Quality of Life in Patient Post Percutaneus Coronary Intervention

(PCI)

Siti Lestari and Tri Sunaryo

Nursing School of Polytechnic of Health, Surakarta, Indonesia

Keywords: Myocardial Infarction, Percutaneus Coronary Intervention, Quality of Life.

Abstract: Acute myocardial infarction is the result from the occurrence of acute coronary occlusion with prolonged

ischemia, then ultimately causes cell damage and myocardial infarction. To overcome stenosis or narrowing

the blood vessel, it need a PCI or Percutaneus Coronary Intervention. These conditions often have impact on

the quality of life. This study was intended to identify factors that affecting the quality of life of patients

myocardial infarction treated with PCI. This cross-sectional study was conducted among 30 respondents

who participated in this study. Chi-square was conducted to analyze the effect of age, marital status, social

support and coping mechanism toward the quality of life with α = 0.05. Statistical test result showed the

relationship of gender and QoL obtained p = 1.00, age and QoL p = 0.72), married status and QoL

p = 1.00, and coping mechanism and QoL p = 0.003. We can conclude that there was relationship

between social support, coping mechanism and the quality of life, but no relationship between age, sex,

marital status and the quality of life.

1 BACKGROUND

Acute myocardial infarction is a disease which affects

the patient in a to a great degree distressing way. It

is described as a threat that leads to a life crisis in

one's entire life and it is additionally a high family

stretch particularly for the couple (Eriksson, 2010).

The frequency of AMI is high and it is the main

source of death in the elderly moreover. According to

WHO in the world 14 million people die annually

(WHO, 2011). Myocardial infarction is also known

as heart attack. It is a condition of heart muscles death

when one or more coronary arteries which supply

oxygen-rich blood to the heart muscle turns out to be

all of a sudden blocked (Compare & Zarbo, 2013).

Blockage results from plaques made of fats and

cholesterol. The accumulation of this plaque is known

as coronary artery disease. The accumulation of

plaque is a process and also can produce chest pain

symptom known as angina pectoris (Herman &

Walsh, 2011). A myocardial infarction occurs when

a plaque burst all of a sudden and it causes a fast

aggregation of coagulating factors at the crack site

which drives a sudden block of blood stream in the

coronary supply route. Sudden obstruction prevents

blood reaching the heart muscle. The heart muscles

start to die if there is no vital supply of oxygen-rich

blood. The longer the obstruction persists, the greater

the amount of heart muscle dies.

Myocardial Infarction is a medical emergency. If

not treated on time it may lead changeless harm of

heart muscles (Linda F. Browna, Kurt Kroenkeb, C,

Dale E. Theobaldd, Jingwei Wub, C, And Wanzhu

Tub, 2011) and Maddox, 2011). Some of the

medical management used in this case are oxygen

inhalation ,anti arrhythmic drugs, in severe cases

administer I/V Morphine sulphate and diazepam as

required, I/V Heparin to prevent from

thromboembolism but it is not necessary for mild

case, pain relief (Nitro-glycerin for active pain),

prevention and treatment of any complications that

may arise, Immediate administration of aspirin and

physical exercises ought to be limited. The other non-

surgical treatment is angioplasty which is also known

as Percutaneus Coronary Intervention (PCI) (Linda F.

Browna, Kurt Kroenkeb, C, Dale E. Theobaldd,

Jingwei Wub, C, And Wanzhu Tub, 2011).

Health-related quality of life is an increasingly

important outcome measure in the management and

care of patients with chronic diseases, such as

myocardial infarct, coronary artery disease (CAD),

when the main treatment aim is not only to reduce

mortality rates, but also to enhance indications and

Lestari, S. and Sunaryo, T.

Quality of Life in Patient Post Percutaneus Coronary Intervention (PCI).

DOI: 10.5220/0008320800780083

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 78-83

ISBN: 978-989-758-336-0

capacity to perform day by day exercises. Health-

related quality of life in nature is multifaceted, in

view of the subjective impression of patient's health,

and incorporates physical as well as mental and social

functioning.

Various studies related to quality of life have been

done, but there has not found a specific research on

the factors influence the quality of life of patients

AMI with PCI, especially research that conducted by

nurses. Nurses have a very important role in the long

term, by knowing the results of research on factors

that affect the quality of life, nurses can arrange

interventions to improve quality of life , so that

nursing intervention becomes more comprehensive

and can improve restoration, and quality of life of

AMI patient after PCI

The majority of scientific literature indicates that

health-related quality of life in AMI patients

significantly improves over a half year after intense

acute coronary; nonetheless, the magnitude of

changes in quality of life is once in a while surveyed

It has been suggested that improvement in health-

related quality of life may shift contingent upon

patients’ age, gender, or treatment method. This study

aims to identify the relationship between gender, age,

marital status, social support, coping and quality of

life in patient post PCI.

2 METHODS

A survey method using cross-sectional research

design was utilized in this study. Samples were 30

patients Myocardial Infarct treated with minimum 3

months post PCI, selecting by purposive sampling

with certain criteria. Data collection of this study was

carried out for 4 months from May to August 2017.

The instrument measuring quality of life was adopted

from the 36-Item Short Form Survey Instrument (SF-

36). Descriptive statistics and inferential statistics

were applied to the data. Paired T test was used to

analysis the influence of age and quality of life, while

to analyze the influence of gender, marital status,

mechanism coping and social support toward quality

of life, statistical was used Chi-square.

3 RESULTS

There were about 30 patients participated in this

study. Most of them were male, and the quality of life

as shown in the following table 1. From Table 1 we

can see that 60% or 18 people has a good quality of

life, while the remaining 40% (12 people) is very

good. Most of respondents in the study was male 21

people or 70%, while 9 people (30%) was female.

Table 2 depicts a cross tab analysis on association

between gender and quality of life among patient MI

with PCI. In the whole, the result shows that male had

good quality of life for 13 people (61.9%) and quality

of life was very good 8 people (38.1%), while female

had good quality of life as many as 5 people (55.6%)

and 4 people (44.4%) with excellent quality of life.

Based on the statistical test results obtained p value of

1.00 (α = 0.05) so it can be concluded that gender is

not related to quality of life.

Table 3 display the distribution of respondent by

age. The average age of respondents was 51 years

with a standard deviation of 9.4 years. The youngest

age is 30 years old and 70 years old. Further analysis

was conducted to determine the association between

age and quality of life, as show in the following Table

4 that showed the average age of respondents with

good quality of life was 50.67 years with a standard

deviation of 10.33 years, whereas in patients with

excellent quality of life the average age was 52.17

with a standard deviation of 8.19. Statistical test

results obtained p value of 0.72 means age factor is

not related to quality of life.

From Table 5 we can see that most of the

respondents were married with 28 people or 93.3%,

while 2 people (6.7%) were not married. Result

analysis to prove the relationship between marital

status and quality of life could be see in Table 6.

Statistical test results obtained p value of 1.00 (α =

0.05) so it can be concluded that married status is not

related to quality of life.

Table 7 reports the mechanism coping of

respondents. More than half percent or 16 people

(53.3%) have excellent coping mechanism, 12 (40%)

have good coping mechanism, while 2 people (6.7%)

have medium coping mechanism. Result of Statictical

analysis can be seen in Table 8. Table 8 indicate that

respondents with medium degree coping mechanisms

have good quality of life (100%). While respondent

with good coping mechanism is 11 people (91.7%)

and have good quality of life and 1 person (8.3%)

very good. Respondents with excellent coping

mechanism have good quality of life 5 people

(31.3%) and 11 people (68,8%) are very good.

Furthermore, in statistical test the relationship

between coping mechanism and quality of life

obtained p = 0.003 , so it can be concluded that coping

mechanism related to quality of life. Then, people

with good coping mechanisms have a 0.67 chance to

improve quality of life.

Quality of Life in Patient Post Percutaneus Coronary Intervention (PCI)

Table 9 displays half of all respondents had a good

of social support, while 10 people (33.3%) had very

good social support and 5 (11.7%) had moderate

social support. Respondents with the level of social

support are having good quality of life of 5 people

(100%) and the respondent with social support at

good level has good quality of life 12 (80%) and 3

(20%) very good. While respondents with very good

social support level have quality of life good 1 person

(90%) and 9 person (90%) very good. In the statistical

test the relationship of social support and quality of

life obtained p value 0,000 so it can be concluded that

social support is related to quality of life. And people

with good social support have a 0.67 chance to

improve the quality of life.

Table 1: Distribution of respondents

Category

Frequency

Precentage

Quality of Life

Not Good

Moderate

Good

Very Good

Total

100

Gender

Male

Female

Table 2: Cross tab analysis between gender and quality of

life

Gender

Quality of life

good

very good

95%

lue

1.3

1.00

Male

61.9

38.1

Female

55.6

44.4

Total

Table 3: Distribution of respondents by age

Variabel

Mean

Standar

Deviasi

Minimal

Maksimal

Age

51.4

9.40

30-70

Table 4: The average age of respondents with good quality

of life

Quality

of Life

Mean

Value

Good

Very

good

50.89

52.17

10.33

8.19

2.44

2.36

0.72

Table 5: Distribution of respondents by marital status

Marital Status

Total

Precentage

Married

93.3

Not married

6.7

Total

100

Table 6: Cross tabulation analysis on association between

marital status and quality of life

Marital

status

Quality of life

Good

Very good

95%

Value

1.55

1.00

Married

60.7

39.3

no marry

total

Table 7: Respondent distribution based on level of

mechanism of coping

Coping Mechanism

Total

Procentage

Not Good

Moderate

Good

Excellent

6.7

40.0

53.3

Total

100

Table 8: Cross tabulation between coping mecanism and

quality of life

Coping

Mechanism

Qualiy of Life

Good

Very

Good

95%

Value

0.67

0.003

less

moderate

100

good

91.7

8.3

very good

31.3

68.8

total

Table 9: Distribution of respondents based on social support

Social Support

Total

Precentage

Not Good

Moderate

Good

Very Good

11.7

50.0

33.3

Total

100

4 DISCUSSION

The mean age of respondents was 51.4 years with a

standard deviation of 9.40. The youngest age 30

years and oldest 70 years. This indicates that the age

of the respondent is in the early adult range to the

elderly, where the range is at risk for experiencing

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

various diseases, including myocardial infarction.

According to basic health research data 2013, the

prevalence of coronary heart disease increases with

age, the highest at age 65-74 years.

The results of this study are in line with a study

conducted on 88 patients by (Panthee, Kritpracha, &

Chinnawong, 2011) that the average of coronary

heart disease patients was 57.43, with the youngest

age 28 years and the oldest 85 years. Another study

conducted Wang et al., (2016), of 128 patients

indicated that the average patient aged 55.4 with a

standard deviation of 9.5. Similarly, in a study

conducted Kroemeke, (2016) the mean age of heart

patients was 52.26 with a standard deviation of 7.08.

Furthermore, the study conducted by (Ginny Brunton

et al., 2015) describes the age factor as a isk factor.

Statistical test results obtained p value of 0.72, it

means that age factor is not related to quality of life.

This is in line with a study conducted by Ruijie Li, et

al, (2012) on 624 MI patients with PCI with 60 years

of age (73.6%), 60-79 years (55.7%) and over 80

years (21.3%). The result is that older patients

experience an increase in physical health best

compared to younger.

According Rubbyana (2012) that quality of life is

a subjective perception of the individual against the

physical, psychological, social, and environmental

conditions in everyday life that happened. WHO

describes the quality of life as an individual

perception of their position in life in the context of the

culture and value system where they live and live in

relation to their life goals, expectations, standards and

the focus of their lives. This concept covers several

broad dimensions: physical health, psychological

health, social and environmental relations.

Most of the gender in this study were men, 21

people or 70%. This happens because men have a risk

of heart disease than women. This is also in line with

a research conducted by Bosworth in 2000 with 4278

patients and 63% of whom are men. Similarly, studies

conducted by (Panthee, Kritpracha, & Chinnawong,

2011) on 88 patients and 72.7% of them are men. The

data suggest that men are at greater risk than women.

This is in accordance with a study conducted by (N,

Suryadipradja, & Shatri, 2005), that MI occurs mostly

in men compared with women with a ratio of 2.5-3:

Then, Statistical test results obtained p value of

1.00 (α = 0.05) so it can be concluded that sex is not

related to quality of life. This is in line with research

conducted by (Kristofferzon ML, Löfmark R, 2005)

that there is no difference in the quality of life

between men and women. Similarly, the study

conducted by Kose and Martha, 2016 showed no

difference in the quality of life between men and

women. Similarly, the study conducted by (Kose, &

Marta, 2016) showed no difference in the quality of

life between men and women.

Judging from the marital status, most of the

patients were married and still have a partner of 93%

and do not have a partner as much as 7%. This result

is in accordance with the study conducted by Chan,

Chau & Chang, 2005 from 115 patients 80% in

married status.

Furthermore, statistical test results obtained p

value of 1.00 (α = 0.05) so it can be concluded that

married status is not related to quality of life.

However, since the partner is one of the support

systems that will be able to provide positive support

for the partner and will decrease anxiety, as the study

conducted by (Panthee, Kritpracha, & Chinnawong,

2011) patients who have no partner found more

anxiety than those who have a partner.

Coupling mechanism is a pattern to withstand

tensions that threaten him or solve problems. The

existence of personal and life-threatening problems

will lead to both adaptive and non-adaptive reactions,

where the problem will create anxiety for the

individual. This is in accordance with the opinion of

Kroemeke (2016) that experience or experience life-

threatening diseases such as MI will certainly lead to

stress.

Furthermore, strategies typically used by

individuals include coping that focuses on problem

solving or problem solving focused coping, as

strategies where individuals are actively seeking

problem solving to eliminate stressful conditions or

situations. In addition, other strategies that can be

used are emotionally focused or emotion-focused

coping, where the individual involves attempts to

regulate his emotions in order to adapt to the impact

that will result in a condition of stress. The way the

individual handles stressful situations is determined

by the individual's own resources and how much

stress he experiences (Ahyarwahyudi, 2010).

In statistical test, the relationship between coping

mechanism and quality of life obtained p value 0.003

so that it can be concluded that coping mechanism

related to quality of life, with positive correlation, the

better coping mechanism the higher quality of life

client. Furthermore, people with good coping

mechanisms have a 0.67 chance to improve quality of

life. This is in accordance with studies conducted

Panthee, Kritpracha, & Chinnawong, (2011) that

coping is correlated with quality of life. Coping

mechanism especially coping strategy-oriented

problem or problem focused coping related to the

quality of life, especially the dimensions of function

Quality of Life in Patient Post Percutaneus Coronary Intervention (PCI)

and health. In this case, more men use this strategy

than women. The study also found that problem

focused coping strategies have a positive effect while

coping strategies avoid having negative effects. In

males, according to Kristofferzon ML, Löfmark R

(2005) often coping mechanisms are optimistic, self-

reliant and confrontational. Nevertheless, the study

conducted by Kose, & Marta (2016) showed different

results, there was no significant correlation between

quality of life with coping strategies in men and

women.

Social support will be effective in treating

psychological pressures in difficult times and

pressing, for example in MI patients often experience

distress and anxiety. The prevalence of anxiety and

depression in MI varies (Wang et al., 2016) Social

support also helps strengthen immune function,

reduce physiologic responses to stress and strengthen

functions to respond to chronic diseases (Taylor &

Broffman, 2011).

The result of statistical test on the relationship

between social support and quality of life is obtained

p value 0,000, so it can be concluded that social

support is related to quality of life. People with good

social support have a 0.67 chance to improve the

quality of life. The results of this study are in line with

the study conducted by (Lett HS, Blumenthal JA,

Babyak MA, Catellier DJ, Carney RM, Berkman LF,

Burg MM, Mitchell P, Jaffe AS, 2007) that positive

social support is associated with improving quality of

life and increasing outcomes of patients with

Coronary Heart Disease. Furthermore, Chung,

Moser, Lennie and Rayens, 2009 explain the lack of

social support and depression affect the decline in

quality of life. Social support will improve the quality

of life if depression is also handled properly.

5 CONCLUSIONS

There is no relationship between age, gender and

marital status with quality of life of MI patients with

PCI. On the other hand, study found that there was

relationship between social support, coping

mechanism with quality of life of MI patients with

PCI.

REFERENCES

Ahyarwahyudi (2010). Mekanisme Koping.

http://Aharwahyudi, Wordpress

Brunton, Ginny, Caird, Jenny, Sutcliffe, Katy, Rees,

Rebecca, Stokes, Gillian, Oliver, Sandy, et al. (2015).

Depression , anxiety , pain and quality of life in people

living with chronic hepatitis C A systematic review and

meta-analysis. Interpretation A Journal Of Bible And

Theology, (2301).

Compare, A., & Zarbo, C. (2013). Social support ,

depression , and heart disease : a ten year literature

review. Compare A Journal Of Comparative

Education, 4(July), 1-7. doi:

10.3389/fpsyg.2013.00384.

Eriksson, M. (2010). Recovery From An Acute Myocardial

Infarction – A Longitudinal Study Of Couples Recovery

From An Acute Myocardial Infarction –.

Herman, P. M., & Walsh, M. E. (2011). Hospital

Admissions for Acute Myocardial Infarction , Angina ,

Stroke , and Asthma After Implementation of Arizona ’

s Comprehensive Statewide Smoking Ban. American

Journal of Public Health, 101(3), 491-496. doi:

10.2105/AJPH.2009.179572.

Kose, Peter Anita & Marta, S. L. (2016). KOse and Martha.

International Journal of Nursing Education and

Research, 4(1), 6. doi: 10.5958/2454–

2660.2016.00001.6.

Kristofferzon ML, Löfmark R, C. M. (2005). Coping, social

support and quality of life over time after myocardial

infarctionCoping, social support and quality of life over

time after myocardial infarction. Journal of Advanced

Nursing . 2005 Oct;52(2):113-24, 113-24. doi: DOI:

10.1111/j.1365-2648.2005.03571.x.

Kroemeke, A. (2016). Changes in well-being after

myocardial infarction : Does coping. Quality of Life

Research, 25(10), 2593-2601. Springer International

Publishing. doi: 10.1007/s11136-016-1286-6.

Lett HS, Blumenthal JA, Babyak MA, Catellier DJ, Carney

RM, Berkman LF, Burg MM, Mitchell P, Jaffe AS, S.

N. (2007). Social support and prognosis in patients at

increased psychosocial risk recovering from

myocardial infarction. Health Psychol. 26(4):418-27,

(July), 418-27. doi: 10.1037/0278-6133.26.4.418.

Linda F. Browna, Kurt Kroenkeb, C, Dale E. Theobaldd,

Jingwei Wub, C, And Wanzhu Tub, C. (2011). The

Association of Depression and Anxiety with Health-

Related Quality of Life in Cancer Patients with

Depression and/or Pain, 19(7), 734-741. doi:

10.1002/pon.1627.The.

N, H. R. K. H., Suryadipradja, H. R. M., & Shatri, H.

(2005). The Influence of Depression on The Quality of

Life of Male Patients Post Acute Myocardial Infarct.

Depression.

Panthee, B., Kritpracha, C., & Chinnawong, T. (2011).

Correlation between Coping Strategies and Quality of

Life among Myocardial Infarction Patients in Nepal.

Nursing, (Mi), 187- 194.

Rubbyana, U. (2012). Hubungan antara Strategi Koping

dengan Kualitas Hidup pada Penderita Skizofrenia

Remisi Simptom, 1(02), 59-66.

Taylor, S. E., & Broffman, J. I. (2011). Psychosocial

Resources : Functions , Origins , and Links to Mental

and Physical Health. Advances, 44, 1-57. Elsevier Inc.

doi: 10.1016/B978-0-12-385522-0.00001-9.

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

Wang, W., Chow, A., Thompson, D. R., Koh, K.,

Kowitlawakul, Y., & He, H.-gu. (2016). Predictors of

Health- Related Quality of Life Among Patients With

Myocardial Infarction. Western Journal of Nursing

Research. doi: 10.1177/0193945914546201.

Quality of Life in Patient Post Percutaneus Coronary Intervention (PCI)