title: The synergistic effect of heart disease and diabetes on self-management, symptoms, and health status.
abstract: BACKGROUND
  Coronary heart disease (CHD) and diabetes may have synergistic effects on symptoms, self-management, and general and cardiac-specific health status.
  
  
  OBJECTIVE
  We compared symptom distress, self-management difficulties, and general and cardiac-specific health status in patients with CHD by the presence and severity of diabetes.
  
  
  METHODS
  We performed a cross-sectional study of 1013 patients enrolled in the COURAGE trial, with the use of clinical data, the Symptom Distress Scale, the Self-Management Difficulties Scale, the Short-Form 36, and the Seattle Angina Questionnaire.
  
  
  RESULTS
  Patients with diabetes and greater severity of diabetes had worse findings in symptom distress, self-management difficulties, and general and cardiac-specific health status than patients without diabetes.
  
  
  CONCLUSIONS
  A robust effect of diabetes on symptom distress and self-management difficulties was found in patients with CHD. The results from the Seattle Angina Questionnaire illustrate difficulty in attributing physical limitations to specific symptoms or conditions, and show the experience of comorbid conditions to be synergistic. Clinicians' understanding of this synergy and integration of condition-specific care with general treatment and self-management practices are needed.
authors.affiliation: The University of Manchester, Manchester, United Kingdom.
authors.forename: Christi
authors.initials: C
authors.lastname: Deaton
authors.forename: Laura P
authors.initials: LP
authors.lastname: Kimble
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: Pamela
authors.initials: P
authors.lastname: Hartigan
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.forename: Robert A
authors.initials: RA
authors.lastname: O'Rourke
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000209:etiology