Self-Efficacy and Health Status in Patients With Coronary Heart Disease: Findings From the Heart and Soul Study

Objective: To examine the relationship between cardiac self-efficacy and health status, including symptom burden, physical limitation, quality of life, and overall health among outpatients with stable coronary heart disease (CHD). We hypothesized that lower self-efficacy would predict worse health status, independent of CHD severity and depression. Methods: We performed a cross-sectional study of 1024 outpatients with CHD, who were recruited between 2000 and 2002 for the Heart and Soul Study. We administered a validated measure of cardiac self-efficacy, assessed cardiac function using exercise treadmill testing with stress echocardiography, and measured depressive symptoms using the Patient Health Questionnaire. Health status outcomes (symptom burden, physical limitation, and quality of life) were assessed using the Seattle Angina Questionnaire, and overall health was measured as fair or poor (versus good, very good, or excellent). Results: After adjustment for CHD severity and depressive symptoms, each standard deviation (4.5-point) decrease in self-efficacy score was independently associated with greater symptom burden (adjusted odds ratio (OR) = 2.1, p = .001), greater physical limitation (OR = 1.8, p < .0001), worse quality of life (OR = 1.6, p < .0001), and worse overall health (OR = 1.9, p < .0001). Depressive symptoms and poor treadmill exercise capacity were also associated with poor health status, but left ventricular ejection fraction and ischemia were not. Conclusions: Among patients with CHD, low cardiac self-efficacy is associated with poor health status, independent of CHD severity and depressive symptoms. Further study should examine if self-efficacy constitutes a useful target for cardiovascular disease management interventions. CHD = coronary heart disease; OR = odds ratio; LVEF = left ventricular ejection fraction.

[1]  Harlan M Krumholz,et al.  Time course of depression and outcome of myocardial infarction. , 2006, Archives of internal medicine.

[2]  D. J. Veldhuisen,et al.  Depressive symptoms are prominent among elderly hospitalised heart failure patients , 2006, European journal of heart failure.

[3]  H. Krumholz,et al.  Difficulty taking medications, depression, and health status in heart failure patients. , 2006, Journal of cardiac failure.

[4]  Martin Fortin,et al.  Relationship Between Multimorbidity and Health-Related Quality of Life of Patients in Primary Care , 2006, Quality of Life Research.

[5]  D. McManus,et al.  Screening for depression in patients with coronary heart disease (data from the Heart and Soul Study). , 2005, The American journal of cardiology.

[6]  W. Haskell,et al.  Effect of Treadmill Testing and Exercise Training on Self-Efficacy in Patients with Heart Failure , 2005, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[7]  R. Sanderman,et al.  The Relationship Between Self-Efficacy and Self-Reported Physical Functioning in Chronic Obstructive Pulmonary Disease and Chronic Heart Failure , 2005, Behavioral medicine.

[8]  Satoshi Watanabe,et al.  Effect of the Self-Monitoring Approach on Exercise Maintenance During Cardiac Rehabilitation: A Randomized, Controlled Trial , 2005, American journal of physical medicine & rehabilitation.

[9]  K. Lorig,et al.  Outcomes of Border Health Spanish/English Chronic Disease Self-management Programs , 2005, The Diabetes educator.

[10]  J. Rumsfeld,et al.  Relation between depressive symptoms and treadmill exercise capacity in the Heart and Soul Study. , 2004, The American journal of cardiology.

[11]  S. Majumdar,et al.  Improvements in patient-reported outcomes associated with an intervention to enhance quality of care for rural patients with type 2 diabetes: results of a controlled trial. , 2004, Diabetes care.

[12]  D. Golden-Kreutz,et al.  Depressive symptoms after breast cancer surgery: Relationships with global, cancer‐related, and life event stress , 2004, Psycho-oncology.

[13]  J. Rumsfeld,et al.  Relation of self-reported angina pectoris to inducible myocardial ischemia in patients with known coronary artery disease: the Heart and Soul Study. , 2003, The American journal of cardiology.

[14]  K. Lorig,et al.  Self-management education: History, definition, outcomes, and mechanisms , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[15]  J. Rumsfeld,et al.  Depressive symptoms and health-related quality of life: the Heart and Soul Study. , 2003, JAMA.

[16]  T. Mcconnell,et al.  Quality of life and self-efficacy: gender and diagnoses considerations for management during cardiac rehabilitation. , 2003, Journal of cardiopulmonary rehabilitation.

[17]  G. Grunwald,et al.  History of depression, angina, and quality of life after acute coronary syndromes. , 2003, American heart journal.

[18]  K. Abriam-Yago,et al.  Life Situations Of Elderly People With Heart Disease: The Impact Of Self-Efficacy On Self-Care , 2002 .

[19]  Carl J Pepine,et al.  ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients , 2002, Journal of the American College of Cardiology.

[20]  Carl J Pepine,et al.  ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients , 2002, Circulation.

[21]  J. W. Schaeffer,et al.  ACC/AHA 2002 guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction—summary article , 2002 .

[22]  J. Spertus,et al.  Health Status Predicts Long-Term Outcome in Outpatients With Coronary Disease , 2002, Circulation.

[23]  J. Rumsfeld.  Health status and clinical practice: when will they meet? , 2002, Circulation.

[24]  L. Pilote,et al.  Quality of life after acute myocardial infarction among patients treated at sites with and without on-site availability of angiography. , 2002, Archives of internal medicine.

[25]  G. Norman,et al.  Self-efficacy, psychosocial factors, and exercise behavior in traditional versus modified cardiac rehabilitation. , 2001, Journal of cardiopulmonary rehabilitation.

[26]  A. Stewart,et al.  Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes , 2001, Medical care.

[27]  K. Lorig,et al.  Effect of a self-management program on patients with chronic disease. , 2001, Effective clinical practice : ECP.

[28]  M Peyrot,et al.  The Impact of Barriers and Self-Efficacy on Self-Care Behaviors in Type 2 Diabetes , 2001, The Diabetes educator.

[29]  P. Armstrong,et al.  A systematic review of randomized trials of disease management programs in heart failure. , 2001, The American journal of medicine.

[30]  S. Cossette,et al.  Clinical Implications of a Reduction in Psychological Distress on Cardiac Prognosis in Patients Participating in a Psychosocial Intervention Program , 2001, Psychosomatic medicine.

[31]  J. Holland,et al.  Social support as a buffer to the psychological impact of stressful life events in women with breast cancer , 2001, Cancer.

[32]  A. LaCroix,et al.  Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease. , 2000, The American journal of cardiology.

[33]  H. Krumholz,et al.  Association of patients' perception of health status and exercise electrocardiogram, myocardial perfusion imaging, and ventricular function measures. , 2000, American heart journal.

[34]  J. Spertus,et al.  Association between depression and worse disease-specific functional status in outpatients with coronary artery disease. , 2000, American heart journal.

[35]  J. Schensul,et al.  Correlates of Self-Efficacy in Diabetes Self-Care Among Hispanic Adults With Diabetes , 2000, The Diabetes educator.

[36]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[37]  B. Buunk,et al.  Change in self-efficacy during cardiac rehabilitation and the role of perceived overprotectiveness. , 1999, Patient education and counseling.

[38]  J. A. Dodge,et al.  Exploring Self-Efficacy as a Predictor of Disease Management , 1999, Health education & behavior : the official publication of the Society for Public Health Education.

[39]  A. LaCroix,et al.  Self-Efficacy and Self-Reported Functional Status in Coronary Heart Disease: A Six-Month Prospective Study , 1998, Psychosomatic medicine.

[40]  A. Bandura.  Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[41]  C. Brotons,et al.  Measuring functional status of chronic coronary patients. Reliability, validity and responsiveness to clinical change of the reduced version of the Duke Activity Status Index (DASI). , 1997, European heart journal.

[42]  D. Mark,et al.  Medical care costs and quality of life after randomization to coronary angioplasty or coronary bypass surgery. Bypass Angioplasty Revascularization Investigation (BARI) Investigators. , 1997, The New England journal of medicine.

[43]  C. Reynolds,et al.  Changes in perceived health status of depressed elderly patients treated until remission. , 1996, The American journal of psychiatry.

[44]  K Kroenke,et al.  Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. , 1995, JAMA.

[45]  I. Wiklund,et al.  Relationship between quality of life and exercise test findings after coronary artery bypass surgery. , 1995, International journal of cardiology.

[46]  R A Deyo,et al.  Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. , 1995, Journal of the American College of Cardiology.

[47]  I. Wilson,et al.  Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. , 1995, JAMA.

[48]  J. Spertus,et al.  Monitoring the quality of life in patients with coronary artery disease. , 1994, The American journal of cardiology.

[49]  M. Follick,et al.  Quality of life among patients post-myocardial infarction at baseline in the Survival and Ventricular Enlargement (SAVE) trial , 1994, Quality of Life Research.

[50]  D. Kavanagh,et al.  Prediction of adherence and control in diabetes , 1993, Journal of Behavioral Medicine.

[51]  N. Wenger.  Improved quality of life after PTCA: generalizability and concerns. , 1992, Catheterization and Cardiovascular Diagnosis.

[52]  D. Nerenz,et al.  Ongoing assessment of health status in patients with diabetes mellitus. , 1992, Medical care.

[53]  G. Holden.  The relationship of self-efficacy appraisals to subsequent health related outcomes: a meta-analysis. , 1992, Social work in health care.

[54]  M A Hlatky,et al.  Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease. , 1992, JAMA.

[55]  M A Hlatky,et al.  Relation of clinical and angiographic factors to functional capacity as measured by the Duke Activity Status Index. , 1991, The American journal of cardiology.

[56]  M. Perri,et al.  Single-Item Vs Multiple-Item Measures of Health-Related Quality of Life , 1991, Psychological reports.

[57]  G. Guyatt,et al.  Issues in quality-of-life measurement in clinical trials. , 1991, Controlled clinical trials.

[58]  I. Wiklund,et al.  The relationship between exercise tolerance and quality of life in angina pectoris , 1991, Clinical cardiology.

[59]  R. Glasgow,et al.  Diabetes Regimen Behaviors: Predicting Adherence , 1987, Medical care.

[60]  G. Klerman,et al.  The effects of antihypertensive therapy on the quality of life. , 1986, The New England journal of medicine.

[61]  R C Bruskewitz,et al.  Analysis of presenting symptoms in prostatism. , 1984, The Journal of urology.

[62]  C. Wells,et al.  The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. , 1984, Chest.

[63]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[64]  L. Wilkins.  Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Quality of life in patients randomly assigned to treatment groups. , 1983, Circulation.

[65]  A. Giles,et al.  Plasmapheresis therapy in rheumatoid arthritis. A controlled, double-blind, crossover trial. , 1983, The New England journal of medicine.

[66]  C. Taylor,et al.  Effects of early postmyocardial infarction exercise testing on self-perception and subsequent physical activity. , 1983, The American journal of cardiology.

[67]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[68]  Jersey Liang,et al.  Emotional support levels can predict physical functioning and health related quality of life among elderly Taiwanese with hip fractures , 2005, Osteoporosis International.

[69]  Yongming Ding,et al.  Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial. , 2003, Bulletin of the World Health Organization.

[70]  N. Oldridge,et al.  Time course of recovery during cardiac rehabilitation. , 1995, Journal of cardiopulmonary rehabilitation.

[71]  M. Gallant,et al.  Impact of social support, social cognitive variables, and perceived threat on depression among adults with diabetes. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[72]  K. Lorig.  Living a healthy life with chronic conditions : self-management of heart disease, arthritis, stroke, diabetes, asthma, bronchitis, emphysema & others/ Kate Lorig ... [et al.] , 1994 .

[73]  W. de Oliveira Júnior.  [The effects of antihypertensive therapy on the quality of life]. , 1989, Arquivos brasileiros de cardiologia.