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Factors Influencing Health-related Quality of Life in Patients with Atrial Fibrillation

Seon Jeong Lee1, Ji Min Seo2
Korean Journal of Adult Nursing 2013;25(1):13-23.
Published online: February 18, 2013

1Ulsan University Hospital, Ulsan

2College of Nursing, Pusan National University, Yangsan, Korea

Corresponding author: Seo, Ji Min College of Nursing, Pusan National University, Beomeo-ri, Mulgeum-eup, Yangsan 626-870, Korea Tel: +82-51-510-8351, Fax: +82-51-510-8308, E-mail: seojimin@pusan.ac.kr
• Received: August 30, 2012   • Accepted: February 16, 2013

© 2013 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to investigate the factors that influence health-related quality of life in patients with atrial fibrillation.
  • Methods
    The subjects were 150 outpatients with atrial fibrillation who visited the cardiology clinic of a university hospital in U city. The instruments used for this study were Mhel Uncertainty in Illness Scale (MUIS), Center for Epidemiologic Studies-Depression Scale (CES-D), State Trait Anxiety Inventory (STAI), and the Short-Form-36 Health Survey (SF-36) Korean version II. The date were analyzed by ANOVA, Pearson-correlation coefficient, and hierachial multiple regression using SPSS/WIN 18.0.
  • Results
    The mean score of physical health-related quality of life (PCS) was 38.92±6.22 and mental health-related quality of life (MCS) was 41.49±5.71. Physical and Mental health-related quality of life had the significant correlations with uncertainty, anxiety and depression. In multiple regression analysis, physical health-related quality of life was significantly influenced by duration of disease, NYHA class, uncertainty. Mental health-related quality of life was significantly influenced by family income, NYHA class, anxiety and depression.
  • Conclusion
    These results suggest that these influencing factors should be consider in developing the nursing interventions to improve the health-related quality of life in patients with atrial fibrillation.
  • Key Words: Quality of life; Atrial fibrillation; Uncertainty; Depression; Anxiety
Table 1.
Differences of Health-related Quality of Life according to Subjects' Characteristics (N=150)
Characteristics Categories n(%) PCS t or F p MCS t or F p
M±SD M±SD
Gender Male 77 (51.3) 39.65±6.65 1.49 .138 41.17±5.81 -0.69 .493
Female 73 (48.7) 38.14±5.67 41.82±5.63
Age (year) ＜50 15 (10.0) 43.20±5.11 5.65 .001 42.71±3.86 3.42 .019
50~59 49 (32.7) 38.88±6.39 41.60±5.94
60~69 48 (32.0) 39.80±5.73 42.84±4.23
≥70 38 (25.3) 36.17±5.91 39.15±6.96
Education None 10 (6.7) 32.57±4.88 6.86 ＜.001 38.78±6.19 1.06 .380
Elementary school 51 (34.0) 38.46±4.76 40.83±5.97
Middle school 50 (33.3) 38.24±5.59 42.15±4.89
High school 29 (19.3) 42.98±6.70 42.07±5.12
≥College 10 (6.7) 39.22±8.87 42.51±8.76
Religion Have 106 (70.7) 38.32±6.16 -1.84 .068 41.23±5.77 -0.85 .396
Haven't 44 (29.3) 40.36±6.18 42.10±5.59
Marital status Yes 119 (79.3) 39.40±5.13 1.36 .182 42.00±5.22 2.19 .030
No 31 (20.7) 37.07±9.17 39.51±7.05
Occupation Have 74 (49.3) 38.87±6.34 -0.09 .928 41.64±4.66 0.33 .744
Haven't 76 (50.7) 38.96±6.14 41.34±6.61
Family income (10,000 won) ＜100 30 (20.0) 36.07±5.58 3.43 .019 37.44±4.28 7.37 ＜ ＜.001
100~199 46 (30.7) 38.63±5.65 42.66±6.34
200~299 56 (37.3) 40.20±6.41 42.06±5.35
≥300 18 (12.0) 40.41±6.79 43.42±4.24
Living together with family Yes 129 (86.0) 39.33±5.41 1.35 .190 41.95±5.41 2.51 .013
No 21 (14.0) 36.41±9.63 38.63±6.78
Duration of disease (year) ＜1 28 (18.7) 40.02±5.05 7.65 ＜.001 40.68±4.76 1.57 .199
1~2 79 (52.7) 40.22±5.66 42.41±5.86
3~5 27 (18.0) 37.47±7.49 39.98±5.69
≥6 16 (10.6) 33.01±4.75 40.90±6.21
Number of admission 0~1 76 (50.7) 39.72±6.44 1.58 .210 41.85±5.90 0.33 .717
2~3 36 (24.0) 38.67±5.74 41.24±6.15
≥4 38 (25.3) 37.56±6.10 40.98±4.94
Classification of atrial fibrillation Paroxysmal 54 (36.0) 39.37±6.65 0.66 .509 41.41±6..31 -0.13 .901
Persistent 96 (64.0) 38.67±5.99 41.53±5.38
Left ventricular ejection fraction (%) ＜55 99 (66.0) 37.59±6.32 -3.80 ＜.001 40.84±6.01 -1.94 .054
≥55 51 (34.0) 41.49±5.18 42.74±4.89
NYHA class Class I 74 (49.3) 41.11±5.59 14.03 ＜.001 42.44±4.89 5.47 .005
Class II 63 (42.0) 37.57±5.83 41.30±6.41
Class III 13 (8.7) 33.00±6.14 36.95±4.43
Underlying heart disease Yes 72 (48.0) 38.04±6.07 -1.67 .097 40.92±5.93 -1.17 .243
No 78 (52.0) 39.73±6.28 42.01±5.49
Hyperthyroidism Yes 24 (16.0) 37.44±6.56 -1.27 .205 40.56±6.78 -0.87 .387
No 126 (84.0) 39.20±6.14 41.66±5.50

NYHA=New York Heart Association; PCS=physical component summary; MCS=mental component summary.

Table 2.
Health-related Quality of Life, Uncertainty, Anxiety and Depression of the Subjects (N=150)
Variables M±SD Possible range Actual range
Health-related quality of life
  PCS 38.92±6.22 0~100 25.90~57.85
  MCS 41.49±5.71 0~100 26.37~60.59
  Physical function 43.27±22.90 0~100 5.00~100.00
  Role limitation-physical 59.29±18.07 0~100 12.50~100.00
  Bodily pain 56.31±21.85 0~100 12.00~100.00
  General health 48.37±13.98 0~100 10.00~85.00
  Vitality 41.46±14.65 0~100 6.25~75.00
  Social function 66.50±14.65 0~100 25.00~100.00
  Role limitation-emotion 58.50±19.27 0~100 16.67~100.00
  Mental health 48.23±14.25 0~100 10.00~90.00
Uncertainty 38.82±6.56 0~88 26~53
  Ambiguity 15.27±2.87 0~32 9~22
  Complexity 6.35±1.58 0~16 2~9
  Inconsistency 7.75±1.73 0~20 4~13
  Unpredictability 9.45±2.19 0~20 5~16
Anxiety 41.17±6.13 20~80 28~52
Depression 19.66±7.25 0~60 6~34

PCS=physical component summary; MCS=mental component summary.

Table 3.
Correlations between Subjects' Uncertainty, Anxiety, Depression and Health-related Quality of Life (N=150)
Variables Health related quality of life
PCS MCS
r p r p
Uncertainty -.49 ＜.001 -.34 ＜.001
Anxiety -.37 ＜.001 -.44 ＜.001
Depression -.41 ＜.001 -.42 ＜.001

PCS=physical component summary; MCS=mental component summary.

Table 4.
Factors Influencing Health-related Quality of Life in Patients with Atrial Fibrillation (N=150)
Variables β p R2 change F change p
Physical component summary
Step 1     .10 5.14 .002
  Age -.08 .552
  Education .20 .063
  Monthly income .08 .505
Step 2     .17 11.39 ＜.001
  Duration of disease -.20 .023
  LVEF† .11 .218
  NYHA class -.24 .004
Step 3     .10 7.65 ＜.001
  Uncertainty -.28 .002
  Anxiety -.06 .502
  Depression -.14 .097
Mental component summary
Step 1     .12 4.69 .001
  Age .11 .349
  Marital status‡ -.07 .443
  Family income .33 .006
  Living together with family‡ -.14 .117
Step 2     .03 4.15 .001
  NYHA class -.16 .044
Step 3     .15 9.83 ＜.001
  Uncertainty -.14 .102
  Anxiety -.24 .008
  Depression -.19 .040

LVEF=left ventricular ejection fraction; NYHA=New York Heart Association.

†LVEF (0:＜55%, 1:≥55%);

‡Marital status, Living together with family (0: Yes, 1: No).

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    Factors Influencing Health-related Quality of Life in Patients with Atrial Fibrillation
    Korean J Adult Nurs. 2013;25(1):13-23.   Published online February 28, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.1.13
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    Factors Influencing Health-related Quality of Life in Patients with Atrial Fibrillation
    Korean J Adult Nurs. 2013;25(1):13-23.   Published online February 28, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.1.13
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    Factors Influencing Health-related Quality of Life in Patients with Atrial Fibrillation
    Factors Influencing Health-related Quality of Life in Patients with Atrial Fibrillation

    Differences of Health-related Quality of Life according to Subjects' Characteristics (N=150)

    Characteristics Categories n(%) PCS t or F p MCS t or F p
    M±SD M±SD
    Gender Male 77 (51.3) 39.65±6.65 1.49 .138 41.17±5.81 -0.69 .493
    Female 73 (48.7) 38.14±5.67 41.82±5.63
    Age (year) ＜50 15 (10.0) 43.20±5.11 5.65 .001 42.71±3.86 3.42 .019
    50~59 49 (32.7) 38.88±6.39 41.60±5.94
    60~69 48 (32.0) 39.80±5.73 42.84±4.23
    ≥70 38 (25.3) 36.17±5.91 39.15±6.96
    Education None 10 (6.7) 32.57±4.88 6.86 ＜.001 38.78±6.19 1.06 .380
    Elementary school 51 (34.0) 38.46±4.76 40.83±5.97
    Middle school 50 (33.3) 38.24±5.59 42.15±4.89
    High school 29 (19.3) 42.98±6.70 42.07±5.12
    ≥College 10 (6.7) 39.22±8.87 42.51±8.76
    Religion Have 106 (70.7) 38.32±6.16 -1.84 .068 41.23±5.77 -0.85 .396
    Haven't 44 (29.3) 40.36±6.18 42.10±5.59
    Marital status Yes 119 (79.3) 39.40±5.13 1.36 .182 42.00±5.22 2.19 .030
    No 31 (20.7) 37.07±9.17 39.51±7.05
    Occupation Have 74 (49.3) 38.87±6.34 -0.09 .928 41.64±4.66 0.33 .744
    Haven't 76 (50.7) 38.96±6.14 41.34±6.61
    Family income (10,000 won) ＜100 30 (20.0) 36.07±5.58 3.43 .019 37.44±4.28 7.37 ＜ ＜.001
    100~199 46 (30.7) 38.63±5.65 42.66±6.34
    200~299 56 (37.3) 40.20±6.41 42.06±5.35
    ≥300 18 (12.0) 40.41±6.79 43.42±4.24
    Living together with family Yes 129 (86.0) 39.33±5.41 1.35 .190 41.95±5.41 2.51 .013
    No 21 (14.0) 36.41±9.63 38.63±6.78
    Duration of disease (year) ＜1 28 (18.7) 40.02±5.05 7.65 ＜.001 40.68±4.76 1.57 .199
    1~2 79 (52.7) 40.22±5.66 42.41±5.86
    3~5 27 (18.0) 37.47±7.49 39.98±5.69
    ≥6 16 (10.6) 33.01±4.75 40.90±6.21
    Number of admission 0~1 76 (50.7) 39.72±6.44 1.58 .210 41.85±5.90 0.33 .717
    2~3 36 (24.0) 38.67±5.74 41.24±6.15
    ≥4 38 (25.3) 37.56±6.10 40.98±4.94
    Classification of atrial fibrillation Paroxysmal 54 (36.0) 39.37±6.65 0.66 .509 41.41±6..31 -0.13 .901
    Persistent 96 (64.0) 38.67±5.99 41.53±5.38
    Left ventricular ejection fraction (%) ＜55 99 (66.0) 37.59±6.32 -3.80 ＜.001 40.84±6.01 -1.94 .054
    ≥55 51 (34.0) 41.49±5.18 42.74±4.89
    NYHA class Class I 74 (49.3) 41.11±5.59 14.03 ＜.001 42.44±4.89 5.47 .005
    Class II 63 (42.0) 37.57±5.83 41.30±6.41
    Class III 13 (8.7) 33.00±6.14 36.95±4.43
    Underlying heart disease Yes 72 (48.0) 38.04±6.07 -1.67 .097 40.92±5.93 -1.17 .243
    No 78 (52.0) 39.73±6.28 42.01±5.49
    Hyperthyroidism Yes 24 (16.0) 37.44±6.56 -1.27 .205 40.56±6.78 -0.87 .387
    No 126 (84.0) 39.20±6.14 41.66±5.50

    NYHA=New York Heart Association; PCS=physical component summary; MCS=mental component summary.

    Health-related Quality of Life, Uncertainty, Anxiety and Depression of the Subjects (N=150)

    Variables M±SD Possible range Actual range
    Health-related quality of life
      PCS 38.92±6.22 0~100 25.90~57.85
      MCS 41.49±5.71 0~100 26.37~60.59
      Physical function 43.27±22.90 0~100 5.00~100.00
      Role limitation-physical 59.29±18.07 0~100 12.50~100.00
      Bodily pain 56.31±21.85 0~100 12.00~100.00
      General health 48.37±13.98 0~100 10.00~85.00
      Vitality 41.46±14.65 0~100 6.25~75.00
      Social function 66.50±14.65 0~100 25.00~100.00
      Role limitation-emotion 58.50±19.27 0~100 16.67~100.00
      Mental health 48.23±14.25 0~100 10.00~90.00
    Uncertainty 38.82±6.56 0~88 26~53
      Ambiguity 15.27±2.87 0~32 9~22
      Complexity 6.35±1.58 0~16 2~9
      Inconsistency 7.75±1.73 0~20 4~13
      Unpredictability 9.45±2.19 0~20 5~16
    Anxiety 41.17±6.13 20~80 28~52
    Depression 19.66±7.25 0~60 6~34

    PCS=physical component summary; MCS=mental component summary.

    Correlations between Subjects' Uncertainty, Anxiety, Depression and Health-related Quality of Life (N=150)

    Variables Health related quality of life
    PCS MCS
    r p r p
    Uncertainty -.49 ＜.001 -.34 ＜.001
    Anxiety -.37 ＜.001 -.44 ＜.001
    Depression -.41 ＜.001 -.42 ＜.001

    PCS=physical component summary; MCS=mental component summary.

    Factors Influencing Health-related Quality of Life in Patients with Atrial Fibrillation (N=150)

    Variables β p R2 change F change p
    Physical component summary
    Step 1     .10 5.14 .002
      Age -.08 .552
      Education .20 .063
      Monthly income .08 .505
    Step 2     .17 11.39 ＜.001
      Duration of disease -.20 .023
      LVEF† .11 .218
      NYHA class -.24 .004
    Step 3     .10 7.65 ＜.001
      Uncertainty -.28 .002
      Anxiety -.06 .502
      Depression -.14 .097
    Mental component summary
    Step 1     .12 4.69 .001
      Age .11 .349
      Marital status‡ -.07 .443
      Family income .33 .006
      Living together with family‡ -.14 .117
    Step 2     .03 4.15 .001
      NYHA class -.16 .044
    Step 3     .15 9.83 ＜.001
      Uncertainty -.14 .102
      Anxiety -.24 .008
      Depression -.19 .040

    LVEF=left ventricular ejection fraction; NYHA=New York Heart Association.

    †LVEF (0:＜55%, 1:≥55%);

    ‡Marital status, Living together with family (0: Yes, 1: No).
    Table 1. Differences of Health-related Quality of Life according to Subjects' Characteristics (N=150)

    NYHA=New York Heart Association; PCS=physical component summary; MCS=mental component summary.

    Table 2. Health-related Quality of Life, Uncertainty, Anxiety and Depression of the Subjects (N=150)

    PCS=physical component summary; MCS=mental component summary.

    Table 3. Correlations between Subjects' Uncertainty, Anxiety, Depression and Health-related Quality of Life (N=150)

    PCS=physical component summary; MCS=mental component summary.

    Table 4. Factors Influencing Health-related Quality of Life in Patients with Atrial Fibrillation (N=150)

    LVEF=left ventricular ejection fraction; NYHA=New York Heart Association.

    LVEF (0:＜55%, 1:≥55%);

    Marital status, Living together with family (0: Yes, 1: No).

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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