There are several practical policy implications of this research, including cost-effectiveness of targeted during lifestyle or medical interventions and attempts to equalize socioeconomic disparities in the provision and utilization of such interventions. It also has relevancy to the broader public policy arena given the rapid increase in health and medical research on health disparities. Theories of Reverse-Causation, Cumulative Advantage/Disadvantage, Fundamental Cause, and Social Exposures/Biological Effects have varying implications for whether or not narrowing the SES gradient of heart disease is a feasible goal. An incidental finding in this research area is that frequent application of these methods to find disparities in a particular measure of disease causation has resulted in a relative dearth of research on the undergraduate epidemiology of heart disease in low SES populations. This is highly detrimental to interventions research as nuanced understanding of targeted endpoints is crucial to the design and evaluation of medical interventions.
Biological, physiological, and life course pathways may help clarify the sociodemographic gradient in heart disease and the extent to which that gradient varies across populations. Sociodemographic groups defined by education, income, social class, occupation, race or ethnicity have a higher risk of incident coronary heart disease or greater severity of subclinical atherosclerosis. Researchers can separate educational and income sources of socioeconomic disparities in health from those with direct social causation arguments, utilizing various institutional and individual-level indicators. Education may represent a durable marker of social class as well as there are clear direct effects of schooling and educational attainment on a wide variety of health outcomes. An example of a more difficult to define construct is social integration or role functioning often measured by occupation or marital status. Underlying these associations is research on multiple health behavior and psychological pathways, but there is far less research on the specific measures of subclinical and clinical disease. A conceptual limitation of this research area has been an equating of SES measures obtained late in the causal pathway with lifetime SES.
2. Risk factors for heart disease
Risk factors are traits that increase the chances of developing a disease. Heart diseases usually develop over the course of time and can ultimately be fatal. Prevention is difficult because the disease itself can be asymptomatic for a long portion of time before the first onset of a related event, such as a heart attack or stroke. Experienced identification and modification of the risk factors are vital to preventing heart disease. Several of these risk factors can be seen in patients with heart diseases; the greater the number of risk factors, the greater the risk of developing the disease. Some of these risk factors can be modified, treated, or controlled, while others are fixed. Major and contributing risk factors are: raised blood pressure, diabetes, and abnormal lipoprotein metabolism are all reversible risk factors for coronary heart disease. Smoking and obesity are both major risk factors for developing atherosclerosis and for suffering a heart attack. Males who are over 45 years old and women who are over 55 years of age are at higher risk of developing heart disease. Family history of coronary heart disease is recognized as a risk factor as well, partly due to the fact that children of parents with heart disease are more likely to develop it themselves. High levels of stress and anger have also been linked to heart disease.
3. Physical and emotional effects of heart disease
Chung-Lieh Hung (2004) used two concepts in a qualitative study of heart failure patients to describe the limitations of heart failure on physical functioning. The first was the inability to perform previous activities and roles due to symptoms and uncertainty about how activity affected symptoms. The second was the use of conscious strategies to avoid activities and social events that would take more energy, exacerbate symptoms, or may even be risky for the patient. He describes these changes to patients’ lifestyles as a climb down a staircase, where the effective activities from normal ones to those that slow down heart rate and respiration. In severe cases, patients may become limited to bed rest or sitting, as trying to do anything causes discomfort. The impact of these adaptations and limitations can be catastrophic for some patients. Serge Limas (2008) suggests that for an adult who becomes an invalid, lack of mobility affects quality of life, self-esteem, and can even have an impact on the will to live.
The first impact on patients is the awareness that they can no longer participate in physical functioning that they once did, or if they attempt to do so, they will suffer symptoms such as breathlessness or fatigue that will detract from the activity. This can also have a detrimental effect on a person’s self-esteem. UK cardiologist, Michael Vardas, coins the term “cardiac cripple” for patients with heart disease, suggesting that over time, the disease can prevent patients from functioning normally in society.
There is clear evidence to suggest that heart disease has an impact on both physical and mental functioning. Faller (2002) suggests that the role of the heart is crucial and when its function is compromised, limitations are placed on what one can potentially do. This is an issue stressed by many with heart failure and has been described as a continuous loop that is difficult to escape from, and one in which patients will mistake the symptoms for the disease they are attempting to prevent.
4. Coping strategies and support for heart disease patients
Rehabilitation helps individuals faced with the limitations of heart disease to optimize their physical, psychological, social, and vocational functioning within the limits imposed by their cardiovascular impairment. It is a coordinated set of activities that helps patients and their families achieve the best possible quality of life. Although structured regimens of exercise can substantially improve exercise tolerance and quality of life in patients with heart failure, provision of comprehensive cardiac rehabilitation services is far from ideal. Such programs are unrecognized by many with potential to benefit, and a lack of availability especially in lower socioeconomic regions and rural areas is concerning. Only a small percentage of suitable patients actually participate in rehabilitation, and it is unclear if this is due to lack of availability or physician referral. There are many reasons for physicians not referring patients, and improved education and advocacy on the part of cardiac professionals are required. Despite the relevance of cardiac rehabilitation to heart disease sufferers, even those with enough motivation to seek it on their own accord may feel unwelcome in public gymnasium-type settings due to a general stigma about exercise as well as being unfamiliar with local available services. The ability of patients to continue exercise in a self-directed manner with the proven effectiveness of recent models of rehabilitation has been emphasized and is an area where more support is needed for patients to achieve long-term maintenance of lifestyle changes. Evidently, rehabilitation is a diverse and changing field with a great deal of potential to help many patients, and areas for modification have been highlighted.
Angina sufferers need some form of organizational set up off the street and at home to allow them prompt access to medical help should an attack occur. This may take the form of an identity card outlining medical details and contact numbers for the patient and an organized family practice up to date with the patient’s medical history. This step is important for patients looking to rehabilitate by taking up exercise; they need to start at a low level and build up fitness under the supervision of a cardiac professional. Knowing that supervised exercise significantly reduces the risk of further heart-related events, it seems intuitive that availability of funded programs at the early and late stage of heart disease would be beneficial.
Coping strategies and support for heart disease patients are very essential to promote the health of individuals who have suffered the effects of heart disease, angina, or myocardial infarction. The individual who has suffered an acute event such as a myocardial infarction must remove the precipitating causes of the attack and modify coronary-prone type A behaviors. Daily stress at home and work needs to be managed in a fashion that does not increase the potential for further heart disease, and regular relaxation may be beneficial. Patients needing to change occupations may require stress-reducing psychological treatment to adjust to a different lifestyle. This is a period that is crucial to relapse, and the fear of another event can in itself become a stressor, although modifying behavior and lifestyle is simpler when the event has been recent. It is difficult for an individual to fail old habits even when they recognize the risks. Some may suffer depression relating to giving up a more enjoyable lifestyle.
5. Conclusion
Having both qualitative and quantitative ways of measuring health-related quality of life has enabled researchers to gain more credibility and understanding of the extent heart disease can impact a person’s daily life. Health professionals need to conduct more research on the public’s perceptions of the impact of health status measures on the decisions they face and the quality of life they are able to achieve. Health status measures are increasingly being used to compare the effectiveness of different treatment methods and to establish priorities for healthcare resources. If such needs and priorities are to reflect the public’s values, then it is essential to know what the public views as the most important aspects of their health and daily life, and how different health conditions can facilitate or hinder their ability to achieve them.