Spirituality – ABC CARDIOL

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Editorial

Spirituality and Cardiovascular Disease: Valuing Cultural Sensitivity in Cardiology

Health professionals should be sensitive to the fact that their patients have different health values, which could be influenced by cultural and spiritual aspects. Current evidence has shown that spiritual and religious (S/R) beliefs can have both a positive and negative association with different health outcomes, such as depression, anxiety, mortality, quality of life, hospitalization, chronic illnesses, and substance use, among others.

In this context, the field of “Spirituality and Health” has been constantly growing in the scientific community, driven by the number of studies, the interest of medical schools, and its incorporation into guidelines from different medical organizations.

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Original Article

Spirituality/Religiosity and Adherence to Treatment in Hypertensive Individuals

Yanne da Silva Camargo et al. Aliny Serafim Borges Ferreira Luana Araújo Macedo Scalia Patrícia Magnabosco … Aline Guarato da Cunha Bragato Maria Beatriz Guimarães Raponi Nelson Dinamarco Valéria Nasser Figueiredo

Abstract

Background

Adherence to drug and non-drug treatment for hypertension has a major socioeconomic impact, in addition to reducing the risk of cardiovascular events and morbidity and mortality. It is known that spirituality and religiosity can be incorporated into coping and managing hypertension.

Objective

To analyze possible factors associated with adherence to treatment in hypertensive patients and the role of spirituality/religiosity in this context.

Methods

Observational, cross-sectional, quantitative study, carried out with 237 hypertensive individuals monitored in a large Brazilian teaching hospital. Sociodemographic, clinical and lifestyle data were collected, in addition to measuring anthropometric data and performing a physical examination. To determine adherence to drug and non-drug treatment for hypertension, the QATSAH instrument was used and, to assess the level of spirituality/religiosity, the Duke Religion Index and the Brief Multidimensional Measure of Religiousness/Spirituality were applied.

Results

Higher levels of adherence to treatment were observed when aged ≥65 years, physically active, and who did not consume alcohol (p<0.05). Regarding religiosity and spirituality, intrinsic religiosity (β = 0.24, 95%CI [0.22, 1.13], p = 0.004), values and beliefs (β = -0.18, 95%CI [-1.58, -0.20], p = 0.012), and forgiveness (β = 0.16, 95%CI [0.13, 1.19], p = 0.015) were statistically significant predictors of treatment adherence. Organizational religiosity, non-organizational religiosity, and daily spiritual experiences were not significant.

Conclusion

Greater intrinsic religiosity, lower scores in Values and Beliefs and higher scores in Forgiveness increase the level of medication and non-medication adherence in hypertensive individuals.

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IJCS

Editorial

Is Spirituality a New or Renewed Tool?

Mario Borba

Editorial referring to the article: Religiosity and Spirituality: The Relationship Between Psychosocial Factors and Cardiovascular Health

The topic of spirituality and religiosity has become more prevalent in scientific publications and clinical practice. Researchers recognize that studying this area can lead to a better understanding of physiology and potential therapeutic interventions. There are even discussions about establishing a prognosis based on spirituality and religiosity, and we are finding evidence related to this topic.

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IJCS

Original Article

Religiosity and Spirituality: The Relationship Between Psychosocial Factors and Cardiovascular Health

José Icaro Nunes Cruz et al. Adelle Cristine Lima Cardozo Enaldo Vieira de Melo Juliana Maria Chianca Lira … Giulia Vieira Santos Gabriela de Oliveira Salazar Bruna Oliveira Mariano César de Souza Reis Diego Maldini Borba de Lima Philipi Santos Soares Antônio Carlos Sobral Sousa Joselina Luzia Menezes Oliveira

Abstract

Background:

Religiosity and Spirituality (R/S), despite being different entities, are multidimensional constructs, whose influence on cardiovascular health has been increasingly studied in recent decades.

Objectives:

To discriminate patients into subgroups according to R/S levels, in order to compare them regarding the distribution of cardiovascular comorbidities and clinical events.

Methods:

This is an observational, cross-sectional, analytical study. Two R/S scales were applied to a sample of patients seen at cardiology outpatient clinics. A cluster analysis was used to discriminate individuals into subgroups regarding R/S levels, which were subsequently compared regarding the frequencies of clinical variables related to cardiovascular health. A significance level of 5% was set for the statistical tests.

Results:

The sample included 237 patients with a mean age of 60.8 years (±10.7), of which 132 were female (55.7%). Cluster analysis (C) distinguished two groups: C1, with lower levels of R/S, and C2, with higher levels of R/S (p<0.001). C2 had a lower frequency of alcohol consumption (29.5% vs. 76.0%; p<0.001), smoking (12.9% vs. 51.0%; p<0.001), systemic arterial hypertension (SAH — 65.5% vs. 82.3%; p=0.005), dyslipidemia (58.3% vs. 77.1%; p=0.003), chronic coronary syndrome (36.7% vs. 58.3%; p=0.001), and prior cardiovascular events (15.8% vs. 36.5%; p<0.001) when compared to C1. There was also a higher frequency of females in C2 (82.0% vs. 17.7%; p<0.001).

Conclusions:

A better cardiovascular morbidity profile was observed in the group of patients with higher R/S levels, suggesting a probable positive relationship between R/S and cardiovascular health.

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Research Letter

Influence of Spiritual Well-Being on Blood Pressure, Central Hemodynamics and Endothelial Function

Maria Emília Figueiredo Teixeira et al. Priscila Valverde de Oliveira Vitorino Andrea A. Brandão Ana Luiza Lima Souza … Talles Marcelo Gonçalves de Andrade Barbosa Roberto Esporcatte Mário Henrique Elesbão de Borba Álvaro Avezum Weimar Kunz Sebba Barroso

Introduction

Spirituality and religiosity (S/R) are cultural aspects that have existed since the beginnings of human existence. Having been long considered as opponent to science, only recently, S/R have gained importance in the context of health.

Definitions of S/R have been constantly evolving, according to the need for adaptation to new knowledge. Today, religion has been related to organizational, institutional and dogmatic aspects, that is, the contact with deity occurs through predetermined formats, specific to each religious segment. Spirituality is a wider term, encompassing a quest for personal, psychological and spiritual well-being, and good-quality interpersonal relationships. According to the Department of Studies in Spirituality and Cardiovascular Medicine (DEMCA, Departamento de Estudos em Espiritualidade e Medicina Cardiovascular ) of the Brazilian Cardiology Society, “spirituality is a set of moral, mental and emotional values that guide thoughts, behaviors and attitudes in life circumstances of intra and interpersonal relationships”.

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Editorial

Chronological Age or Biological Age, Mainly a Matter of Lifestyle

Paulo César B. Veiga Jardim et al. Thiago de Souza Veiga Jardim

Despite the significant global socioeconomic disparities, the world’s population has grown exponentially, and the average life continues to increase significantly.^–

If at the beginning of the 19th century, life expectancy in Europe was around 35 years, at present, only the African continent has populations with an average life expectancy of fewer than 60 years.^–

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IJCS

Original Article

Spirituality, Religiosity and Quality of Life of Hypertensive and Diabetic Patients in a Referral Hospital in Pernambuco

Gabriela de Paula Lopes Brito et al. Maria Eduarda Farias Barbosa Vera Azevedo Bérgamo Barrêto Bruna Almeida Andrade Velloso … Rafaela Siqueira Duarte Ribeiro Sophia Barreto Tenório Luna Leopoldo Nelson Fernandes Barbosa Arturo de Pádua Walfrido Jordán

Abstract

Background

Religiosity is a system of worship and doctrine that is shared by a group, and spirituality is the individual search for the meaning of life. The relationship between spirituality/religiosity (S/R) and health has a long history, and a positive correlation between spirituality and chronic diseases has been described in scientific literature, showing a decrease in morbidity and mortality in general.

Objective

To evaluate the association between S/R and the quality of life of patients with diabetes and/or systemic arterial hypertension.

Method

An observational, analytical, cross-sectional, quantitative study was conducted with a sample consisting of 40 patients treated at the hypertension and diabetes outpatient clinic of a medical center in Recife. The collection used three assessment instruments (SSRS, Duke-DUREL scale, and WHOQOL-BREF). Data from the questionnaires were analyzed using descriptive (frequency and percentage) and inferential statistics (chi-square test and F test) using the R software, version 3.4.3. The level of significance in all analyses was 5%. The study was approved by CEP/IMIP, according to report no. 2.890.126.

Result

All four domains of the quality-of-life scale (WHOQOL-BREF) showed a positive relationship when correlated with the religiosity scale (DUREL), with statistical significance in the relationship between organizational religiosity and the environmental domain. When correlated with the spirituality scale (SSRS), WHOQOL-BREF also showed a positive relationship, except in the physical domain.

Conclusion

A positive relationship between quality of life and S/R was shown, thus confirming its importance for patients with diabetes and SAH.

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Original Article

Association between Spirituality and Adherence to Management in Outpatients with Heart Failure

Juglans Souto Alvarez et al. Livia Adams Goldraich Alice Hoefel Nunes Mônica Cristina Brugalli Zandavalli … Rafaela Brugalli Zandavalli Karlyse Claudino Belli Neusa Sica da Rocha Marcelo Pio de Almeida Fleck Nadine Clausell

Abstract

Background:

Spirituality may influence how patients cope with their illness.

Objectives:

We assessed whether spirituality may influence adherence to management of outpatients with heart failure.

Methods:

Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence.

Results:

One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments.

Conclusion:

Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

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