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