A comparative study of the quality of life before and after therapeutic interventions in patients with acute coronary syndrome

Number of pages: 95 File Format: word File Code: 32065
Year: Not Specified University Degree: Master's degree Category: Paramedical
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  • Summary of A comparative study of the quality of life before and after therapeutic interventions in patients with acute coronary syndrome

    Master's Thesis

    Special nursing care

    Abstract

    Background and purpose: Improving the quality of life is considered the most important goal of therapeutic interventions in chronic diseases, so the present study aims to determine the results of using different treatment methods on the quality of life of patients with acute coronary syndrome.

    Materials and methods: A group study was conducted in patients with acute coronary syndrome admitted to Shahid Beheshti Hospital in Kashan in 2012 with available samples.  The quality of life of patients who underwent one of the medical treatment methods, angioplasty or vascular transplant according to the treatment criteria of the cardiologist, was evaluated using the SF36 questionnaire [1] before and two months after receiving the above treatments and was analyzed with the paired t-test [2], chi-score [3] and one-way analysis of variance [4].

    Results: 167 patients They were studied with an average age of 56.5 ± 10.22, and 50.3% of them were women. Angioplasty and drug treatment; The score of dimensions of general health, physical pain and the total score of quality of life of patients increased. Drug treatment also had a positive effect on the dimension of social activity (P=0.01). Coronary artery transplantation improved the post-operative role (P=0.005), but it did not improve the overall quality of life two months after treatment. In the comparison of the overall quality of life of the three drug treatment groups, angioplasty and coronary artery transplantation, no significant difference was observed (P=0.67).

    Conclusion: Different treatments of acute coronary syndrome are effective in the quality of life of these patients and can have a positive role in improving some of its dimensions.

    Key words: quality of life, acute coronary syndrome, angioplasty, coronary artery transplantation

    Statement of the problem

    1-1 Introduction

    Acute coronary syndrome is still considered one of the biggest life-threatening disorders and has affected many people all over the world (1.2). Cardiovascular diseases have increased significantly in recent decades with the growth of population age and inactivity and unhealthy diet (4.3) and it is predicted that it will affect more than 40% of the world's population by 2030 (5). According to global statistics in 2008, about 7,249,000 people have died due to this disease (4), and a large number of victims were under 65 years old (6). According to the statistics of the Ministry of Health of Iran in 2013, about 40% of deaths in Iran were caused by cardiovascular diseases (7) and 60% of heart surgeries in Iran are coronary artery graft surgeries (8). Acute coronary syndrome is one of the most expensive expenses for national health, if people affected by this disease frequently refer to cardiac emergency rooms and this disease also causes a lot of labor loss (9-11). It has been announced that in 2009, about 166 billion dollars was the direct and indirect cost of treating this disease in the United States (12).

    Today, with new innovations in the field of vascular reconstruction and the arrival of new drugs, a wide range of treatments for coronary disease are available, which raises the need to re-evaluate the quality of life following the use of different treatments (13-15). The basis of the treatment of coronary diseases is non-invasive treatment (drug therapy) (16) and invasive treatments of this disease include coronary bypass surgery and subcutaneous coronary interventions including the use of angioplasts (17-19).

    The most important goal of therapeutic interventions for diseases without definitive treatment such as ischemic heart diseases is to improve the quality of life (21,20). Life is a person's understanding of his life situation according to the value system of the culture, goals, expectations, standards and concerns of the individual (22). Since the last decade, measuring and evaluating the quality of life has been a measure of the effectiveness of cardiovascular treatments (21), which has led to a richer understanding of the results of treatment and reduced costs related to chronic disease and improved health. Today, the management of acute coronary syndrome treatment is not only aimed at reducing mortality, but also at reducing disability and the risk of accidents leading to a reduction in quality of life.Since the last decade, measurement of the quality of life has been a measure of the effectiveness of cardiovascular treatments (21), which has led to a richer understanding of the treatment results and reduction of costs related to chronic disease and improved health, and today, the management of acute coronary syndrome treatment is not only aimed at reducing mortality, but also at reducing disability and the risk of accidents leading to a reduction in quality of life (24, 23) and considering the benefit of a healthy and efficient workforce (25).

    In the studies that have been conducted in order to investigate the quality of life following various treatments, contradictions and defects are seen. For example, in a study on 1680 diabetic patients with coronary artery involvement, the quality of life in the bypass surgery treatment group was significantly better than in the drug release treatment group (19), but in the study by Van Damburg et al. in the Netherlands, comparing the quality of life between the group of patients treated with angioplasts and the group of patients treated with surgery Bypass did not make a difference (26). Also, in a multicenter trial study on 389 patients, no difference was found between the results of the quality of life of the two groups of bypass surgery and drug-eluting stents (27). In a study conducted in England comparing the drug treatment method and the use of subcutaneous coronary intervention, it was shown that the quality of life of the group treated with subcutaneous coronary intervention was higher (28), but another study in Switzerland on 282 patients showed a significant difference in the quality of life of the two groups. The drug treatment group and subcutaneous coronary intervention were not observed (29) and Christopher also states that there is no significant difference between the rate of pathogenicity and consequently the quality of life, conservative treatment (pharmacotherapy) and aggressive treatment methods of revascularization (30). Which of the ischemia treatments, including: cardiopulmonary bypass, stenting, or drug therapy are more effective in increasing the quality of life, is still unanswered (31). .

    Improving the quality of life of heart patients is considered one of the duties of nursing (32, 33) and by creating a health-oriented attitude instead of treatment-oriented, nurses can lead the health team to improve the quality of life of patients (36-34), considering that nurses spend the most time with patients, they are in the best position to examine the quality of life of patients after various treatments for ischemia of the heart (38-35) and They can use their results to evaluate the financial and human costs caused by various ischemia treatments and the effects of drugs and advanced equipment (11 and 37). The difference in the quality of life in patients treated with different ischemia treatment strategies; Sometimes it is so small that it is possible to consider the preferences of the patients. Nurses should inform patients and their family members and health care providers about the consequences of cardiac ischemia treatment methods on the quality of life and consider the patient's preferences regarding the treatment method as much as possible (15). In addition, due to access to patients, nurses can assess the quality of life before and after ischemia treatments, care needs, possible hospitalization rates and complications of the disease, and measures required for the patient (39).

    At the same time, despite the tremendous progress in the treatment of cardiovascular diseases, especially coronary artery occlusion, if these treatment methods are not accompanied by subsequent measures and supports (such as rehabilitation programs), the quality of life of patients with disorders In other words, after the treatment, the patients do not have enough mobility and vitality, and at least, they are reluctant to do physical activities, and the treatment method provided has the most important role in this situation. With regard to the above-mentioned materials and the high rate of ischemic heart diseases and the different treatment procedures that are performed on them, and the lack of research in this field in Asian countries including Iran (40) and considering that the geographical area includes cultural, socio-economic factors and the characteristics of health care providers and the health system are effective in the outcome of treatment of cardiovascular diseases (35, 34), therefore, conducting this study in order to determine the effect of the type of treatment on the quality of life of patients seemed necessary and necessary.

  • Contents & References of A comparative study of the quality of life before and after therapeutic interventions in patients with acute coronary syndrome

    List:

    Chapter One: Statement of the Problem

    1-1 Introduction.. 2

    1-2 Goals and Assumptions.. 4

    1-2-1 General Goal.. 4

    1-2-2 Specific Goals.. 4

    1-2-3 Hypothesis.. 5

    1-3 Definition of Key Words. 5

    1-3-1 quality of life.. 5

    1-3-1-1 theoretical definition.. 5

    1-3-1-2 operational definition.. 5

    1-3-2 therapeutic interventions.. 5

    1-3-2-1 operational definition: includes PTCA, CABG and drug interventions. 5

    1-3-3 aggressive and non-aggressive groups. 5 1-3-3-1 operational definition. 6

    Chapter Two: conceptual framework and research background

    2-1 acute coronary syndrome. 9

    2-2-2-1 Unstable angina.. 9

    2-2-2-2 Myocardial infarction without ascending NSTEMI) 10

    2-2-3 cardiac angina or acute coronary syndrome. 10

    2-3 Definition of cardiac angina.. 10

    2-3-1 Stable angina.. 10

    2-3-2 Unstable angina.. 11

    2-3-2-1 Examining the causes of unstable angina or infarction. 11

    2-3-2-1-1 stages of atherosclerosis. 12

    2-3-2-1-1-1 cholesterol and lipoprotein. 12

    2-3-2-1-1-2 oxidation. 12

    2-3-2-1-1-3 inflammatory response. 12

    2-3-2-1-1-3-1 vessel closure. 13

    2-4 clinical symptoms of coronary syndrome. 13

    4-2-1 Quality of pain .. 14

    4-2-2 Duration of pain .. 14

    4-2-3 Location of pain .. 14

    4-2-4 Pain starters. 14

    4-2-5 heart attack, the latest case of acute coronary syndrome. 15

    2-5 manifestations of coronary syndrome disease. 15

    2-5-1 Prinzmetal's angina.. 15

    2-5-2 silent ischemia.. 15

    2-5-3 X syndrome.. 16

    2-6 methods of diagnosing acute coronary syndrome or heart attack. 16

    2-6-1 History and clinical examination. 16

    2-6-2 heart tape or ECG .. 17

    2-6-3 laboratory markers. 17

    2-6-4 Non-invasive tests. 18

    2-6-4-1 Echocardiography. 18

    2-6-4-2 Exercise test.. 18

    2-6-4-3 Thallium scan.. 18

    2-6-4-4 Angiography.. 19

    2-6-4-5CT Angiography. 19

    2-5 ways of treatment.. 20

    2-5-1 drug treatment.. 20

    2-5-1-1 nitroglycerin or nitrates. 20

    2-5-1-2 betablocker.. 21

    2-5-1-3 verapamil - heparin and LMWH. 21

    2-5-1-4 unstable angina.. 23

    2-5-1-5 myocardial infarction with ST segment elevation. 23

    Coronary interventions through the skin. 23

    2-5-2 stent.. 23

    2-5-3 coronary artery bypass surgery. 25

    2-5-3-1 importance.. 25

    2-5-4 cardiopulmonary bypass. 25

    2-5-4-1 risks.. 26

    2-5-5 risk factors of coronary syndrome. 26

    2-5-5-1 age .. 27

    2-5-5-2 gender.. 27

    2-5-5-3 genetic factors. 27

    2-5-5-4 race.. 27

    2-5-5-5 quality of life.. 28

    2-5-5-1 history of quality of life. 30

    2-5-5-2 The concept of quality of life from the point of view of theorists. 31

    2-5-5-2-1 Kalman.. 31

    2-5-5-2-2 Goodman.. 32

    2-5-5-2-3 Reiff and Singer. 32

    2-5-5-2-4 Murray.. 32

    2-5-5-2-5 David Phillips. 33

    2-5-5-3 characteristics of quality of life. 33

    2-5-5-3-1 multi-dimensionality. 33

    2-5-5-3-2 being subjective.. 34

    2-5-5-3-3 being dynamic.. 34

    2-5-5-4 social psychological and sociological approach to the concept of quality of life. 34

    2-5-5-4-1 social learning theory. 35

    2-5-5-4-2 Durkheim's theory of anomie. 35

    2-5-5-4-3 Parsons theory of social action. 36

    2-5-5-4-4 Simmel's theory.. 37

    2-6 background of research.. 39

    2-6-1 external research.. 39

    2-6-2 internal research.. 41

    Chapter 3: research methodology

    3-1 type of research.. 44

    3-2 Research environment.. 44

    3-3 Research community.. 44

    3-4 study entry and exit criteria. 44

    3-4-1 entry criteria.. 44

    3-4-2 exclusion criteria. 45

    3-5 Sampling method.. 45

    3-6 Determining the sample size.. 45

    3-7 Implementation method46

    3-8 information gathering methods. 47

    3-9 data collection tools. 47

    3-10 SF6 scoring questionnaire. 47

    3-11 Introduction of research variables. 50

    3-12 information analysis method. 51

    3-13 used software. 51

    3-14 Ethical considerations. 51

    Chapter 4: description and analysis of data (findings)

    4-1 General findings of the research. 53

    4-2- Studying the demographic characteristics of patients with acute coronary syndrome. 54

    4-3 Determining the quality of life of patients with acute coronary syndrome at the beginning of the study. 56

    4-4- Determining the quality of life of patients with coronary syndrome two months after treatment 58

    5-4 Comparing the quality of life of patients before and after therapeutic interventions 63

    Chapter five: discussion and conclusion

    5-1 Discussion and conclusion. 66

    5-2 Conclusion. 69

    3-5 suggestions. 69

    5-3-1 Practical suggestions. 69

    5-3-2 Research proposals. 70

    Sources and sources. 72

    Appendix. 79

    English abstract. 85

     

     

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A comparative study of the quality of life before and after therapeutic interventions in patients with acute coronary syndrome