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Relationship Among the Physiologic, and Situational Factors and Health Related Quality of Life in the Adult Pulmonary Hypertension Population: A Pilot Study

Todd Tartavoulle


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Conference: 2011 PH Professional Network Symposium

Release Date: 09.22.2011

Presentation Type: Abstracts

T. Tartavoulle, MN, RN, CNS
Louisiana State University Health Sciences Center School of Nursing, New Orleans, LA

PURPOSE: The purpose of this pilot research study is to identify the relationship among the physiologic, psychologic, and situational factors and health related quality of life in the adult pulmonary hypertension population. The pilot research study will identify relationships that need further exploration in future research to improve patients with adult PH health related quality of life.

BACKGROUND/SIGNIFICANCE: Pulmonary hypertension (PH) is a progressive and ultimately fatal disease that presents as an elevated blood pressure in the pulmonary arteries. The demographic profile of adult PH population includes men and women of all ages, racial and ethnic groups. During the time period of 1980 - 2002, the number of PH deaths increased from 10,922 to 15,668 respectively. The largest increase in mortality rates were observed only among women (Badesch et al., 2009). Among all racial populations, the number of adult PH deaths has increased mostly among the African American population (Badesch et al., 2009). Regardless of the gender, age, or race, PH clients require continuous evaluation and management to alter disease progression and minimize negative impacts on multiple organ systems. The ultimate goal is to reduce the symptomatic disease burden associated with PH and increase the client's health related quality of life. Currently there is no cure for pulmonary hypertension which affects both the pulmonary and cardiovascular systems with a potential negative impact on health related quality of life. Despite the pharmacologic advances in the last several years that has been associated with the improvement in the hemodynamic profile of the PH client, many PH clients continue to experience a reduction in health related quality of life as seen in an increase in multiple symptoms such as depression, anxiety, stress, fatigue, dyspnea, and panic attacks.

METHOD: A descriptive, correlational design used a retrospective chart review, concurrent administration of data collection instruments (DASS-21, COOP charts) and clinical assessment of edema.

The psychological factors of depression, anxiety, and stress will be collected concurrently via the Depression, Anxiety and Stress Scales (DASS-21). The DASS-21 is a 21 item abbreviation of the original DASS-42 and assesses the severity of core symptoms of depression, anxiety, and stress in individuals greater than 17 years of age. The three scales, depression, anxiety, and stress, provide a broad spectrum measure of psychological distress, indicating the severity and frequency of symptoms (McDowell, 2006).

The Dartmouth Cooperative Functional Assessment (COOP) charts provide a rapid way to assess the health and functioning of patients in primary care practices. The COOP chart system contains nine charts, each of which is used to measure a different aspect of patient functional status. Three of the charts focus on function (physical, fitness, daily and social activities), three are related to health perception (quality of life, overall health, and change in condition), two cover symptoms and feelings (pain and emotional status), and one focuses on social support. Within each individual chart are a simple title, one question, and five response choices. Each possible response is presented graphically and described in words along with a five point ordinal scale (McDowell, 2006).

Edema is a physiologic variable that may cause a decrease in health related quality of life. There was an assumption that an increase in edema may cause a decrease in health related quality of life but there has been no significant correlation between edema and health related quality of life.

FINDINGS: The pilot study included a consecutive sample of 63 subjects examined in a pulmonary hypertension clinic. There was a consistent correlation identified between depression, anxiety, stress and health related quality of life. The Pearson's correlations among health related quality of life and depression (.584), anxiety (.538), and stress (.555) are significant at the 0.01 level.

IMPLICATIONS: Health care providers will be able to provide and teach interventions to the PH patient to reduce and possibly eliminate depression, anxiety, and stress which ultimately leads to a reduction in health related quality of life.


  1. Badesch, D. B., Hunter, C.C., & Sanchez, M.G. et al. (2009) Diagnosis and assessment of pulmonary arterial hypertension. Journal of American College of Cardiology 54, Suppl, S55-S66.
  2. McDowell, I. (2006). Measuring Health. (3rd edition) Oxford University Press: New York, NY