THE EFFECT OF HEART FAILURE ON HEALTH-RELATED QUALITY OF LIFE DURING CRITICAL TRANSITIONS IN THE LIFE COURSE
Open Access
- Author:
- Walsh, Alison Lee
- Graduate Program:
- Nursing
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- March 01, 2017
- Committee Members:
- Lisa Ann Kitko, Dissertation Advisor/Co-Advisor
Lisa Ann Kitko, Committee Chair/Co-Chair
Judith E Hupcey, Committee Member
Ying-Ling Jao, Committee Member
Linda Ann Wray, Outside Member - Keywords:
- Heart failure
CHF
HF
Quality of Life
Health-Related Quality of Life
HRQoL
QoL
Lifespan
Young adult
Middle aged adult
Mixed methods - Abstract:
- Purpose: This study explored the effect of heart failure on health-related quality of life during critical transitions earlier in the life course. Background: Heart failure is an epidemic impacting approximately 6 million Americans, with 1.4 million under the age of 65. Patients living with heart failure report significant impacts to their perceived health-related quality of life. The majority of current evidence has been conducted with older individuals living with heart failure and limited data exists on health-related quality of life in younger individuals and the impact of heart failure on life course. Methods: Participants with heart failure between the ages of 35 and 55 were recruited from two hospital systems in this explanatory sequential mixed methods study. Each participant completed the Minnesota Living with Heart Failure (MLHFQ) and the Short-Form 36 (SF-36) questionnaires. Semi-structured qualitative interviews were conducted based on questionnaire responses to explore the complex, subjective nature of what constitutes health-related quality of life and how it is affected by heart failure during critical transitions in the life course. Qualitative interviews continued until saturation was reached. Questionnaires were scored according to published guidelines and analyzed using linear regressions. Qualitative data were analyzed utilizing a thematic analysis approach. Inferences were drawn about how the qualitative results helped explain the quantitative results. Results: Participants with heart failure (n=18) yielded questionnaire results that were comparable to existing literature, revealing very poor health-related quality of life in this population. Statistical significance could not be determined between questionnaire results and demographics due to small sample size. Seven themes emerged: Role fulfillment, autonomy, financial impact, perception, retrospective life changes, symptom burden, and outlook. Participants frequently linked health-related quality of life to accomplishing life goals and to a sense of productivity and purpose. This was reflected in how participants perceived their roles as a parent, caregiver, spouse, employee, and friend have been affected by heart failure. Participants reported high levels of depression, anxiety, and fatigue throughout the interviews. The majority of participants also expressed regret for life choices that may have led to the progression of their heart failure. Conclusions: Younger individuals living with heart failure have a markedly different perception of what constitutes health-related quality of life than their older counterparts. This is largely a result of how heart failure affects critical transitions that traditionally occur earlier in the life course such as establishing a career, meaningful relationships, family, and financial security. By using an explanatory sequential design, this study was able to contribute to existing literature on this population by adding rich qualitative data to help explain the consistently low health-related quality of life scores. The Lifespan Developmental Perspective also adds a unique viewpoint that addressed critical transitions that commonly occur earlier in the lifespan, and how an interruption in these transitions as a result of heart failure can negatively impact health-related quality of life. In order to provide holistic care to patients living with heart failure, nursing interventions to improve health-related quality of life should be considered in relation to the heavy burden of psychosocial symptoms and the alterations in role fulfillment experienced by the younger population.