This study investigated the potential association between quality of life and perceived social support among CVDs patients who referring Emam Khomeini Hospital of Sarab. Findings of regression modeling indicated that monthly income status and all dimensions of social support, excluding tangible assets support, were significant predictors of quality of life. We found that self-esteem support as the most important predictor of quality of life in cardiovascular patients among social support dimensions.
According to the literature, social support has a positive and significant association with the heart patients' quality of life and has better outcomes for them [29–32]. Increasing social support in heart patients can reduce depression, hospitalization, and mortality, as well as increase self-care behaviors, health problems management, and overall quality of life [33, 34]. In fact, heart diseases can lead to a wide range of physiological, psychological, socioeconomic, and familial problems [30, 31].These problems can cause frustration and disappointment and negatively affect the patients' quality of life . Patients who receive adequate social support are better able to overcome these problems and better adapt psychologically to their disease. Helgeson (2003) believes that social support improves mood, encourages people to participate in social activities, increases health behaviors and overall improves quality of life. People on a social network persuade each other for healthy behaviors . High perceived social support leads to enjoyment of recreational activities, a better feeling of life, and life satisfaction .
In the present study, self-esteem support was identified as the strongest predictor of quality of life in CVDs’patients. This result was consistent with Helgeson (2003) and Friedman and King (1994) studies [35, 37]. Esteem support that is also known as emotional support or appraisal support, is the provision of empathy, love, affection, trust, acceptance, intimacy, encouragement, and caring from social support sources such as family and friends. Providing emotional support allows the patients to know that they are valuable to others . As a result, they feel valued, loved, and cared for, and are better able to overcome the outcomes of illness and achieve psychological well-being .
Studies that have examined the relationship between demographic characteristics of heart patients and quality of life have found that gender, age, education, marital status, employment status, duration of illness, and frequency of hospitalizations affect patients' quality of life. Among the various factors, our study found an association between occupational status, education level, and income status with patients' quality of life. Heart disease changes a person's life as it increases dependence on others for daily and social activities, and reduces financial worries and job opportunities . Unemployment has been associated with increased CVDs burden . Low income, loss of job, or working days due to illness can create a stressful environment for patients and their families . On the other hand, low income reduces the patient's access to costly medical care or increases receiving lower-quality care, and therefore, these negatively influence health and quality of life [39, 40].
In addition, according to the literature, there is an inverse relationship between educational level and heart disease. Educational levels may affect heart patients' health in several ways. Individuals with low education tend to have an increased number of CVD risk factors such as smoking, obesity, physical inactivity, and hypertension. Researchers also found a strong correlation between education and health literacy as a potential contributor to CVD risk. Individuals with poor health literacy are not more likely to be able to adherence their medications properly and thus experience more problems that may be contributing to adverse their health and quality of life .
On the other hand, our results indicated that there is an association between occupational and income status with social support. It's obvious individuals with an occupation have a larger social network and therefore receive more social support . In addition, given that, the economic situation of Iran, it is seems that access to more income and having a stable job that guarantees the living expenses and treatment of the patient increases receiving social support from family, friends and relatives.