Demoralization Syndrome Affects Health-Related Quality of Life (HRQOL) in Patients With Heart Failure

Friday, 28 July 2017: 11:05 AM

Hsing-Mei Chen, PhD
Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Liang-Miin Tsai, MD
Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Yun-Han Shie, MSN
Department of Nursing, National Cheng Kung University Hospital, Taiwan, Tainan, Taiwan


Health-related quality of life (HRQOL) is an important outcome measure for guiding appropriate and effective therapeutic interventions for patients with heart failure (HF). Demoralization syndrome consists of a cluster of emotional symptoms including loss of meaning, dysphoria, disheartenment, helplessness, and sense of failure. Patients with demoralization syndrome may have poor quality of life. To date, information about the relationship between demoralization syndrome and HRQOL in patients with HF, however, is still lacking. Therefore, the purpose of this study was to examine the relationship between demoralization syndrome and HQROL in patients with HF.


A cross-sectional correlational research design was employed, and a convenience sample of 120 heart failure participants was recruited from a medical center located in southern Taiwan. Measurements included Demoralization Scale, and Left Ventricular Dysfunction questionnaire. Bivariate analysis and hierarchical multiple regression analysis were carried out to test the relationship between demoralization syndrome and HRQOL.


The mean age was 64.95 (SD 13.67) years with a majority of male (71%), married (80%), unemployed (68%), sufficient financial status (84%), and New York Heart Association (NYHA) Class II (74%). The bivariate analyses showed that HRQOL was significantly associated with age (r = 0.22, p < 0.05), education (F = 3.08, p < 0.05), employment status (F=6.08, p<0.001), NYHA Class (t = -3.80, p < 0.001), and all demoralization domains and total score (r = 0.26, p <0.01 to r = 0.53, p <0.001). A two-step hierarchical multiple regression analysis showed that the significant determinants of HRQOL were age (β= 0.24, CI = 0.04-0.22), financial status (β= -0.29, CI = -8.62- -2.05), NYHA Class (0.17, CI = 0.13-5.44), demoralization-disheartenment (β= 0.40, CI = 0.33-1.16), and demoralization-sense of failure (β= 0.21, CI = 0.06-0.41). The total model explained 40.2% of the variance in HRQOL, with demoralization domains accounting for 12.1% of the variance.


HF participants who were elderly, had poor financial status, identified as NYHA Class III and IV, reported higher disheartenment, and perceived greater sense of failure experienced poor HRQOL. The study suggests demoralization syndrome is common in patients with HF and should be early identified to maintain HRQOL of the patients.