Recovery Trajectory of Quality of Life and Symptoms in Acute Myocardial Infarction Patients: A follow-up study

• Main Authors: CHENG, HSIU HUA, 鄭秀華
• Other Authors: TSAY, SHIOW-LUAN
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/n287xe

博士 === 國立臺北護理健康大學 === 護理研究所 === 106 === Patients with acute myocardial infarction need to face the physiological and psychological symptoms caused by the disease. Chest pain and depression are the most common symptoms. Many patients do not fully relieve their symptoms after receiving treatment, which affects the quality of life and physical function. Thus, the purpose of this study was to investigate the level of physical and psychological symptoms such as chest pain, depression, fear of death and quality of life of patients with acute myocardial infarction from the onset to 6 months. In the meanwhile, also to detect the predict factors of recovery trajectory pattern. This study was designed for prospective longitudinal study. The cardiac and internal medicine wards of two teaching hospitals in eastern Taiwan were used as the venues for the collection of data. The data were collected for a total of four times. The structured questionnaires were used during hospitalization and discharge for one month, three months and six months respectively. Research tools including demographic data, disease-related attributes data, Seattle Angina Questionnaire (SAQ), Hospital Anxiety and Depression Scale (HADS), Death Anxiety Scale (DAS), Morisky Medication Adherence Scale (MMAS-8) and a Short Form Life Quality (SF-12). In this study, a total of 102 people were enrolled, 79 patients were completed for the second time, and 76 patients were completed for the fourth time. 80 (78.4%) were males and 22 (21.6%) were females, with an average age of 62.75 (SD=11.71). The type of acute myocardial infarction was NSTEMI (52%) and STEMI (48%); 86% received percutaneous coronary intervention (PCI); the disease severity of the myocardial infarction (Killip classification) was Killip II, 32.4%; the left ventricular ejection fraction (LVEF) averaged 47.97% (SD=13.97); The length of stay was 6.06 days (SD = 4.74). 98% of patients experienced angina pectoris at the time of acute myocardial infarction. There were about one-third of patients remaining intermittent angina after six months of treatment. The proportion of depression was 56.9% initially, then significantly declined after 6 months. The average score of fear of death during hospitalization was 5.68 (SD = 2.62), and decreased to 2.21 (SD = 2.87) at 6 month. The recovery trajectory of quality of life has not reached significant changes in either the physiological or psychological aspects. The predictive factor analysis by the generalized estimating equation (GEE) showed that the age, length of stay, type of reperfusion treatment were predictors of physical symptoms, and the number of myocardial infarction was significantly related to the recovery trajectory of psychological symptoms; the predictor of quality of life was ethnicity, marriage status, occupation, length of stay, number of myocardial infarctions, and degree of initial chest pain. The results of this study provide better clinical observation of acute myocardial infarction patients, especially in the early stages of the disease, which the degree of physical and psychological symptoms is more serious. The nurses should be more alert about patient’s symptoms and to provide comprehensive support and treatment. In addition, about one-third of patients still suffer from angina symptoms after discharge. They also need medical staff to provide adequate education and resources to assist patients and medical treatment.