Introduction:
In patients with heart failure (IHF), health-related quality of life (HRQOL) is as important as longer survival. Deaths are inevitable for all human beings, but clinicians may help patients with HF to maintain or improve HRQOL until almost at the end of their lives. Psychological and physical symptoms can impact HRQOL through different pathways, and behavioral factors can indirectly impact HRQOL, but the relationships have not been tested in prior theoretical models.
Hypothesis:
Sociodemographic (i.e., age), biological/physiological (i.e., comorbidity), psycho-social (i.e., depressive symptoms and social support), physical (i.e., physical symptoms and functional status), and behavioral factors (i.e., dietary adherence) in Heo-Moser model will be associated with HRQOL directly and indirectly in patients with HF through different pathways.
Methods:
This is a secondary analysis of baseline data from two observational studies in which baseline data were collected using the same instruments (N = 358 patients with HF, mean age: 60.4 years). Structural equation modeling (SEM) was used to test the hypothesis.
Results:
In the SEM, the analysis showed desirable model fit: Chi-square = 7.710, p = .260, RMSEA = .028 (95% confidence interval = 0.00, 0.078), CFI = 0.998, TLI = 0.989, and SRMR = 0.023. Age, depressive symptoms, physical symptoms, and functional status were directly associated with HRQOL. Age, comorbidity, depressive symptoms, social support, dietary adherence, and physical symptoms were indirectly associated with HRQOL through different pathways (Figure 1).
Conclusions:
All the factors in the model were directly and/or indirectly associated with HRQOL through different pathways. The pathways of physical symptoms, depressive symptoms, and dietary adherence differed. This model can be used to develop interventions targeting improvement in HRQOL in patients with chronic diseases.
Depressive symptoms, social support, and health-related quality of life: A community-based study in Shanghai, China
