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Direction of the Relationship Between Acceptance of Illness and Health-Related Quality of Life in Chronic Heart Failure Patients

Obiegło, Monika PhD; Siennicka, Agnieszka PhD; Jankowska, Ewa A. MD; Danel, Dariusz P. PhD

The Journal of Cardiovascular Nursing: July/August 2017 - Volume 32 - Issue 4 - p 348–356
doi: 10.1097/JCN.0000000000000365
ARTICLES: Heart Failure

Background: This study provides an in-depth insight into the relationships between illness acceptance and health-related quality of life (HRQoL) of chronic heart failure (CHF) patients. Although HRQoL is a well-established endpoint in CHF, little is known on illness acceptance in this group.

Aims: The aim of this study is to critically reconsider the direction of a relationship between HRQoL and illness acceptance in CHF patients.

Methods: The study included 204 patients (160 men and 44 women; mean age, 63 ± 11 years) with at least 6-month clinical evidence of CHF corresponding to New York heart Association (NYHA) classes I to IV. All the patients were examined with the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and Acceptance of Illness Scale (AIS).

Results: Univariate analysis showed that the level of illness acceptance correlated inversely with patient age, and the level of HRQoL decreased with the severity of CHF (NYHA class). A relationship between illness acceptance and HRQoL was analyzed by structural equation modeling. Model 1 was based on the assumption that HRQoL is modulated by illness acceptance, and model 2 tested the opposite relationship. Both models included patient age and NYHA class as extrinsic determinants of AIS and MLHFQ scores, respectively. Model 2 proved to be well fitted (χ 2 [df = 2] = 3.22, P = .20, root-mean-square error of approximation = 0.055). Scores on the AIS correlated inversely with age (b age->AIS = −0.15, SE = 0.05, P = .002) and HRQoL (b QoL->AIS = −0.15, SE = 0.02, P < .001), and an increase in NYHA class was reflected by an increase in HRQoL scores (b NYHA->QoL = 5.75, SE = 1.97, P = .004).

Conclusion: Patients with CHF may not accept their disease due to deteriorated HRQoL. As a result, they may be uninvolved in the therapeutic process, which leads to exacerbation of CHF, further deterioration of HRQoL, and inability to accept the illness.

Monika Obiegło, PhD Registred Nurse, Department of Clinical Nursing, Wroclaw Medical University, and Department of Cardiac Surgery, Centre for Heart Disease, Military Hospital, Wroclaw, Poland.

Agnieszka Siennicka, PhD Senior Researcher, Department of Cardiology, Centre for Heart Disease, Military Hospital, Wroclaw, and Department of Physiology and Department of Heart Diseases, Wroclaw Medical University, Poland.

Ewa A. Jankowska, MD Professor, Department of Cardiology, Centre for Heart Disease, Military Hospital, Wroclaw; Laboratory of the Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University; and Polish Academy of Sciences, Anthropology Unit in Wroclaw, Poland.

Dariusz P. Danel, PhD Senior Researcher, Polish Academy of Sciences, Anthropology Unit in Wroclaw, Poland.

The authors have no conflicts of interest to disclose.

Financial support was based on an National Science Centre grant (no. 2011/03/N/NZ5/00243).

Correspondence Monika Obiegło, PhD, Centre for Heart Disease, Department of Cardiac Surgery, Military Hospital, ul. R. Weigla 5, 50-981 Wroclaw, Poland (

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