Abstract
Objective: The improvement of the quality of life of chronically ill patients has become an important goal in treatment. However, it is seldom taken into account that many other factors, in addition to somatic factors, have an influence on the quality of life of patients. Using patients with congenital heart defects as an example, we examined the relative significance of biological factors, compared to psychological and social factors, for the various quality of life dimensions. Research design and methods: One hundred and eleven patients (aged 33 ± 12 years) with different degrees of cardiac dysfunction were examined (NYHA 0: 2 I: 56, II: 38, III: 13, IV: 2). All patients for whom there was no contra-indication underwent a treadmill ergometry in order to determine their level of cardiopulmonary functioning (peak oxygen consumption: \(V_{{{\rm O}_2}_{\max}}\)). All patients were asked to fill out questionnaires concerning their quality of life (WHOQOL-Bref), their cardiac complaints (Giessener Complaint Questionnaire GBB), their personality traits (Giessen Test GTS), and the social support they experience (Social Support Questionnaire SOZU-k22). The data were analyzed using a linear structural equation model (SEM). Results: In all aspects but the social domain, the HRQL of CgHD patients was significantly diminished compared to the normal population. The SEM proposed was valid, showing good indices of fit (χ2=1.18; p=0.55; AGFI=0.92). The level of cardiopulmonary functioning was most significant for the reporting of specific cardiac complaints (β=−28) and for the physical component of the general HRQL (β=32), although the former was also influenced by a depressed disposition (β=−0.20) and the extent of social support experienced (β=0.18). The objective findings, however, had virtually no individual significance for the psychological (β=0.09) and social domains (β=−0.02). These HRQL domains are primarily influenced by depressive personality traits (β=−26/−0.16) and the social support experienced (β=0.51/0.51). Conclusions: The patient’s organic dysfunction primarily determines illness-specific complaints but has little relevance for the psychological and social aspects of the HRQL. These aspects are predominantly determined by the patient’s depressive disposition and by the experienced social support. A successful therapy should therefore take biological as well as psycho-social determinants of the quality of life into account.
Similar content being viewed by others
References
M Bullinger J Hasford (1991) ArticleTitleEvaluating quality-of-life measures for clinical trials in Germany Control Clin Trials 12(Suppl. 4) 91S–105S
MA Testa DC Simonson (1996) ArticleTitleAssessment of quality-of-life outcomes N Engl J Med 334 IssueID13 835–840 Occurrence Handle10.1056/NEJM199603283341306 Occurrence Handle8596551
IB Wilson PD Cleary (1995) ArticleTitleLinking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 273 IssueID1 59–65
M Rose U Burkert G Scholler et al. (1998) ArticleTitleDeterminants of the quality of life of patients with diabetes under intensified insulin therapy Diabetes Care 21 IssueID11 1876–1885 Occurrence Handle9802736
M Rose H Fliege M Hildebrandt T Schirop BF Klapp (2002) ArticleTitleThe Network of Psychological Variables in Patients with Diabetes and their Importance for Quality of Life and Metabolic Control. Diabetes Care 25 35–42 Occurrence Handle11772898
DA Lane GY Lip TA Millane (2002) ArticleTitleQuality of life in adults with congenital heart disease. Heart 88 IssueID1 71–75 Occurrence Handle10.1136/heart.88.1.71 Occurrence Handle12067950
LC Simko KA McGinnis (2003) ArticleTitleQuality of life experienced by adults with congenital heart disease. AACN Clin Issues 14 IssueID1 42–53 Occurrence Handle12574702
J Somerville (1990) ArticleTitle‘Grown-up’ survivors of congenital heart disease: Who knows? Who cares? Br J Hosp Med 43 IssueID2 132–136
MC Angermeyer R Kilian H Meils (1999) WHOQOL 100—Handbuch für die deutschsprachige Version des WHO Instruments zur Erfassung von Lebenqualität. Hogrefe Göttingen
E Braehler JW Scheer (1995) Der Giessener Beschwerdebogen (GBB). Huber Bern
G Sommer T Fydrich (1991) ArticleTitleEntwicklung und Ueberpruefung eines Fragebogens zur sozialen Unterstuetzung (F-SOZU) Development and evaluation of a questionnaire on social support. Diagnostica 37 IssueID2 160–178
D Beckmann E Braehler HE Richter (1991) Der Giessen-Test (GT). Ein Test fuer Individual- und Gruppendiagnostik (Handbuch 4., ueberarbeitete Auflage mit Neustandardisierung 1990). Huber Bern
K Wasserman (1984) ArticleTitleThe anaerobic threshold measurement in exercise testing. Clin Chest Med 5 IssueID1 77–88 Occurrence Handle6723245
K Wasserman (1984) ArticleTitleThe anaerobic threshold measurement to evaluate exercise performance. Am Rev Respir Dis 129(2 Pt 2) S35–S40
Wasserman K. Determinants and detection of anaerobic threshold and consequences of exercise above it. Circulation 1987; 76(6 Pt 2): VI29–VI39.
K Wasserman (1987) ArticleTitleEvaluation of dyspnea using the exercise test. Pneumonol Pol 55 IssueID11–12 495–498 Occurrence Handle3444735
Braehler E. Der Giessen-Test 1968–1991: eine Spezialbiobliographie internationaler Literatur. [The Giessen-Test 1968–1991: A special biobliography of international literature.] Bibliographien zur Psychologie Nr. E2 edn. Thier: ZPID, 1991.
TS Rector SH Kubo JN Cohn (1987) ArticleTitlePatients’ self assessment of their congestive heart failure Heart Failure 198 209
E Breivik U Olsson (2001) Adding variables to improve fit: The effect of model size on fit assessment in LISREL R Cudeck D Sörbom (Eds) Structural equation Modeling: Present and Future. Scientific Software International Lincolnwood, IL, USA 112–126
M Browne R Cudeck (1993) Alternative ways of assessing model fit. R Cudeck J Long (Eds) Testing structural equation models. Sage Newbury Park, CA, USA 136–162
SW Davies SL Jordan DP Lipkin (1992) ArticleTitleUse of limb movement sensors as indicators of the level of everyday physical activity in chronic congestive heart failure. Am J Cardiol 69 IssueID19 1581–1586 Occurrence Handle10.1016/0002-9149(92)90707-6 Occurrence Handle1598873
Rector TS, Kubo SH, Cohn JN. Patients’ self assessment of their congestive heart failure. Heart failure 1987; 198–209.
TS Rector (1998) ArticleTitleMeasurement of clinical efficacy in studies of heart failure. Circulation 97 IssueID7 707 Occurrence Handle9495309
J Juenger D Schellberg S Kraemer et al. (2002) ArticleTitleHealth related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart 87 IssueID3 235–241 Occurrence Handle10.1136/heart.87.3.235 Occurrence Handle11847161
DA Mahler JI Mackowiak (1995) ArticleTitleEvaluation of the short-form 36-item questionnaire to measure health related quality of life in patients with COPD. Chest 107 IssueID6 1585–1589 Occurrence Handle7781351
Petermann F Bergmann K-C (1994) Lebensqualität und Asthma. Quintessenz Berlin
M Grey EA Boland C Yu S Sullivan-Bolyai WV Tamborlane (1998) ArticleTitlePersonal and family factors associated with quality of life in adolescents with diabetes [see comments]. Diabetes Care 21 IssueID6 909–914 Occurrence Handle9614606
GY Lip DA Lane TA Millane MH Tayebjee (2003) ArticleTitlePsychological interventions for depression in adolescent and adult congenital heart disease. Cochrane Database Syst Rev 3 CD004394 Occurrence Handle12918013
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rose, M., Köhler, K., Köhler, F. et al. Determinants of the quality of life of patients with congenital heart disease. Qual Life Res 14, 35–43 (2005). https://doi.org/10.1007/s11136-004-0611-7
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11136-004-0611-7