RESUMEN

BACKGROUND: Providing adequate medical information and ensuring that patients do not identify with fellow-sufferers who are doing worse are significant contributors to a better quality of life (QOL) in cardiac patients. In addition, in these patients gender and the level of psychic tension are significant predictors of QOL. We do not know (1) whether we can improve QOL by increasing patients' ability to cope with the unpleasant aspects of the underlying condition, (2) whether gender and level of psychic tension interact or act independently. OBJECTIVE: To assess both questions. METHODS: Thirty-eight patients on the waiting list for coronary angiography were assessed with validated test batteries. To increase the patients' ability to cope, they were randomly assigned to read either (1) the comments of a patient who had previously been treated successfully or (2) general information. The former information, unlike the latter, was assumed to improve coping ability and, thus, provide better QOL. Homogeneity of the patient group was estimated by Cronbach's alphas. For analysis, linear regression and general factorial analyses of variance were applied. RESULTS: The group was psychologically homogeneous as indicated by Cronbach's alphas which were generally over 75%. There was a significant or close to significant association between the use of coping information and a better mobility and social performance QOL (p<0.05 and p<0.06). High levels of psychic tension were associated with low self-perceived QOL and low psychological scores (both p<0.02). Female gender was associated with lower mobility, lower psychological scores and lower overall QOL (p<0.05, p<0.02 and p<0.05). A significant or close to significant interaction was observed between gender and psychic tension as combined determinants of self-perceived QOL, mobility index, and overall QOL index (p<0.03, p<0.09, and p<0.05). Separate assessments of these determinants showed that female gender was the strongest determinant of a low QOL. CONCLUSION: In patients on the waiting list for coronary angiography, an increased ability to cope with the unpleasant aspects of a possible underlying heart condition improves QOL. Female gender and a high level of psychic tension place patients at risk for a low QOL. It is to be hoped that this paper will raise physicians' awareness of these psychological mechanisms and that they will be given adequate attention in the future, particularly in female patients.