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Self-Efficacy and Health Status in Patients With Coronary Heart Disease: Findings From the Heart and Soul Study

From the Department of Medicine (U.S.), Division of General Internal Medicine, University of California, San Francisco, San Francisco, California; Department of Veterans Affairs Medical Center (S.A., M.A.W.), San Francisco, California; Departments of Medicine, Epidemiology and Biostatistics (M.A.W.), University of California, San Francisco, San Francisco, California.

Address correspondence and reprint requests to Urmimala Sarkar, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, Box 1211, San Francisco, CA 94143-1211. E-mail: usarkar{at}medicine.ucsf.edu; alternate E-mail: urmimala{at}stanfordalumni.org

Objective: To examine the relationship between cardiac self-efficacy and health status, including symptom burden, physical limitation, quality of life, and overall health among outpatients with stable coronary heart disease (CHD). We hypothesized that lower self-efficacy would predict worse health status, independent of CHD severity and depression.

Methods: We performed a cross-sectional study of 1024 outpatients with CHD, who were recruited between 2000 and 2002 for the Heart and Soul Study. We administered a validated measure of cardiac self-efficacy, assessed cardiac function using exercise treadmill testing with stress echocardiography, and measured depressive symptoms using the Patient Health Questionnaire. Health status outcomes (symptom burden, physical limitation, and quality of life) were assessed using the Seattle Angina Questionnaire, and overall health was measured as fair or poor (versus good, very good, or excellent).

Results: After adjustment for CHD severity and depressive symptoms, each standard deviation (4.5-point) decrease in self-efficacy score was independently associated with greater symptom burden (adjusted odds ratio (OR) = 2.1, p = .001), greater physical limitation (OR = 1.8, p < .0001), worse quality of life (OR = 1.6, p < .0001), and worse overall health (OR = 1.9, p < .0001). Depressive symptoms and poor treadmill exercise capacity were also associated with poor health status, but left ventricular ejection fraction and ischemia were not.

Conclusions: Among patients with CHD, low cardiac self-efficacy is associated with poor health status, independent of CHD severity and depressive symptoms. Further study should examine if self-efficacy constitutes a useful target for cardiovascular disease management interventions.

Key Words: self-efficacy • health status • heart disease • epidemiology

Abbreviations: CHD = coronary heart disease; OR = odds ratio; LVEF = left ventricular ejection fraction.