Heart-focused Anxiety: THE ROLE OF SOCIOECONOMIC STATUS


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Health-related quality of life (QOL) is defined as the functional effect of an illness and its treatment. Quality of life assessments include an evaluation of patient-perceived physical, mental, social, and occupational functioning, as well as overall health.1 As a key contributor to mental well-being, anxiety plays a significant role in the QOL of cardiac patients. Of particular concern for this population is heart-focused anxiety (HFA), which refers to the fear of cardiac-related events and sensations due to their presumed negative consequences.2 Individuals with high HFA tend to monitor or focus on cardiac sensations and avoid activities believed to elicit cardiac symptoms.2 Heart-focused anxiety and subsequent behavioral avoidance may have adverse consequences on the QOL outcomes of cardiac patients. Greater attention to the detection and treatment of anxiety is an important consideration for health professionals working in a secondary prevention setting.3 This is particularly true now that there is growing evidence of an association between psychological distress and the development of coronary artery disease.4Indicators of socioeconomic status (SES), such as income, education, and employment status, are key determinants of cardiovascular health, access to cardiac services (including cardiac rehabilitation), and psychosocial adjustment.5-7 It follows that there is a need to identify factors, such as socioeconomic determinants of health, which may predispose or influence a cardiac patient to experience a poorer QOL and/or HFA. The purpose of this study was to investigate whether QOL and HFA differed as a function of SES in a cross-sectional sample of secondary prevention patients.METHODSSeventy-one English-speaking adults who were physician-referred to a full-day cardiac risk-reduction education program participated in this study. This program provides education regarding the modification of cardiac risk factors in an attempt to reduce the likelihood of future cardiac events. After obtaining informed consent, participants were administered a brief questionnaire packet that included measures of SES, cardiac anxiety, and health-related QOL.Background Information FormQuestions pertained to ethnocultural background, marital status, household status, education, occupation, and income. Response categories were later collapsed into fewer categories to facilitate statistical analysis. For example, 11 income brackets were collapsed into 3 categories (all in Canadian dollars): less than $40,000, $40,000 to $79,999, and $80,000 or more.Cardiac Anxiety QuestionnaireThe Cardiac Anxiety Questionnaire (CAQ) has 18 items to which individuals respond on a 5-point Likert-type scale.8 A total score plus the following 3 subscales are calculated: (1) heart-related worry and fear, (2) avoidance behavior, and (3) attention. Scores reflect mean item scores and higher scores indicate greater cardiac anxiety.Short-form Health Status InstrumentThe SF-12 is an efficient and reliable alternative to the Short Form-36 (SF-36), its 36-item predecessor,9 which has been deemed to be the most appropriate generic instrument to assess QOL among cardiac patient populations.10,11 SF-12 algorithms produce 8 health domain subscales and 2 summary scales: (1) Physical Component Summary (PCS) and (2) Mental Component Summary (MCS). Higher PCS and MCS scores reflect fewer limitations and better health-related QOL.RESULTSOf the 125 individuals who attended the group education session during the study period, 71 (57%) consented to participate in the study; of these, 9 were women and 62 were men. The female and male participation rates were 35% (9/26) and 63% (62/99), respectively. Approximately half of the participants were born outside of Canada (54.3%) and did not describe themselves as Canadian (52.2%). For those individuals born outside of Canada, the mean year of immigration was 1974 (with a range of 1949-2002). Most of the study participants had coronary artery disease (83.6%), had experienced a myocardial infarction (53.

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