Factors Affecting Quality of Life in Patients with Coronary Artery Disease

Info Artikel Masuk Revisi Diterima DOI Number : : 30 September 2017 : 23 November 2017 : 30 November 2017 : 10.18196/ijnp.1371 Abstract Background: Coronary artery disease impact physical , psychological, and social aspects on quality of l ife. The aims in this study was to examine effecting factors of quality of l ife (QoL). Methods: In this study the analytic correlation with cross sectional design was used. One hundred and three subjects paticipated with purposive sampling (88 male and 23 female). QoL quesioner (SF-36) was used to collect the data. The data were analyzed by multivariate regression. Results: One hundred and three patients (80 males and 23 female) were enrolled on this study. This study indicates that independent variables were not associated with quality of l ife (p value > 0.05). The greater quality of l ife found in patients graduated from university (62,2%) and had more income (51.9%). Other variables l ike male (57.5%), patients between 48-57 years of ages (68.2%), married patients with coronary artery disease (62.0%), the retired or unemployee (78.9%), patients with hypertension (57.8%), never taking alcohol (60.8%), never smoking (50%) and never doing exercise (66%) had lower quality of l ife score. Conclusion: There were no statistically significant factors affecting quality of l ife in patients with CAD. The more respondents needed to know the factors affecting quality of l ife


Introduction
Coronary artery disease (CAD) is a one of diseases that cause high death in the world.According to World health orgnization in 2012, 7,4 millions people die due to CAD (WHO, 2016).Based on basic research of health by Ministry of Health in 2013, mortality rate by CAD is 883.447peoples in Indonesia.
Secondly, psychological impact of CAD.Patients of CAD often suffering stress, poor of mood, anxiety, and depression.It will affected directly to the function of heart.Simpatic nerves will activate, increase heart beat, atrial and ventricul ar contraction, vasocontriction of blood vessels.That conditions make worse and bad perception of patients to the illness (Lewis, Heitkemper, & Dirksen, 2010., Monahan et al., 2007).
The last impact of CAD is social.Impairement of social interaction, hobby aktivitiy, and resign from the workplace.It cause of physical limitations (Improve Heart Health, 2009).
Coronary artery disease is high recurrent after hospitalization (Briffa et al., 2011).It is indicated that low of QoL (Desai, Akhshay, & Stevenson, 2012).Study found that QoL score in CAD patiens was low (Dale et al., 2014., Yulianti, Kosasih, & Emaliyat.This study aimed to evaluate the factors associated with the quality of life in patients with coronary artery disease.

Methods
This was an analytic correlation with cross-sectional design.One hundred and three respondents with purposive sampling attending at the dr.Kariadi Central Hospital of Semarang between July and August 2017 were recruited.The inclusion criteria were male or female with medical diagnose of CAD.The characteristics of respondent that may affect their quality of life, such as age, gender, level of education, merital status, income, history of health, occupational, exercise, smoke, and alcohol consumption.The respondents who refused were exclused.The study was approved by the Ethics Committee of RSUP dr.Kariadi and Universitas Diponegoro.The quality of life data we re measured using Short-Form (36).Multivariate regression analysis was us e d to identify the independent variables on QoL with p value < 0.05 was considered statistically significant.
Table 2 showed that there were no statistically significant (p value > 0.05) factors affecting between independent variables with quality of life   36.9)Financial < mi nimum of regional wage mi nimum of regional wage > mi nimum of regional wage 3 (10.7)9 (42.9)28 (51.9) 25 ( 89 In this paper, there were no statisticall y significant factors affecting between independent variables with QoL.However, this study explained that male had lower quality of life score than female.The number of male respondents is more than that of female.In the previous study, female had lower QoL than male (Gijsberts, Agostoni, Hoefer, Asselbergs, Pasterkamp, Nathoe, Appelman, De, & Den, 2015).Risk factors of CAD can influence QoL score in male.Female had lower of risk factor in CAD than male (Bajaj, Mahajan, Grover, Mahajan, & Mahajan, 2016).
In the study of Durmaz, Keles, Akar, Ozdemir, Akyunak, & Bozkurt in 2009 explained that patients 37-47 years only have greater QoL.Similarly, we found that patients between 48-57 years of ages had low QoL score.The increasing of ages indicated decrease of physical functioning and have high risk of coronary artery disease.Impaired of physical in patients with CAD can causes decrease QoL score (Sanchis-Gomar, Perez-Quilis, Leischik, & Lucia, 2016).
In contras, many studies reporting that living alone have worse QoL score than married patients score (Han, Kyu-Tae, Park, Eun-Cheol, Kim, Jae-Hyun, Kim, Sun, & Sohee, 2014).In this, we found that married patients had lower QoL.Gerard, Mark, Gemma, & Yoichi in 2008 explored, lower QoL score in married patients causes by less of social support from partner, family member or community.
In the risk factor variables, CAD patients with hypertension had lower QoL score.According to the previous studies (Soni, Porter, Lash, & Unruh, 2010) that hypertension patients with CAD have lower QoL.Negative impact of hypertension is decrease physical function of patients (Xu, Rao, Shi, Liu, Chen, & Zhao, 2016).
Contrally, never taking alcohol and smoking cessation had lower quality of life score.In the previous studies showed that patients cessation of smoke are associated with greater QoL score (Durmaz, Keles, Akar, Ozdemir, Akyunak, & Bozkurt, 2009).Smoking can damage vascular endothelial function and stablibity, promote myocardial hypoxia and cause coronary artery spasm.It is also can induce a variety of factors, such as thromboxane A2, CD40 and prostacyclin, that cause angiosclerosis-accelerated plaque formation, which subsequently induces plaque rupture and thrombosis.Activate oxidative stress and alter the activities of several inflammatory cytokines, including ET-1, tumor necrosis factor-α, interleukin-6 and nitric oxide, subsequently leading to plaque formation and blood clots in the blood vessels promote by increase alcohol consumption (Wan, Ma, Yuan, Fei, Yang, & Zhang, 2015).
In this study we found that patients who never doing exercise had lower quality of life.Previous research by Firouzabadi, Sherafat, & Vafaeenasab in the 2014 displayed, one of methods to increase score of the quality of life are exercise.Adequate exercise improves blood circulation, prevents thrombosis and embolism, improves the internal functioning of the body, improves sleep, relieves anxiety and restores normal nerve and humoral regulation (Wan, Ma, Yuan, Fei, Yang, & Zhang, 2015).

Conclusion
The quality of life is based on individual perceptions.Factors affecting QoL need to be identified.This will help healthcare providers (nurses) identify quality of life, promote health especially for CAD patients.