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The term ‘‘quality of life’’ is commonly used interchangeably with ‘‘health-related quality of Life’’ (HRQOL) (Varrocchio & Ferrans, 2010). Some researchers have preferred the term “health related QOL” over “quality of life” because the focus is on health.It can be used to measure the impact of illness and treatment strategies on an individual (Roebuck et al., 2001) and the impact of different experiences and treatments for the same condition or the impact of different treatments across different conditions (Thompson & Roebuck, 2001).Health- related quality of life (HRQOL) is generally defined as the extent to which perceived health, or changes in health, have an influence on an individual’s physical, psychological, and social functioning (Bowling, 1997; Drummond et al., 2005). Researchers and theorists have identified three important characteristics of HRQOL. HRQOL has been defined as a temporal, multidimensional and subjective construct (Peterson & Bradow, 2009).

Mandzuk & Macmillan (2005) in the concept analysis of QOL highlighted the three critical attributes based on a literature review to further illuminate QOL. These attributes were: (1) individuals make a subjective appraisal of their own lives; (2) individuals identify their satisfaction with their lives as it pertains to the

physical, psychological, and social domains of their life, and (3) objective measures may supplement people’s subjective evaluations of the QOL. They elaborated that an individual’s subjective evaluation plays a significant role, however the objective assessment such as socioeconomic status and education may also contribute towards QOL (Marshall, 1990; Lee, 2002 as cited in Mandzuk & Macmillan, 2005). It was further stated (Mandzuk & Macmillan, 2005; Hays et al 2009) that general health and functioning is included in the physical domain, while the psychological domain encompasses personal satisfaction, spirituality, and feelings of wellbeing. Social support and networks, family and friends and feelings of belonging to a community or group are included in the social domain of QOL (Mandzuk & Macmillan 2005)

Numerous research studies have reported QOL as a multidimensional construct (Ferrans & Powers, 1992; WHOQOL Group, 1995; Efficace and Marrone, 2002; Cimete et al., 2003; Kaasa& Loge, 2003). Some Researchers (Padilla &Grant, 1985; WHOQOL Group, 1995) have identified HRQOL in terms of physical, psychological, social and environmental domains. Others (Blumenthal & Mark, 1994) reported HRQOL as physical functioning, emotional status, cognitive performance, social functioning, general perceptions of health and well-being, and disease- specific symptoms.

HRQOL is temporal in nature and patients have the ability to change their perceptions and set their own priorities in term of quality of life on the basis of their experiences in everyday life (Peplau, 1994; Sprangers & Schwartz, 1999). Factors such as culture (Marshall, 1990; Collinge et al., 2002; WHO, 2004) and

spirituality (Efficace & Marrone 2002; Horton 2002) have a significant influence on people’s perception regarding their QOL. Research evidence supports the subjective nature of QOL and HRQOL depending upon patients’ perspectives and their subjective feelings (Ager, 2002; Collinge et al., 2002; Hacker, 2003).

Rosen and colleagues (1997) examined whether emotional distress, social support, and physical functioning, together with socio-demographic and clinical variables, could predict subjective global health in patients with left ventricular dysfunction. They found that socio-demographic and clinical variables had no, or only indirect, effects on quality of life. Social support and emotional distress were identified as significant determinants of physical functioning. A research study by Westin et al (1997) illustrated that patients with cardiac problems often experience impairment in quality of life and given that psychological distress has a negative impact on quality of life, this therefore has implications for rehabilitation of these patients. Research findings have also demonstrated that quality of life of an MI patient is more impaired than general population (Brown et al., 1999, Schweikert, 2009).

Recent research evidence has suggested that psychosocial factors such as Type D personality, (Mols et al., 2010; Middel et al., 2013) anxiety , depression (Stafford et al., 2007; Faller et al, 2010; Beek et al., 2012) and social support (Heo et al., 2012: Chung et al.,2013) have significant impact on quality of life of patients with CHD.

Saeed et al (2011) reported that MI patients with Type D personality have more impaired quality of life compared to non-Type D patients. Type D personality, depression, and anxiety were identified as significant predictors of impaired quality of life in patients with MI (Gul, 2010) in Pakistan. Sertoz et al.(2013) undertook study to examine the effect of comorbid medical disease and depression on quality of life of MI patients in Turkey. Depressive symptoms and comorbid diseases were identified as significant determinants of quality of life post MI. In another study Faller at el. (2009) also found depression to be an independent predictor of impaired HRQOL in patients with chronic heart failure (CHF).

Vinod and Christopher (2014) conducted a systematic review to explore the relationship between social support and outcomes in patients with cardiac diseases. They concluded that increased in the levels of social support is associated with a decrease in the symptoms of anxiety and depression and improvement in the HRQOL. Arestedt et al (2013) also reported significant association between social support with HRQOL, specifically the emotional aspect of HRQOL, in patients with CHF.

In the current research the terms quality of life (QOL) and health related quality of life (HRQOL) were used interchangeably. Identification of specific psychosocial factors and its impact on QOL of MI patients would highlight the importance of routine screening of patients for Type D personality, psychological distress, and lack of social support which would be beneficial in responding to the specific treatment needs of the patients.Furthermore therapeutic

interventions and rehabilitation programs may incorporate these psychosocial factors for the treatment and management of patients with MI.