Sage Journals: Discover world-class research

Abstract

Positive health (PH) offers a broader perspective on well-being, emphasizing the ability to self-manage social, physical, and emotional challenges. This study explores PH among cardiac patients by assessing their self-perceived health, personal goals, and what is needed to achieve these goals, aiming to guide healthcare improvements from a holistic perspective. A qualitative, phenomenological study was conducted with 10 Dutch-speaking cardiac patients at the Medisch Spectrum Twente cardiology outpatient clinic. Participants completed the My Positive Health tool online, followed by a semistructured interview conducted at the clinic. Thematic analysis revealed that participants rated their health as moderate. Participants reported physical limitations (fatigue and shortness of breath) and mental challenges (anxiety and difficulty accepting). Personal goals included improving physical health, reducing anxiety, enhancing daily functioning, and adopting healthier lifestyles. Participants identified professional support, self-care, tools (eg, diet apps and planners), and changes in medical practices as critical factors needed to achieve their goals. Cardiac patients face multidimensional challenges beyond physical symptoms. A personalized, holistic healthcare approach aligned with the PH concept can better address these needs, improving well-being and reducing disease burden.

Keywords

positive health holistic health cardiac patients personal goals patient-centered care

Introduction

Healthcare systems worldwide face rising demands and costs, driven in part by an aging population and the growing prevalence of chronic conditions like cardiovascular diseases (CVDs).^1–3 CVD remains a leading cause of mortality and disease burden worldwide.⁴ In the Netherlands, where this study is conducted, CVD accounts for a significant proportion of hospital admissions.⁵ This study focuses on the cardiac conditions of CVDs, like coronary artery disease, heart failure, myocardial infarction, and arrhythmias. The number of patients with cardiac diseases is expected to rise.⁶ These conditions interact with physical, psychosocial, and lifestyle factors, which makes the broader perspective of positive health (PH) on well-being highly relevant in this context. For example, unhealthy lifestyles, along with conditions such as hypertension, obesity, and comorbidities like chronic obstructive pulmonary disease and diabetes, increase the likelihood of developing or worsening cardiovascular conditions.⁷ In addition to the physical burden of CVD, mental health issues are prevalent, often exacerbating the condition and increasing hospital readmissions.⁸^,⁹

Despite this, healthcare systems have traditionally focused on diagnosis and treatment rather than prevention, health promotion, and well-being,^10–13 calling for a shift to a more holistic approach. The concept of PH, developed by Huber et al,¹⁴ can be utilized to understand and enhance a person's health and well-being. It is described as “the ability to adapt and self-manage in the face of social, physical, and emotional challenges.” PH encompasses 6 dimensions: bodily functions, mental well-being, quality of life, participation, daily functioning, and meaningfulness. The dialogue tool, My Positive Health (MPH tool), provides insights into how individuals perceive their health and set personal goals.¹⁴^,¹⁵

To the best of our knowledge, no studies have examined PH among cardiac patients. Existing research often focuses on particular aspects, such as self-perceived mental attitudes toward cardiac disease.¹⁶ Currently, little is known about the self-perceived health of cardiac patients. This study aims to explore how cardiac patients experience PH, their personal goals, and what is needed to achieve them, with the goal of guiding healthcare to better align with patients’ needs from a holistic health perspective, improving well-being and reducing disease burden.

Method

Study Design and Setting

A phenomenological qualitative study was conducted to explore the lived experiences and perceptions of cardiac patients regarding their health and well-being, which was investigated through semistructured interviews held between April and May 2023 at the cardiology outpatient clinic of Medisch Spectrum Twente (MST), a tertiary hospital in the Netherlands.

Participants

The participants were 10 Dutch-speaking cardiac patients who were undergoing cardiac treatment at MST. The following inclusion criteria were applied: patients diagnosed with a cardiovascular condition, patients currently or previously treated at the cardiology outpatient clinic of MST, and patients over 18 years of age.

Data Collection

Participants were recruited through convenience sampling by physicians or nurses. After informed consent, they completed the MPH tool online before the interview, assessing health across 6 dimensions: bodily functions, mental well-being, quality of life, participation, daily functioning, and meaningfulness. The 44-item tool uses an 11-point Likert scale (0 = completely disagree; 10 = completely agree) with results visualized in a spiderweb diagram.¹⁵^,¹⁷^,¹⁸ Interviews were conducted face-to-face at MST by a Health Sciences bachelor's student. The results, including the MPH spiderweb scores across the PH dimensions, were used to guide the discussion. Each interview lasted 45 to 60 min, and was audio-recorded, transcribed, and anonymized.

Data Analysis

Thematic analysis was employed, following established steps.¹⁹ Initial phases involved reading transcripts and preliminary coding. Two researchers independently (MHG and IB) coded 2 interviews. The codes between the coders largely aligned, but were sometimes expressed in different terms, for which overarching terms were created. The coding was performed manually using the Word program. A codebook was created, categorizing codes into themes and subthemes, with MHG coding the remaining interviews and updating the codebook with the support of IB. Final themes were reviewed for coherence with the dataset, in collaboration with SHK and MHV. All interviews were recorded using the final codebook, and participant results were organized in a matrix following the Framework Method.¹⁹ The SRQR guideline was followed for reporting this research.²⁰

Results

Ten participants, aged 34 to 66 years (median age 60.5), were predominantly male (n = 8), as shown in Table 1. Participants’ cardiac conditions were informally shared during interviews without systematic data collection or official diagnoses. Obviously, interviews revealed various cardiac conditions, including myocardial infarctions, cardiac arrests, blocked arteries, myocarditis, and arrhythmias. Eight participants mentioned having undergone surgical procedures.

Table 1.

Participant Characteristics.

Participant number	Gender	Age
P1	Male	34
P2	Male	58
P3	Male	66
P4	Female	61
P5	Female	54
P6	Male	51
P7	Male	66
P8	Male	65
P9	Male	62
P10	Male	60

Self-Perceived Health

Most participants rated their self-perceived health as moderate. Many noted the significant impact of cardiac disease on their self-perceived health.

Bodily Functions

While a few participants expressed partial satisfaction with their bodily functions, nearly all participants reported experiencing physical complaints due to cardiac problems. Commonly mentioned issues include reduced physical condition, fatigue, palpitations, and shortness of breath: “I have very little physical condition, I try to move as much as possible, but I get tired quickly” (P5). A few participants experienced pain, either from recent cardiac surgery or comorbid conditions. Almost all participants reported fatigue and some experienced sleep problems caused by shortness of breath. Physical complaints are limiting in daily activities: “I am unable to perform certain tasks without becoming fatigued” (P9).

Mental Well-Being

Mental health was a key theme in nearly all interviews. Anxiety was the most common challenge, often linked to fear of death or worsened by symptoms like shortness of breath. Sleep problems were frequently caused or intensified by anxiety: “I’m afraid I might die at night” (P2). Several participants also struggled to adjust to illness-related limitations and increased dependence, leading to feelings of guilt or uselessness: “I don’t want to accept that I have to rely on others … or that I’m dependent on a pacemaker” (P5). A few mentioned memory and concentration issues, though these were not seen as major obstacles. Despite these challenges, most participants remained generally positive about their mood and zest for life.

Lifestyle

Nearly all participants mentioned difficulties in maintaining a healthy lifestyle, particularly when it came to diet and physical activity. Fatigue and shortness of breath were major barriers to healthy habits: “Often, I’m so tired that I have no energy to eat and end up skipping meals” (P5). Anxiety also played a limiting role, especially in regaining the confidence to be physically active and to place more strain on the heart.

Daily Functioning

Many participants experienced limitations in daily functioning due to their cardiac condition. Several had to stop or reduce work and leisure activities: “I had to stop my business due to my cardiac problems” (P3). Some pushed their limits to maintain pleasure and autonomy, sometimes leading to serious consequences: “I pushed my limits too far, which led to arrhythmias and a hospital admission” (P5). Others learned to set boundaries, often accompanied by greater acceptance, enabling them to continue activities with adjustments. Support from loved ones was, and continues to be, essential in coping with daily challenges. Participants were satisfied with their personal situation (financial and housing).

Meaningfulness

Several participants noted a positive change in their outlook on life despite the challenges posed by cardiac disease. They have developed a more positive attitude and express gratitude: “After my cardiac surgery, I find more joy in the small things” (P8). Some expressed gratitude particularly for still being alive.

Medical Practices

Participants appreciated the positive impact of medical care, including support from motivating physicians and cardiac rehabilitation for both physical and mental recovery. Many also expressed gratitude for treatments and surgeries. However, nearly all noted shortcomings in medical practices, particularly the overwhelming nature of being a heart patient, especially with acute conditions. A common issue was the lack of clear, accessible information about symptoms and when to seek help: “At first, I linked every symptom to my heart and felt scared, not knowing some were normal” (P6). Additionally, some participants, especially those with anxiety, felt a lack of reassurance and support. They mentioned follow-up appointments being too spaced out and that mental health issues and sleep problems were sometimes overlooked: “I sometimes call the hospital when I suddenly feel short of breath because I’m scared. They tell me it's normal, but that doesn’t provide enough reassurance” (P3). A few also highlighted delays in starting cardiac rehabilitation and unpleasant medication side effects.

Personal Goals

Participants discussed personal goals for improving their self-perceived health, which are outlined in Table 2.

Table 2.

Participants Personal Goals.

Theme	Personal goals
Bodily functions (n = 7)	Improve physical condition Improve sleep quality Reduce fatigue Reduce shortness of breath Lose weight
Mental well-being (n = 7)	Reduce anxiety Improve acceptance Improve concentration and memory
Lifestyle (n = 8)	Establish a healthier diet Increase physical activity Improve sleep (habits) Maintain current lifestyle
Daily functioning (n = 8)	Learn to set limits Learn to ask for help Maintain/improve/resume daily activities

Bodily Functions and Mental Well-Being

Many participants aimed to enhance their physical condition and sleep quality. The majority sought to reduce anxiety, while a smaller group aimed to improve acceptance. A few wanted to improve their memory and concentration. These goals were interconnected: reducing anxiety can increase motivation for physical activity, and increased physical activity, in turn, improves physical condition. Conversely, more physical activity can boost confidence and reduce anxiety. A participant mentioned: “I want to improve my physical condition so I can walk short distances without shortness of breath. To feel better, I also need to accept my limitations and sleep without the fear of dying” (P3).

Lifestyle

Almost all participants expressed a personal goal for a healthier lifestyle to improve their overall health, focusing on improved exercise habits, dietary patterns, and sleep routines. Some mentioned the importance of daily structure as a stabilizing factor for both mental and physical health: “I want to improve my lifestyle by cycling and walking more and adding more structure to my meals and sleep” (P4).

Daily Functioning

Improving or maintaining daily functioning was a significant goal for nearly all participants. They emphasized the value of work, hobbies, and social activities for their overall well-being and quality of life. Importantly, these functional goals were often grounded in earlier-mentioned personal goals such as improving physical condition and reducing anxiety. Additionally, participants aimed to learn to ask for help and accept help, as well as to manage their physical limits, and mental challenges and to improve daily functioning: “The most important thing I want to learn is to accept and manage my physical limitations and set boundaries. Then I will feel much healthier” (P5).

What Is Needed to Achieve Personal Goals?

Participants identified key needs are shown in Table 3.

Table 3.

Participants Need for Achieving Personal Goals.

Theme	What is needed
Professional help (n = 7)	Psychological support Paramedical assistance: physiotherapist, dietitian Other: cardiac rehabilitation, household help
Tools (n = 6)	Dietary tracking app Planner Treadmill Listening to music or a meditation
Support from others (n = 9)	Loved ones: ongoing communication, understanding, maintaining strong family bond, doing things together/practical help Peer contact with cardiac patients
Self-care (n = 9)	Set realistic goals Dose activities/take timely breaks Taking responsibility for lifestyle Structure in daily life Staying active (leisure activities) Avoid stress
Changes in medical practices (n = 8)	More frequent check-up appointments Improved education and information provision Holistic approach Personalized approach More time for patients Automatic referral to cardiac rehabilitation

Professional Support

Over half of the participants expressed a need for professional support. They hope to address issues such as anxiety, acceptance, and management of their limits with the help of a psychologist: “Talking to a professional is different from talking to friends” (P1). Several participants expressed the need for help from a dietitian. A few participants mentioned needing physical therapy for exercise and confidence, while most had received or were receiving it as part of cardiac rehabilitation.

Tools

Some participants expressed interest in tools, including diet management apps, planners for memory aid, treadmills for exercise, and meditation and music to improve sleep.

Support From Others

Nearly all participants emphasized again the importance of maintaining or expanding support from others in achieving their personal goals. Continued communication with loved ones is crucial for mental support, and a strong bond with them aids in the recovery and acceptance process. Participants also expressed a need for more practical support, particularly in terms of doing activities together, such as cooking and exercising: “I find it helpful to have someone walk with me. It gives me a sense of safety” (P10). Additionally, some participants expressed the need to connect with other cardiac patients who have similar experiences.

Self-Care and Lifestyle

Almost all participants highlighted that taking good care of oneself and maintaining personal responsibility are crucial for achieving their personal goals. Especially in lifestyle. Many expressed the goal to take the responsibility for staying active: “I want to keep exercising once a week because I feel much healthier then” (P4). Regular walking was frequently mentioned, as was the responsibility to eat healthily and maintain good sleep habits. Also, as part of self-care half of the participants plan to manage their physical limits by dosing their activities, incorporating rest moments, and setting realistic goals for themselves.

Changes in Medical Practices

Almost all participants felt that changes in medical practices would support their personal goals. Over half expressed a need for a more personalized or holistic approach, such as addressing anxiety or customizing medication. There was also a strong demand for better information and education on cardiac disease, surgery, symptoms, and lifestyle, with some suggesting designated contact persons within the hospital or reliable resources. Participants favored more frequent follow-ups: “I would prefer to have appointments every three months instead of every six months. It provides more reassurance and control” (P6). They also emphasized the need for timely referral to cardiac rehabilitation, suggesting the implementation of automatic referrals.

Discussion

This study examined self-perceived health using the concept of PH, personal goals, and the needs of cardiac patients. Most participants rated their health as moderate, citing physical and mental complaints like reduced physical condition, fatigue, shortness of breath, anxiety, and difficulties with acceptance. Cardiac-related symptoms can significantly impair daily functioning,²¹^,²² a finding echoed by participants who reported limitations in daily activities and feelings of uselessness. Participants expressed a big challenge with anxiety, which can be classified as a stress factor. Both in this study and in the literature, sleep problems were common among cardiac patients, with anxiety being the leading cause.²³ Poor sleep, can negatively affect recovery and rehabilitation outcomes.²⁴ Participants emerged fatigue and anxiety as the most frequently mentioned barriers to maintaining a healthy lifestyle. This aligns with existing evidence linking fatigue to reduced self-care in heart failure patients²⁵ and showing that mental health issues can hinder lifestyle adherence.²⁶ Many participants struggled with accepting the consequences of their cardiac condition. A low level of illness acceptance is known to negatively impact quality of life, particularly in chronic cardiac diseases.²⁷ While depression and posttraumatic stress are common in this population,²⁸^,²⁹ depression was not observed in this study—possibly due to participants’ generally positive outlook, satisfaction with their social environment, or limitations in study design. Although participants generally reported strong social support, it is well established that inadequate support can adversely affect health outcomes.³⁰ Participants emphasized the importance of ongoing support—both emotional and practical. Social determinants such as access to transport, healthy food, and community resources were not major concerns in this study, likely due to the well-developed facilities in the Netherlands and participants’ general satisfaction with their personal circumstances, including finances and housing. To the best of our knowledge, no studies have examined the personal goals of cardiac patients in relation to PH. In this study, patients’ goals focused on reducing physical and mental symptoms, improving lifestyle, and maintaining daily functioning. Personal goals were interconnected. For many, the observed pattern was that the desire to reduce anxiety contributed to better sleep, which decreased fatigue and provided more energy to adopt a healthier lifestyle. Most participants preferred a more personalized, holistic medical approach, suggesting more frequent follow-ups and better information to reduce anxiety and improve acceptance. Professional support, especially from psychologists and dietitians, was seen as instrumental to achieving personal goals. Participants were familiar with physiotherapy. Tools like mobile apps could offer practical support. To ultimately achieve their goals, participants emphasized the importance of maintaining support from others and improving personal responsibility, including being open to accepting help and recognizing physical limits. Interviews revealed a diverse range of cardiac conditions. A notable finding was that nearly all participants reported experiencing anxiety and limitations in daily functioning. This suggests that a holistic and personalized approach is desirable for all cardiac patients. Addressing not only physical symptoms but also mental health, lifestyle, and daily functioning can lead to improved overall well-being. Evidence indicates that psychological interventions are beneficial for successful lifestyle changes among cardiac patients.³¹ It is recommended that mental health issues be assessed during hospital admission following a cardiac event to prevent adverse outcomes.³² These findings and the needs expressed in this study call for a shift in healthcare practices. More preventive and holistic care could potentially reduce costs and unnecessary healthcare services. Growing evidence supports tailored care approaches like patient-centered care, shared decision-making, and holistic nursing.^22,33–35 This study and evidence have shown the concept of PH aligns with this approach.³⁶

Limitations

A limitation of this study is the narrow demographic profile, with mostly male participants over 50. While this reflects the higher CVD prevalence in older men in the Netherlands,³⁷ it limits generalizability to other groups. The lack of detailed socioeconomic data and specific information on participants’ cardiac conditions (eg, type and duration) further restricts applicability. This made it difficult to tailor personal goals to subgroups. At the same time, it underlines the need for a holistic approach for all individuals, regardless of their specific diagnosis.

Conclusion

The impact of cardiac disease on patients is significant and affects physical and psychosocial aspects. On average, cardiac patients perceive their health as moderate. In addition to physical symptoms, they experience issues with mental well-being and feel restricted in their lifestyle and daily functioning, with these factors mutually reinforcing each other. Cardiac patients have multifaceted personal goals and needs that requires a transition towards a holistic approach in healthcare. The concept of PH appears to be well-suited for addressing these needs.

Footnotes

Acknowledgments

We would like to thank the student for assisting with data collection and all participants in the study.

Authors’ Contributions

The researchers (MHV) and (SHK) were responsible for the overall management and execution of the research. The researchers SHK and MHV performed the final coding. All authors have given final approval for this article to be published and agreed to be accountable for all aspects.

Declaration of Conflicting of Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors (MHG, MHV, IB, and SKH), including the interviewees, were not involved in the development of the conceptual model of Positive Health and declared they have no conflict of interest.

Funding

This research received no specific grant from any funding agency. It is part of the L.INT lectorate Positive Health, which is partially funded by the Taskforce for Applied Research SIA.

Ethical Approval

Ethical approval to report this case was obtained from the Institutional Review Board of MST (protocol number K22-25).

ORCID iDs

Marleen Hofman-van der Gronden

Martine te Hoonte-Veehof

Imke van Bunningen

Sandra van Hogen-Koster

Statement of Human and Animal Rights

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board of MST and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards (protocol number K22-25).

Statement of Informed Consent

Written informed consent was obtained from the patients for their anonymized information to be published in this article.

Data Availability Statement

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

References

James

Abate

, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet [Internet]. 2018 Nov 10 [cited 2024 Oct 2];392(10159):1789-1858. Available from: https://pubmed.ncbi.nlm.nih.gov/30496104/

Chronische aandoeningen en multimorbiditeit | Leeftijd en geslacht | Multimorbiditeit | Volksgezondheid en Zorg [Internet]. [cited 2024 Oct 2]. Available from: https://www.vzinfo.nl/chronische-aandoeningen-en-multimorbiditeit/leeftijd-en-geslacht/multimorbiditeit

Johansen

Loorbach

Stoopendaal

Exploring a transition in Dutch healthcare. J Health Organ Manag [Internet]. 2018 Nov 22 [cited 2024 Oct 2];32(7):875-890. Available from: https://www.researchgate.net/publication/328683594_Exploring_a_transition_in_Dutch_healthcare

Roth

Mensah

Johnson

, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. J Am Coll Cardiol. 2020 Oct;76(25):2982-3021.

Ziekenhuiszorg | Gebruik | Volksgezondheid en Zorg [Internet]. [cited 2024 Oct 9]. Available from: https://www.vzinfo.nl/ziekenhuiszorg/gebruik

Coronaire hartziekten | Toekomst | Volksgezondheid en Zorg [Internet]. [cited 2024 Oct 9]. Available from: https://www.vzinfo.nl/coronaire-hartziekten/toekomst

Hart- en vaatziekten | Oorzaken en gevolgen | Volksgezondheid en Zorg [Internet]. [cited 2024 Oct 9]. Available from: https://www.vzinfo.nl/hart-en-vaatziekten/oorzaken-gevolgen

Murphy

Higgins

Jackson

AC.

Incidence and impacts of post-cardiac event mental health problems. Aust J Gen Pract [Internet]. 2023 [cited 2024 Oct 9];52(11):781-786. Available from: https://pubmed.ncbi.nlm.nih.gov/37935151/

Sreenivasan

Kaul

Khan

Malik

Usman

Michos

ED.

Mental health disorders and readmissions following acute myocardial infarction in the United States. Sci Rep [Internet]. 2022 Dec 1 [cited 2024 Oct 9];12(1):19162. Available from: https://pubmed.ncbi.nlm.nih.gov/35228619/

10.

De Vries

Emons

WHM

Plantinga

, et al. Comprehensively measuring health-related subjective well-being: dimensionality analysis for improved outcome assessment in health economics. Value Health [Internet]. 2016 Mar 1 [cited 2024 Oct 9];19(2):167-175. Available from: https://pubmed.ncbi.nlm.nih.gov/27021750/

11.

Jadad

O’Grady

How should health be defined?

BMJ [Internet]. 2008 Dec 13 [cited 2024 Oct 9];337(7683):1363-1364. Available from: https://pubmed.ncbi.nlm.nih.gov/19073663/

12.

Smith

. The end of disease and the beginning of health – The BMJ [Internet]. [cited 2024 Oct 9]. Available from: https://blogs.bmj.com/bmj/2008/07/08/richard-smith-the-end-of-disease-and-the-beginning-of-health/

13.

Vanderweele

TJ.

On the promotion of human flourishing. Proc Natl Acad Sci U S A [Internet]. 2017 Aug 1 [cited 2024 Oct 9];114(31):8148-8156. Available from: https://pubmed.ncbi.nlm.nih.gov/28705870/

14.

Huber

Knottnerus

Green

, v. d. et al.

How should we define health?

Br Med J. 2011 Oct;343(jul26 2):d4163-d4163.

15.

Huber

van Vliet

Giezenberg

, et al. Towards a ‘patient-centred’ operationalisation of the new dynamic concept of health: a mixed methods study. BMJ Open. 2016 Oct;6(1):e010091.

16.

Chiavarino

Poggio

Rusconi

Beretta

AAR

Aglieri

Psychological factors and self-rated health: an observative study on cardiological patients. J Health Psychol [Internet]. 2019 Dec 1 [cited 2024 Oct 9];24(14):1993-2002. Available from: https://pubmed.ncbi.nlm.nih.gov/28810469/

17.

Mijn Positieve Gezondheid [Internet]. [cited 2024 Oct 9]. Available from: https://vragenlijsten.mijnpositievegezondheid.nl/adults-en

18.

Free Downloads - Stichting Institute for Positive Health [Internet]. [cited 2024 Oct 9]. Available from: https://www.iph.nl/en/participate/free-downloads/

19.

Gale

Heath

Cameron

Rashid

Redwood

Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol [Internet]. 2013 [cited 2024 Oct 9];13(1):117. Available from: /pmc/articles/PMC3848812/

20.

O’Brien

Harris

Beckman

Reed

Cook

DA.

Standards for reporting qualitative research: a synthesis of recommendations. Acad Med [Internet]. 2014 [cited 2024 Oct 9];89(9):1245-1251. Available from: https://journals.lww.com/academicmedicine/fulltext/2014/09000/standards_for_reporting_qualitative_research__a.21.aspx

21.

Niklasson

Maher

Patil

, et al. Living with heart failure: patient experiences and implications for physical activity and daily living. ESC Heart Fail [Internet]. 2022 Apr 1 [cited 2024 Oct 9];9(2):1206-1215. Available from: https://pubmed.ncbi.nlm.nih.gov/35081667/

22.

Nordblom

Broström

Fridlund

Impact on a person’s daily life during episodes of supraventricular tachycardia. J Holist Nurs [Internet]. 2017 Mar 1 [cited 2024 Oct 9];35(1):33-43. Available from: https://pubmed.ncbi.nlm.nih.gov/27004745/

23.

Cheng

Lei

Zhu

, et al. The association between poor sleep quality and anxiety and depression symptoms in Chinese patients with coronary heart disease. Psychol Health Med [Internet]. 2022 [cited 2024 Oct 9];27(6):1347-1356. Available from: https://pubmed.ncbi.nlm.nih.gov/33506709/

24.

Soh

PQP

Wong

WHT

Roy

Tam

WWS.

Effectiveness of non-pharmacological interventions in improving sleep quality after cardiac surgery: a systematic review and meta-analysis. J Clin Nurs [Internet]. 2024 Jun 1 [cited 2025 Apr 16];33(6):2084-2098. Available from: https://pubmed.ncbi.nlm.nih.gov/38477050/

25.

Kessing

Denollet

Widdershoven

Kupper

Fatigue and self-care in patients with chronic heart failure. Eur J Cardiovasc Nurs [Internet]. 2016 Aug 1 [cited 2024 Oct 9];15(5):337-344. Available from: https://pubmed.ncbi.nlm.nih.gov/25715645/

26.

Pająk

, Jankowski P, Kotseva K, Heidrich J, de Smedt D, De Bacquer D, et al. Depression, anxiety, and risk factor control in patients after hospitalization for coronary heart disease: the EUROASPIRE III study. Eur J Prev Cardiol [Internet]. 2013 Apr 1 [cited 2024 Oct 9];20(2):331-340. Available from: https://doi.org/10.1177/2047487312441724

27.

Obieglo

Uchmanowicz

Wleklik

Jankowska-Polanska

Kusmierz

The effect of acceptance of illness on the quality of life in patients with chronic heart failure. Eur J Cardiovasc Nurs [Internet]. 2016 Jun 1 [cited 2024 Oct 9];15(4):241-247. Available from: https://doi.org/10.1177/1474515114564929

28.

Henao Pérez

López Medina

Lemos Hoyos

Ríos Zapata

Depression and the risk of adverse outcomes at 5 years in patients with coronary heart disease. Heliyon [Internet]. 2020 Nov 1 [cited 2024 Oct 9];6(11):05425. Available from: https://pubmed.ncbi.nlm.nih.gov/33210006/

29.

Bürker

Hardersen

Lappegård

KT.

Symptoms of depression, anxiety, and posttraumatic stress among patients with cardiac pacemakers. Int J Environ Res Public Health [Internet]. 2022 Dec 1 [cited 2024 Oct 9];19(24):16838. Available from: https://pubmed.ncbi.nlm.nih.gov/36554718/

30.

Olano-Lizarraga

Wallström

Martín-Martín

Wolf

Causes, experiences and consequences of the impact of chronic heart failure on the persońs social dimension: a scoping review. Health Soc Care Community [Internet]. 2022 Jul 1 [cited 2024 Oct 9];30(4):e842-e858. Available from: https://pubmed.ncbi.nlm.nih.gov/34918403/

31.

Greco

Adorni

De Matteis

, et al.

Latent change models of lifestyle in acute coronary syndrome patients: are lifestyle changes associated with resilience changes?

Health Psychol Open [Internet]. 2023 Jan 1 [cited 2024 Oct 9];10(1):205510292311781. Available from: https://pubmed.ncbi.nlm.nih.gov/37007212/

32.

Murphy

Le Grande

Alvarenga

Worcester

Jackson

Anxiety and depression after a cardiac event: prevalence and predictors. Front Psychol [Internet]. 2020 Jan 29 [cited 2024 Oct 9];10:502260. Available from: www.frontiersin.org

33.

Khatib

Lee

Marques-Sule

, et al. Evaluating the extent of patient-centred care in a selection of ESC guidelines. Eur Heart J Qual Care Clin Outcomes [Internet]. 2020 Jan 1 [cited 2024 Oct 9];6(1):55-61. Available from: https://pubmed.ncbi.nlm.nih.gov/31119288/

34.

Mitropoulou

Grüner-Hegge

Reinhold

Papadopoulou

Shared decision making in cardiology: a systematic review and meta-analysis. Heart [Internet]. 2022 Aug 25 [cited 2024 Oct 9];109(1):34-39. Available from: https://pubmed.ncbi.nlm.nih.gov/36007938/

35.

Klein

Anderson

Cigarroa

Shared decision-making in cardiovascular practice. Cardiol Rev [Internet]. 2023 Jan 1 [cited 2024 Oct 9];31(1):52-56. Available from: https://pubmed.ncbi.nlm.nih.gov/35349540/

36.

van Vliet

de Kleijn

van den Brekel-Dijkstra

, et al. Rapid review on the concept of positive health and its implementation in practice. Healthcare (Basel) [Internet]. 2024 Mar 1 [cited 2024 Oct 9];12(6). Available from: https://pubmed.ncbi.nlm.nih.gov/38540636/

37.

Hart- en vaatziekten | Leeftijd en geslacht | Totaal | Volksgezondheid en Zorg [Internet]. [cited 2024 Oct 9]. Available from: https://www.vzinfo.nl/hart-en-vaatziekten/leeftijd-en-geslacht/totaal

Exploring Positive Health in Cardiac Patients: Personal Goals and Key Factors for Achieving Improved Well-Being

Abstract

Keywords

Introduction

Method

Study Design and Setting

Participants

Data Collection

Data Analysis

Results

Self-Perceived Health

Bodily Functions

Mental Well-Being

Lifestyle

Daily Functioning

Meaningfulness

Medical Practices

Personal Goals

Bodily Functions and Mental Well-Being

Lifestyle

Daily Functioning

What Is Needed to Achieve Personal Goals?

Professional Support

Tools

Support From Others

Self-Care and Lifestyle

Changes in Medical Practices

Discussion

Limitations

Conclusion

Footnotes

Acknowledgments

Authors’ Contributions

Declaration of Conflicting of Interests

Funding

Ethical Approval

ORCID iDs

Statement of Human and Animal Rights

Statement of Informed Consent

Data Availability Statement

References