underlying CAD. Finally, research will be summarized that supports the importance of both chronic psychosocial factors (e.g., low socioeconomic status and/or high hostility) and episodic psychological distress syndromes, such as vital exhaustion and depression. In reviewing this literature, two perspectives will be focused on: (1) the relationship between psychosocial factors and progressive CAD; and (2) the evidence concerning underlying pathophysiological mechanisms.
The article describes a longitudinal study testing the hypothesis that everyday stress can aggravate angina pectoris (AP). Every weekend for 1 year, 42 patients with coronary heart disease filled out a questionnaire on perceived stress for the preceding week. They also rated AP symptoms, again for the previous week. Within-subject correlation between stress and severity of AP was quite pronounced in some subjects and resulted in a sample mean of 0.38. The distribution of correlation coefficients in the sample was significantly different from a random distribution around 0. Stress values also predicted AP in the week to come. However, this finding was no longer significant when the influence of lag 1 auto-correlations between stress values was eliminated. Our results show that the effect of everyday stress on AP is essentially immediate and that it can be quite important in some subjects.
There are approximately 1.8 million patients with angina in the United Kingdom, many of whom report a poor quality of life, including raised levels of anxiety and depression.
To evaluate the effect of a cognitive behavioural disease management programme, the Angina Plan, on psychological adjustment in patients newly diagnosed with angina pectoris.
Randomised controlled trial.
Patients from GP practices in a Northern UK city (York) between April 1999 and May 2000.
Recruited patients were randomised to receive the Angina Plan or to a routine, practice nurse-led secondary prevention educational session.
Twenty of the 25 practices invited to join the study supplied patients' names; 142 patients attended an assessment clinic and were randomised There were no significant differences in any baseline measures. At the six month post-treatment follow-up, 130 (91%) patients were reassessed. When compared with the educational session patients (using analysis of covariance adjusted for baseline scores in an intention-to-treat analysis) Angina Plan patients showed a greater reduction in anxiety (P = 0.05) and depression (P = 0.01), the frequency of angina (reduced by three episodes per week, versus a reduction of 0.4 per week, P = 0.016) the use of glyceryl trinitrate (reduced by 4.19 fewer doses per week versus a reduction of 0.59 per week, P = 0.018), and physical limitations (P<0.001: Seattle Angina Questionnaire). They were also more likely to report having changed their diet (41 versus 21, P<0.001) and increased their daily walking (30 versus 2, P<0.001). There was no significant difference between the groups on the other sub-scales of the Seattle Angina Questionnaire or in any of the medical variables measured.
The Angina Plan appears to improve the psychological, symptomatic, and functional status of patients newly diagnosed with angina.
Statistical package for the social sciences (version 10.0)
- Spss Inc
SPSS Inc. (1999). Statistical package for the social
sciences (version 10.0). Chicago, IL: SPSS Inc.
Illness representations and recovery from myocardial infarction
- K J Petrie
- J A Weinman
Petrie, K. J., & Weinman, J. A. (1997). Illness
representations and recovery from myocardial
infarction. In K. J. Petrie & J. A. Weinman (Eds.),
Perceptions of health and illness (pp. 441-465).
London: BMJ Books. Task Force of the European Society of Cardiology
- S A Stansfield
- M G Marmot
Stansfield, S. A., & Marmot, M. G. (2002). Introduction. In S. A. Stansfield & M. G. Marmot (Eds.),
Stress and the heart (pp. 1-4). London: BMJ Books.
Task Force of the European Society of Cardiology.
(1997). Management of stable angina pectoris.
European Heart Journal, 18, 394-413.
The primary care management of stable angina: Evidence based clinical practice guideline
- J G Maeland
- O E Havik
Maeland, J. G., & Havik, O. E. (1989). Use of health
services after a myocardial infarction. Scandinavian
Journal of Social Medicine, 17, 93-102.
North of England Evidence Based Guideline Project.
(1999). The primary care management of stable
angina: Evidence based clinical practice guideline.
Newcastle upon Tyne: Centre for Health Services
Research, University of Newcastle upon Tyne.
National service framework for coronary heart disease: Main report. London: Department of Health
- R B Cattell
Cattell, R. B. (1966). The Scree test for the number of
factors. Multivariate Behavioural Research, 1,
141-161.
Department of Health. (2000). National service framework for coronary heart disease: Main report.
London: Department of Health.