Factors related to health-related quality of life in patients with acute coronary syndrome in West Java, Indonesia: A correlational study


health-related quality of life
acute coronary syndrome
functional status

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Imam, H., & Jitpanya, C. (2022). Factors related to health-related quality of life in patients with acute coronary syndrome in West Java, Indonesia: A correlational study. Belitung Nursing Journal, 8(4), 349–356. https://doi.org/10.33546/bnj.1247
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Background: Although acute coronary syndrome impacts patients’ health-related quality of life, a dearth of studies explore this issue in Indonesia. Thus, understanding factors associated with health-related quality of life among patients with acute coronary syndrome is a necessity.

Objective: This study aimed to examine the relationships between age, pain, dyspnea, functional status, self-efficacy, social support, and health-related quality of life in patients with acute coronary syndrome in West Java, Indonesia.

Methods: This study employed a descriptive correlational study involving 186 patients with acute coronary syndrome purposively selected in the outpatient clinics of the top referral public hospital. Data were collected in 2020 using validated instruments: Rose Questionnaire for Angina (RQA), Rose Dyspnea Scale (RDS), Seattle Angina Questionnaire (SAQ), General Self-efficacy Scale (GSE), ENRICHD Social Support Instrument (ESSI), and MacNew Health-Related Quality of Life. Data were analyzed using descriptive statistics and Spearman-rank correlation.

Results: Overall, the health-related quality of life in patients with acute coronary syndrome was high (Mean = 4.97, SD = 0.92), including in its subscales: emotional (Mean = 4.94, SD = 0.88), physical (Mean = 5.07, SD = 1.12), and social (Mean = 5.05, SD = 1.55) subscales. Significant factors related to health-related quality of life were pain (r = 0.296, p <0.001), functional status (r = 0.601, p <0.001), dyspnea (r = -0.438, p<0.001), and self-efficacy (r = 0.299, p <0.001). Meanwhile, age and social support had no significant relationships with health-related quality of life (p = 0.270, p = 0.059). Interestingly, social support was significantly correlated with the emotional subscale of health-related quality of life (r = 0.156, p = 0.034).

Conclusion: Functional status, pain, and self-efficacy were positively correlated with health-related quality of life, while dyspnea had a negative association. This finding serves as basic information for nurses and other healthcare professionals to consider the related factors identified in this study to improve nursing interventions in order to increase health-related quality of life among patients with acute coronary syndrome.


Supporting Agencies

1) Graduate Scholarship Program for ASEAN Countries, Chulalongkorn University, Bangkok, Thailand, and 2) Teaching Assistantship Scholarship, Graduate School, Chulalongkorn University, Bangkok, Thailand


Copyright (c) 2022 Haerul Imam, Chanokporn Jitpanya

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

All authors declare no conflict of interest in this study.


The authors acknowledge the Graduate Scholarship Program for ASEAN Countries and the Teaching Assistantship Scholarship, Graduate School, Chulalongkorn University, for all the funding support. Also, gratitude to the Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand, for all valuable support. Sincere appreciation also to Assoc. Prof. Capt. Dr. Yupin Aungsuroch and Assist. Prof. Teera Sindecharak for their insightful comments and suggestions in this study. In addition, the authors also thank the directors, doctors, nurses, research assistant (Rini Yuliarti, S.Kep, Ners), and other staff of Hasan Sadikin General Hospital and Regional Hospital of Majalaya, Indonesia, for their unconditional support, as well as all the experts (Prof. Kusman Ibrahim, PhD, RN; Joko Gunawan, PhD; Cecep Eli Kosasih, PhD; Titis Kurniawan, PhD; Nurlaeci, M.Kep; Noviyah, S.Kep, Ners) who helped in the instruments’ translation and validation.

Authors’ Contributions

All authors contributed equally to this study according to ICMJE authorship criteria, except for data collection by the first author (HI). The second author (CJ) was the thesis advisor of the first author in this study. Furthermore, all authors approved the final version of the article and agreed to be accountable for all stages of the study.

Data Availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.


Ali, A., Rasheed, A., & Naz, S. (2020). Health-related quality of life of nurses working in Tertiary Care Hospital of Karachi. Pakistan Journal of Medical Sciences, 36(3), 490-495. https://doi.org/10.12669%2Fpjms.36.3.1267

Aljabery, M. A., Saifan, A. R., AbuRuz, M. E., Masa'Deh, R., & Hayeah, H. M. A. (2017). Quality of life among patients with acute coronary syndrome. IOSR Journal of Nursing and Health Science, 6(2), 23-30.

Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., Jaffe, A. S., Jneid, H., Kelly, R. F., Kontos, M. C., Levine, G. N., Liebson, P. R., Mukherjee, D., Peterson, E. D., Sabatine, M. S., Smalling, R. W., & Zieman, S. J. (2014). 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 64(24), e139-e228. https://doi.org/10.1016/j.jacc.2014.09.017

Arnold, S. V., Spertus, J. A., Jones, P. G., Xiao, L., & Cohen, D. J. (2009). The impact of dyspnea on health-related quality of life in patients with coronary artery disease: Results from the PREMIER registry. American Heart Journal, 157(6), 1042-1049. https://doi.org/10.1016/j.ahj.2009.03.021

Bakas, T., McLennon, S. M., Carpenter, J. S., Buelow, J. M., Otte, J. L., Hanna, K. M., Ellett, M. L., Hadler, K. A., & Welch, J. L. (2012). Systematic review of health-related quality of life models. Health and Quality of Life Outcomes, 10(1), 1-12. https://doi.org/10.1186/1477-7525-10-134

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. https://psycnet.apa.org/doi/10.1037/0033-295X.84.2.191

Banik, A., Schwarzer, R., Knoll, N., Czekierda, K., & Luszczynska, A. (2018). Self-efficacy and quality of life among people with cardiovascular diseases: A meta-analysis. Rehabilitation Psychology, 63(2), 295-312. https://psycnet.apa.org/doi/10.1037/rep0000199

Barham, A., Ibraheem, R., & Zyoud, S. e. H. (2019). Cardiac self-efficacy and quality of life in patients with coronary heart disease: A cross-sectional study from Palestine. BMC Cardiovascular Disorders, 19, 290. https://doi.org/10.1186/s12872-019-01281-7

Barnett, L. A., Prior, J. A., Kadam, U. T., & Jordan, K. P. (2017). Chest pain and shortness of breath in cardiovascular disease: A prospective cohort study in UK primary care. BMJ Open, 7(5), e015857. http://dx.doi.org/10.1136/bmjopen-2017-015857

Brink, E., Alsén, P., Herlitz, J., Kjellgren, K., & Cliffordson, C. (2012). General self-efficacy and health-related quality of life after myocardial infarction. Psychology, Health & Medicine, 17(3), 346-355. https://doi.org/10.1080/13548506.2011.608807

Bucholz, E. M., Strait, K. M., Dreyer, R. P., Geda, M., Spatz, E. S., Bueno, H., Lichtman, J. H., D'Onofrio, G., Spertus, J. A., & Krumholz, H. M. (2014). Effect of low perceived social support on health outcomes in young patients with acute myocardial infarction: results from the variation in recovery: Role of gender on outcomes of young AMI patients (VIRGO) study. Journal of the American Heart Association, 3(5), e001252. https://doi.org/10.1161/JAHA.114.001252

Chan, P. S., Jones, P. G., Arnold, S. A., & Spertus, J. A. (2014). Development and validation of a short version of the Seattle angina questionnaire. Circulation: Cardiovascular Quality and Outcomes, 7(5), 640-647. https://doi.org/10.1161%2FCIRCOUTCOMES.114.000967

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Routledge.

Coven, D. L., Compton, S. J., Kalyanasundaram, A., Shirani, J., Windle, M. L., Yang, E. H., Basson, C. T., Bessman, E., Brown, D. F., Compton, S. J., & Setnik, G. (2016). Acute Coronary Syndrome Clinical Presentation. https://emedicine.medscape.com/article/1910735-clinical

Dai, X., Busby-Whitehead, J., & Alexander, K. P. (2016). Acute coronary syndrome in the older adults. Journal of Geriatric Cardiology, 13(2), 101-108. https://doi.org/10.11909/j.issn.1671-5411.2016.02.012

Deiwi, J. K., & Widaryati, W. (2015). Hubungan jenis sindrom koroner akut dengan kualitas hidup aspek psikologis pada pasien pasca serangan jantung yang dirawat di RS PKU Muhammadiyah Yogyakarta [The relationship between types of acute coronary syndrome with quality of life psychological aspects in post-heart attack patients treated at PKU Muhammadiyah Hospital Yogyakarta] [Thesis, STIKES'Aisyiyah Yogyakarta]. Yogyakarta, Indonesia.

Fischbacher, C. M., Bhopal, R., Unwin, N., White, M., & Alberti, K. (2001). The performance of the Rose angina questionnaire in South Asian and European origin populations: A comparative study in Newcastle, UK. International Journal of Epidemiology, 30(5), 1009-1016. https://doi.org/10.1093/ije/30.5.1009

Fitrari, Lia, & Widaryati. (2015). Hubungan jenis sindrom koroner akut dengan kualitas hidup aspek seksual pasien pasca serangan jantung di RS PKU Muhammadiyah Yogyakarta [The relationship between types of acute coronary syndrome and quality of life in sexual aspects of patients after a heart attack at PKU Muhammadiyah Hospital Yogyakarta] [Thesis, STIKES 'Aisyiyah Yogyakarta]. Yogyakarta, Indonesia.

Handrinos, A., Braitberg, G., & Mosley, I. T. (2014). Acute coronary syndrome diagnosis at hospital discharge: How often do we get it right in the emergency department? Emergency Medicine Australasia : EMA, 26(2), 153-157. https://doi.org/10.1111/1742-6723.12165

Hawkes, A. L., Patrao, T. A., Ware, R., Atherton, J. J., Taylor, C. B., & Oldenburg, B. F. (2013). Predictors of physical and mental health-related quality of life outcomes among myocardial infarction patients. BMC Cardiovascular Disorders, 13(1), 1-9. https://doi.org/10.1186/1471-2261-13-69

Höfer, S., Turk-Adawi, K., & Oldridge, N. (2016). The MacNew heart disease health-related quality of life questionnaire: Updated reference data for users. European Journal for Person Centered Healthcare, 4(1), 221-229. http://dx.doi.org/10.5750/ejpch.v4i1.1076

Imam, H., & Jitpanya, C. (2020). Factors related to health-related quality of life in patients with acute coronary syndrome in West Java, Indonesia [Master Thesis, Chulalongkorn University]. Bangkok, Thailand.

Indonesian Heart Association. (2019). Press Release, World Heart Day PERKI 2019. http://www.inaheart.org/news_and_events/news/2019/9/26/press_release_world_heart_day_perki_2019

Indonesian Ministry of Health. (2013). Basic health research (Riset kesehatan dasar) https://pusdatin.kemkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf

Jankowska-Polanska, B., Uchmanowicz, I., Dudek, K., & Loboz-Grudzien, K. (2016). Sex differences in the quality of life of patients with acute coronary syndrome treated with percutaneous coronary intervention after a 3-year follow-up. Patient Preference and Adherence, 10, 1279-1287. https://doi.org/10.2147%2FPPA.S106577

Kahyaoglu Sut, H., & Unsar, S. (2011). Is EQ-5D a valid quality of life instrument in patients with acute coronary syndrome? Anatolian Journal of Cardiology/Anadolu Kardiyoloji Dergisi, 11(2), 156-162. https://doi.org/10.5152/akd.2011.037

Khayyam-Nekouei, Z., Neshatdoost, H., Yousefy, A., Sadeghi, M., & Manshaee, G. (2013). Psychological factors and coronary heart disease. ARYA Atherosclerosis, 9(1), 102-111.

King, C. R. (2006). Advances in how clinical nurses can evaluate and improve quality of life for individuals with cancer. Oncology Nursing Forum, 33(1), 5-12.

Krethong, P., Jirapaet, V., Jitpanya, C., & Sloan, R. (2008). A causal model of health-related quality of life in Thai patients with heart-failure. Journal of Nursing Scholarship, 40(3), 254-260. https://doi.org/10.1111/j.1547-5069.2008.00235.x

Kyoungrim, K., Gholizadeh, L., Inglis, S. C., & Hae-Ra, H. A. N. (2019). Validation of the Korean version of the MacNew heart disease health-related quality of life questionnaire. Journal of Nursing Research, 27(2), e11. https://doi.org/10.1097/jnr.0000000000000274

Loo, D. W. Y., Jiang, Y., Koh, K. W. L., Lim, F. P., & Wang, W. (2016). Self-efficacy and depression predicting the health-related quality of life of outpatients with chronic heart failure in Singapore. Applied Nursing Research, 32, 148-155. https://doi.org/10.1016/j.apnr.2016.07.007

Nuraeni, A., Anna, A., Praptiwi, A., & Nurhamsyah, D. (2021). Illness cognition and depression among patients with coronary heart disease. Belitung Nursing Journal, 7(4), 304-310. https://doi.org/10.33546/bnj.1540

Nuraeni, A., Mirwanti, R., Anna, A., Prawesti, A., & emaliyawati, e. (2016). Faktor yang memengaruhi kualitas hidup pasien dengan penyakit jantung koroner [Factors influencing quality of life in patients with coronary heart disease]. Jurnal Keperawatan Padjadjaran, 4(2), 107-116. https://doi.org/10.24198/jkp.v4i2.231

OGara, P. T., Kushner, F. G., Ascheim, D. D., Casey, D. E., Chung, M. K., de Lemos, J. A., Ettinger, S. M., Fang, J. C., Fesmire, F. M., Franklin, B. A., Granger, C. B., Krumholz, H. M., Linderbaum, J. A., Morrow, D. A., Newby, L. K., Ornato, J. P., Ou, N., Radford, M. J., Tamis-Holland, J. E., . . . Zhao, D. X. (2013). 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation, 127(4), e362-e425. http://doi.org/10.1161/CIR.0b013e3182742cf6

Peters, M., Potter, C. M., Kelly, L., & Fitzpatrick, R. (2019). Self-efficacy and health-related quality of life: A cross-sectional study of primary care patients with multi-morbidity. Health and Quality of Life Outcomes, 17, 37. https://doi.org/10.1186/s12955-019-1103-3

Radisauskas, R., Kirvaitiene, J., Bernotiene, G., Virviciutė, D., Ustinaviciene, R., & Tamosiunas, A. (2019). Long-term survival after acute myocardial infarction in Lithuania during transitional period (1996–2015): Data from population-based Kaunas Ischemic heart disease register. Medicina, 55(7), 357. https://doi.org/10.3390/medicina55070357

Rahman, M. A., Spurrier, N., Mahmood, M. A., Rahman, M., Choudhury, S. R., & Leeder, S. (2013). Rose Angina Questionnaire: Validation with cardiologists' diagnoses to detect coronary heart disease in Bangladesh. Indian Heart Journal, 65(1), 30-39. https://doi.org/10.1016/j.ihj.2012.09.008

Rieckmann, N., Neumann, K., Feger, S., Ibes, P., Napp, A., Preuß, D., Dreger, H., Feuchtner, G., Plank, F., & Suchánek, V. (2020). Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain. Health and Quality of Life Outcomes, 18(1), 1-10. https://doi.org/10.1186/s12955-020-01312-4

Rodriguez, F., & Mahaffey, K. W. (2016). Management of patients with NSTE-ACS: A comparison of the recent AHA/ACC and ESC guidelines. Journal of the American College of Cardiology, 68(3), 313-321. https://doi.org/10.1016/j.jacc.2016.03.599

Rose, G. A. (1962). The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bulletin of the World Health Organization, 27(6), 645-658.

Rose, G. A., Blackburn, H., Gillum, R. F., & Prineas, R. J. (1982). Cardiovascular survey methods. World Health Organization Monograph Series, 56, 1–888.

Saiwutthikul, S., Siripitayakunkit, A., & Duangbubpha, S. (2021). Selected factors related to physical activity among persons with heart failure in a university-affiliated hospital, Bangkok, Thailand. Belitung Nursing Journal, 7(6), 500-507. https://doi.org/10.33546/bnj.1829

Sanchis-Gomar, F., Perez-Quilis, C., Leischik, R., & Lucia, A. (2016). Epidemiology of coronary heart disease and acute coronary syndrome. Annals of Translational Medicine, 4(13), 256. https://doi.org/10.21037%2Fatm.2016.06.33

Santoso, T., Sujianto, U., & Susilawati, D. (2017). Factors affecting quality of life in patients with coronary artery disease. Indonesian Journal of Nursing Practices, 1(3), 133-139. https://doi.org/10.18196/ijnp.1371

Schwarzer, R., & Jerusalem, M. (1995). Generalized self-efficacy scale. In J. Weinman, S. Wright, & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-37). NFER-NELSON.

Singh, A., Museedi, A. S., & Grossman, S. A. (2022). Acute coronary syndrome. Treasure Island, FL: StatPearls Publishing.

Spertus, J. A., McDonell, M., Woodman, C. L., & Fihn, S. D. (2000). Association between depression and worse disease-specific functional status in outpatients with coronary artery disease. American Heart Journal, 140(1), 105-110. https://doi.org/10.1067/mhj.2000.106600

Spertus, J. A., Winder, J. A., Dewhurst, T. A., Deyo, R. A., Prodzinski, J., McDonnell, M., & Fihn, S. D. (1995). Development and evaluation of the Seattle Angina questionnaire: A new functional status measure for coronary artery disease. Journal of the American College of Cardiology, 25(2), 333-341. https://doi.org/10.1016/0735-1097(94)00397-9

Tan, N. C. (2016). Self-efficacy assessment: A step towards personalized management of chronic diseases. Proceedings of Singapore Healthcare, 25, 71-71. https://doi.org/10.1177%2F2010105816643738

Thiruvisaakachelvy, B., Ab Manap, N., Khalid, K. B. M. K. M., Alias, M. N. B. A., & Jamaludin, N. B. (2019). Quality of life among post acute myocardial infarction patient. ILKKM Journal of Medical and Health Sciences, 1(1), 20-24.

Usman, Y., Iriawan, R. W., Rosita, T., Lusiana, M., Kosen, S., Kelly, M., Forsyth, S. J., & Rao, C. (2019). Indonesia's sample registration system in 2018: A work in progress. Journal of Population and Social Studies, 27(1), 39-52. https://doi.org/10.25133/JPSSv27n1.003

Vaglio, J., Conard, M., Poston, W. S., O'Keefe, J., Haddock, C. K., House, J., & Spertus, J. A. (2004). Testing the performance of the ENRICHD Social Support Instrument in cardiac patients. Health and Quality of Life Outcomes, 2(1), 1-5. https://doi.org/10.1186/1477-7525-2-24

WHO. (2015). Indonesia : WHO Statistical Profile. http://www.who.int/gho/countries/idn.pdf?ua=1

Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life: A conceptual model of patient outcomes. JAMA, 273(1), 59-65. https://doi.org/10.1001/jama.1995.03520250075037

Wu, J.-R., Lennie, T. A., Frazier, S. K., & Moser, D. K. (2016). Health-related quality of life, functional status and cardiac event-free survival in patients with heart failure. The Journal of Cardiovascular Nursing, 31(3), 236-244. https://doi.org/10.1097%2FJCN.0000000000000248