ATLANTA, Nov. 8 -- For some older women, a new questionnaire appears to be a better measure of quality of life scores that may identify worsening symptoms of heart disease, researchers reported today at the American Heart Association's Scientific Sessions.
"Many of the instruments we use to measure the impact of heart disease symptoms on quality of life have been developed primarily in studies of men," says Laura P. Kimble, Ph.D., an associate professor at the Emory University School of Nursing, Atlanta Georgia.
"One of the major ways to evaluate how heart disease limits physical activity is with tests of functional ability," she says. "The gold standard is a treadmill test. But many elderly women have rarely walked on a treadmill, so it is unfamiliar to them, which presents problems in testing. Treadmill tests are also expensive and require the patient to come to the hospital," says Kimble. "Practical tools to measure limitations in daily activities caused by heart disease would be useful for clinicians to monitor their patients."
Other questionnaires to measure quality of life in the area of physical function ask about activities that are irrelevant for many elderly women such as jogging, swimming or playing tennis, she says. "If they're sedentary older women they may not be able to tell if they were limited in these vigorous activities because the activities they're asked about are not applicable to their everyday life."
Kimble wondered if she could develop a questionnaire that better reflected the day-to-day activities of elderly women. The questionnaire could be used every six months to monitor the progression of heart disease based on the symptoms the women experienced while performing their household tasks.
She tried out her Household Activities Scale on 30 women ages 39 to 85 with angina -- chest pain caused when the heart cannot get enough oxygen-rich blood. Angina is often an indication that fatty plaque deposits have narrowed the arteries that supply blood to the heart. Exercise causes the body to put more demands on the heart, increasing the possibility that chest pain will occur. Patients anxious that exertion might worsen their chest pain tend to limit their activities. Over time, self-limiting behavior can lead to deconditioning, a vicious cycle in which lack of exercise leads to weakness, she says. In addition, patients may no longer be able to perform activities that are important to them. Doctors can reduce chest pain by prescribing medication or by performing procedures that improve blood flow to the heart, but they must be able to recognize disease progression before deconditioning begins.
This research is particularly important because women tend to live longer than men, Kimble says. Accurate assessment and prompt treatment could mean greater independence into old age for many women.
Kimble based her questionnaire on the work of previous researchers who had studied the amount of energy needed to do some common household tasks. "For instance, it takes a fairly high amount of energy to make a bed or to scrub the floor on your hands and knees."
The scale lists 14 common household tasks such as moving furniture, vacuuming, scrubbing the floor, doing laundry and unpacking groceries. The women were asked whether they could perform each task without difficulty, with modifications, or if they no longer attempted the task due to chest pain. Most of the women in the study said they could no longer perform some of the more difficult chores around the house such as scrubbing floors, moving furniture and vacuuming. And 60 percent of the women said they had to modify the way they changed beds because of the limitations brought on by chest pain. Forty-three percent of the women reported that they could cook, wash dishes by hand, and load and unload the washer and dryer without difficulty.
"Further research should focus on how household task performance changes over time and how women adapt household activities because of chest pain. It should also look at whether the questionnaire could actually document heart disease progression in addition to symptom progression," she says.
Co-authors include Allison J. Spencer, M.S.N. and Yasmin Collier-Kenny, B.A.
Media advisory: Dr. Kimble can be reached at (404) 727-9678. Her fax number is (404) 727-8514. Her email is lkimble@nurse.emory.edu . (Please do not publish telephone numbers.)