Elsevier

Heart & Lung

Volume 35, Issue 5, September–October 2006, Pages 315-323
Heart & Lung

Issues in cardiovascular nursing
The synergistic effect of heart disease and diabetes on self-management, symptoms, and health status

https://doi.org/10.1016/j.hrtlng.2006.05.005Get rights and content

Background

Coronary heart disease (CHD) and diabetes may have synergistic effects on symptoms, self-management, and general and cardiac-specific health status.

Purpose

We compared symptom distress, self-management difficulties, and general and cardiac-specific health status in patients with CHD by the presence and severity of diabetes.

Methods

We performed a cross-sectional study of 1013 patients enrolled in the COURAGE trial, with the use of clinical data, the Symptom Distress Scale, the Self-Management Difficulties Scale, the Short-Form 36, and the Seattle Angina Questionnaire.

Results

Patients with diabetes and greater severity of diabetes had worse findings in symptom distress, self-management difficulties, and general and cardiac-specific health status than patients without diabetes.

Conclusions

A robust effect of diabetes on symptom distress and self-management difficulties was found in patients with CHD. The results from the Seattle Angina Questionnaire illustrate difficulty in attributing physical limitations to specific symptoms or conditions, and show the experience of comorbid conditions to be synergistic. Clinicians’ understanding of this synergy and integration of condition-specific care with general treatment and self-management practices are needed.

Section snippets

Conceptual framework

The conceptual framework for this study is based on the premise that the effectiveness of chronic condition management ultimately depends on the patient’s actions, and the importance of understanding how chronic conditions impact patients’ lives and their ability to manage.15, 16 Health care in the United States is primarily organized around single diseases and conditions, and many self-management programs focus on a particular illness or condition, so integration of management of two or more

Methods

The sample for this cross-sectional study was drawn from a baseline sample of participants enrolled in the U.S. Department of Veterans Affairs Cooperative Study of Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation Trial (COURAGE). COURAGE is a multisite, randomized clinical trial comparing optimal medical therapy with optimal medical therapy plus percutaneous coronary intervention (PCI) in patients with stable CHD.17 Patients were eligible if they had stable but

Results

A total of 1013 patients were included in this study. The patients were primarily male (85%) and white (87%), with a mean age of 62 (±10) years (range 31–88 years). Only 22% lived alone, and the education level was at least a high school education (32%), some college or technical school (24%), or college graduate/postgraduate (19%). Approximately one-third of the sample had diabetes (32%), and other comorbidities included hypertension (66%), current smoker (20%), previous myocardial infarction

Discussion

In this large sample of patients with CHD, patients with diabetes comprised approximately one-third. Patients in the sample were generally stable, and rates of heart failure, renal dysfunction, and higher CCS classes were low. Other factors were not significantly different, but patients with diabetes and those with moderate to severe diabetes had significantly worse findings in several measures of self-management difficulty, symptom distress, and cardiac-specific and general health status than

Limitations

Data from this study came from one cross-sectional survey of predominantly white male patients with CHD and anatomy suitable for revascularization, and thus may not be generalizable to other groups of patients with CHD. However, a major strength of the study is in the large sample of patients who had been living with CHD and were now being evaluated for additional treatment. These patients were not acutely ill or experiencing unstable angina at the time of enrollment. A large number of

Implications

Other studies have consistently shown a synergistic effect of diabetes and CHD related to patient mortality, morbidity, and physical functioning. This study adds to our knowledge by demonstrating a robust effect of diabetes presence and severity on symptom distress and self-management difficulties in patients with CHD. The general factors contributing to variability in the cardiac-specific SAQ physical limitation score illustrate the difficulty patients may have in attributing physical

References (26)

  • M. Loutfi et al.

    Impact of restenosis and disease progression on clinical outcome after multivessel stenting in diabetic patients

    Catheter Cardiovasc Interv

    (2003)
  • J. Bucerius et al.

    Impact of diabetes mellitus on cardiac surgery outcome

    Thorac Cardiovasc Surg

    (2003)
  • P. Wandell et al.

    Functioning and well-being of patients with type 2 diabetes or angina pectoris, compared with the general population

    Diabetes Metab

    (2000)
  • Additional Courage Investigators and Staff: Cheryl Lewis, RN, Edmund Becker, PhD, Stephen Culler, PhD, Paul Kolm, PhD, Sandra Dunbar, DSN (Emory University, Atlanta, GA); Elizabeth Mahoney, ScD (New England Research Institutes, Watertown, MA); Bernard O’Brien, PhD, Ron Goeree, MA, Gordon Blackhouse, MBA, Koon Teo, MD (McMaster University, Hamilton, Ontario); Robert Nease, PhD, Washington University (St Louis, MO); John Spertus, MD, MPH (University of Missouri, Kansas City, MO); Stan Kaufman, MD (San Francisco, CA).

    Supported by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development and the Canadian Institute for Health Research.

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