A Comparison of Quality of Life in Adult Patients with Heart Failure in Two Medical Settings: A Heart Failure Clinic and a Physician Practice

Heart Failure (HF), a major chronic disease that affects 4.8 million Americans, traditionally is medically managed by a primary care physician, with acute treatment at hospital emergency rooms often followed by inpatient admission. Ongoing support (prevention, diagnosis, treatment, intervention, symptom management, and end of life care), education, and intervention over the continuum are important to manage HF. The Modeling Role Modeling theory (Erickson, Tomlin, and Swain), is the study\u27s conceptual framework. When an individual knows about their illness, they mobilize internal/external resources to gain, maintain, or promote equilibrium. These resources affect daily activities. The purpose of this descriptive study is to compare perceptions of quality of life (QOL) in adult HF patients in two different treatment settings: a HF clinic and physician practices. IRB approval was obtained. Inclusion criteria included adults ages 18 or older, HF diagnosis for greater than six months, current medical management of HF, ability to read/write English, and verbal validation of orientation to time, place, person. Quantitative analysis was conducted using SPSS and SF Health Outcomes Scoring Software. Convenience samples were used. Subject age (n=60) ranged from 24 to 85 years of age. Mean age in the HF clinic was lower (56.3) than the physician practice (72.9). In the total sample 41(68.3%) were male and 19(31.7%) were female. The majority of the sample 53 (68.3%) were white and 7(11.7%) were black (p=.044). There were no Asian or Hispanic subjects. The research questions that were addressed in this study are as follows: 1. Does health-related QOL differ among HF patients who are receiving medical care in two different clinical settings as measured by the SF-36v2 Health Survey using the Physical Component Scale (PCS) and the Mental Component Scale (MCS)? There was no significance difference found in the PCS score (p=.889) or the MCS score (p=.135). Of 8 sub-scores only role-emotional showed significance (p=.007). 2. Does disease specific QOL differ among HF patients who are receiving medical care in two different clinical settings as measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score, physical sub-score, and emotional sub-score? No significant differences in the MLHFQ total score (p=.907) with mean scores of 2 groups virtually equal, (HF clinic=46.4, physician office=47.2). The physical dimension sub-score was not different (p=.896). Mean sub-scores in the 2 groups were virtually equal, (HF Clinic=19.6, physician practice=19.3). The emotional dimension sub-score was not significant (p=.953)(HF Clinic=10.4, physician practice=10.5). No significant difference in disease specific QOL. 3. Are there differences in self care resources of HF patients that are receiving medical care in two different clinical settings as measured by the Self Care Resource Inventory and the Needs(SCRIN) and Availability(SCRIA) sub scores? Several items showed significance. Both the internal (p=.003) and external (p=\u3c.001) SCRIN showed difference. The external (p=.004) SCRIA showed difference