心臟衰竭為所有心臟疾病的最終共同表徵，隨著人口老化及醫療進步，盛行率持續增加中。而隨著醫療進步發達，治療的目的不再只是延長生命而已，更重要的是去除症狀及改善功能，提昇生活品質。目前臨床上對於心臟衰竭的生活品質探討也逐漸增多，然而在其改善生活品質的相關因素研究中，成效仍不佳。因此，本研究依據Leventhal等（2003）所提出的自我調節模式（self-regulation model），病患面對疾病的刺激產生疾病詮釋，進而有因應行為與結果評價；依此架構探討心臟衰竭病患的疾病詮釋與疾病特性之關係，及疾病詮釋對疾病特性與生活品質的中介影響。
為橫斷性研究設計（cross-sectional study）採立意取樣，針對符合美國紐約心臟學會(NYHA)定義之心臟衰竭分級Ⅰ~Ⅳ級的病患，於北部某醫學中心心臟內科病房收案共76人，以疾病詮釋量表（Illness Representation Questionnaire）及中文版美國明尼蘇達心臟衰竭生活品質問卷（Minnesota Living With Heart Failure Questionnaire，MLWHFQ），進行資料收集，並以SPSS 20.0進行資料建檔及分析，運用階層線性迴歸分析（hierarchical linear regression analyses）相關性及Sobel test等進行中介關係檢測。
研究結果發現NYHA功能分級和疾病詮釋七個次項及生活品質均呈現高度顯著相關（p <.001），疾病詮釋七個次項和生活品質都呈顯著相關（p <.01）。NYHA功能分級和疾病詮釋都是生活品質的預測因子。以階層迴歸發現，NYHA功能分級對生活品質的解釋變異量為27％，疾病詮釋對生活品質的總解釋變異量為44％。疾病詮釋中的「時間性急性/慢性」、「時間週期循環」、「疾病結果」、「個人對疾病的控制」及「情緒詮釋」等五項，均對心臟衰竭病患的NYHA功能分級和生活品質有部分中介影響。
NYHA功能分級不單和生活品質直接相關，也間接透過疾病詮釋影響生活品質；研究之結果可協助護理人員了解病患的疾病詮釋，及提供未來照護介入措施之參考。因此，建議未來醫護相關人員若想改善病患的生活品質，應不單僅著重在病患的生理症狀，更應了解病患的疾病信念，方能有效提升生活品質。

Heart failure (HF) is the final common sign of all kinds of heart diseases, and the prevalence is continuously elevated followed by aging and medical progression. Along with the development of medical profession, the goal of treatments is no longer extending human lives, but alleviating symptoms and improving functions, thus enhancing the quality of life (QoL). There are more and more investigations for the QoL of people with HF, but in those researches studying the related factors of improving QoL, the effectiveness is still not good enough. Therefore, we utilized the self-regulation model stated by Leventhal in 2003 which mentioned that patients will give illness representations to those stimulations of diseases and then have coping behaviors and outcome appraisals, to investigate the relationships between disease characteristics and illness representations, and the mediating influences of illness representations to disease characteristics and QoL in patients with HF.

Seventy-six.NYHA I to IV HF subjects were recruited from an internal cardiology ward of one northern medical centerby purposive sampling methodand cross-sectional study. Research data were collected by Illness Representation Questionnaire and Minnesota Living With Heart Failure Questionnaire (MLWHFQ) Chinese version, and sorted and analyzed by SPSS 20.0. Hierarchical linear regression analysis was used to determine the correlations, and Sobel test was used to determine the mediating relationship.

The results showed that NYHA functional classification was highly significantly correlated with all 7 dimensions of illness representations and QoL (all p <.001), and all 7 dimensions of illness representations were significantly correlated with QoL (all p <.01). NYHA functional classification and illness representationsare the predictors for QoL. The results of hierarchical linear regression showed the R2 of NYHA functional classification to QoL was .27, the R2 of illness representations to QoL was .44. The results of Sobel test showed that 5 dimensions (timeline acute/chronic, timeline cyclical, illness consequences, personal control and emotional representation) of illness representations were revealed partial mediating influences between NYHA functional classification and QoL.

NYHA functional classification is not only correlated with QoL, but affects QoL via illness representations indirectly. Our research results can help nursing professionals to understand such patients’ illness representations, and provide a reference for the care and intervention of the future. Therefore, we suggest that if medical and nursing professionals would like to improve patients’QoL, they should not only focus on patients’ physiological symptoms, but have to understand patients’ illness representations, and thus can enhance QoL effectively.

目錄
摘要 I
Abstract III
目錄 V
表目錄 VIII
圖目錄 X
第一章 緒論 1
第一節研究動機與重要性 1
第二節研究目的 6
第貳章文獻查證 7
第一節心臟衰竭的疾病特性與治療 7
(一) 心臟衰竭的病因 7
(二) 心臟衰竭的類型 8
(三) 心臟衰竭的症狀 9
(四) 心臟衰竭的診斷 9
(五) 心臟衰竭的NYHA功能分級 10
(六) 心臟衰竭的治療 11
第二節心臟衰竭病患之生活品質 14
(一) 生活品質的定義 14
(二) 影響心臟衰竭病患生活品質的因素 14
第三節心臟衰竭病患之疾病詮釋 18
(一) 疾病詮釋的起源 18
(一) 心臟衰竭病患的疾病詮釋 21
第四節心臟衰竭病患疾病詮釋與生活品質相關性 24
第五節心臟衰竭病患的疾病詮釋對生活品質之中介影響 26
第二章 研究方法 27
第一節研究設計 27
第二節研究架構 28
第三節名詞定義 29
(一) 心臟衰竭： 29
(二) 疾病詮釋： 29
(三) 生活品質: 29
第四節研究對象與場所 30
第五節研究工具及信效度 31
(一) 人口學變項及疾病特性： 31
(二) 美國明尼蘇達心臟衰竭生活品質問卷（MinnesotaLiving With Heart Failure Questionnaire，MLHFQ）： 31
(三) 心臟衰竭病患疾病詮釋量表（Illness Representation Questionnaire）: 32
第六節研究步驟 34
第七節研究倫理考量 34
第八節資料處理與分析方法 35
(一) 描述性統計: 35
(二) 推論性統計: 35
第四章分析與結果 37
第一節心臟衰竭病患人口學特性 37
第二節心臟衰竭病患生活品質 39
(一) 整體性生活品質 39
(二) 生理性生活品質 39
(三) 情緒性生活品質 39
(四) 社交性生活品質 39
第三節心臟衰竭病患疾病詮釋 41
第四節心臟衰竭病患人口學特性與疾病詮釋、生活品質之分析 44
(一) 心臟衰竭病患人口學變項、疾病特性與生活品質的相關性 44
(二) 心臟衰竭病患人口學變項、疾病特性與疾病詮釋的相關性 46
(三) 心臟衰竭病患其疾病詮釋和生活品質之相關性 48
(四) 心臟衰竭病患生活品質之預測因子 50
第五節疾病詮釋對心臟衰竭病患NYHA功能分級與生活品質的中介影響 58
第五章討論 69
第一節心臟衰竭病患的基本屬性分布狀況 69
(一) 人口學變項 69
(二) 疾病特性 69
第二節心臟衰竭病患生活品質 71
(一) 個人基本屬性與生活品質及其相關性 71
(二) 疾病特性與生活品質之相關性 71
第三節心臟衰竭病患疾病詮釋 73
(一) 個人基本屬性與疾病詮釋之相關性 73
(二) 疾病特性與疾病詮釋之相關性 73
第四節心臟衰竭病患NYHA功能分級、疾病詮釋和生活品質的相關性 75
第五節心臟衰竭病患的疾病詮釋對NYHA功能分級和生活品質的中介影響 77
第六章結論與建議 79
第一節研究結論與建議 79
第二節研究貢獻與限制 80
(一) 護理臨床實務 80
(二) 護理教育 80
(三) 護理研究 80
(四) 研究限制 81
參考文獻 82
附錄 91
附錄一基本屬性資料問卷 91
附錄二心臟衰竭病患疾病詮釋量表 92
附錄二心臟衰竭病患疾病詮釋量表（續） 93
附錄三心臟衰竭病患生活品質量表 94
附錄四問卷授權同意書 95
附錄四問卷授權同意書（續） 96


表目錄
表3-8-1研究目的及統計方法 36
表4-1-1心臟衰竭病患之人口學特性 (N=76) 38
表4-2-1明尼蘇達心衰竭生活品質問卷分析(N=76) 40
表4-3-1心臟衰竭病患之疾病詮釋 (N=76) 42
表4-4-1心臟衰竭病患人口學變項、疾病特性與生活品質的相關性（N=76） 45
表4-4-2心臟衰竭病患人口學變項、疾病特性與疾病詮釋的相關性(N=76) 47
表4-4-3心臟衰竭病患的疾病詮釋和生活品質之PEARSON相關性(N=76) 49
表4-4-4心臟衰竭病患的疾病詮釋對整體生活品質影響之迴歸分析(N=76) 51
表4-4-5心臟衰竭病患的NYHA對生活品質影響之迴歸分析(N=76) 53
表4-4-6心臟衰竭病患的NYHA對疾病詮釋影響之迴歸分析(N=76) 53
表4-4-7心臟衰竭病患的疾病詮釋（時間性急性/慢性）對整體性生活品質影響之迴歸分析(N=76) 54
表4-4-8心臟衰竭病患的疾病詮釋（時間週期循環）對整體性生活品質影響之迴歸分析(N=76) 54
表4-4-9心臟衰竭病患的疾病詮釋（疾病結果）對整體性生活品質影響之迴歸分析(N=76) 55
表4-4-10心臟衰竭病患的疾病詮釋（個人對疾病的控制）對整體性生活品質影響之迴歸分析(N=76) 55
表4-4-11心臟衰竭病患的疾病詮釋（治療對疾病的控制）對整體性生活品質影響之迴歸分析(N=76) 56
表4-4-12心臟衰竭病患的疾病詮釋（對疾病認知的一致性）對整體性生活品質影響之迴歸分析(N=76) 56
表4-4-13心臟衰竭病患的疾病詮釋（情緒詮釋）對整體性生活品質影響之迴歸分析(N=76) 57
表4-5-1時間性急性/慢性對NYHA與整體性生活品質之中介迴歸分析(N=76) 61
表4-5-2時間週期循環對NYHA與整體性生活品質之中介迴歸分析(N=76) 61
表4-5-3疾病結果對NYHA與整體性生活品質之中介迴歸分析(N=76) 62
表4-5-4個人對疾病的控制對NYHA與整體性生活品質之中介迴歸分析(N=76) 62
表4-5-5治療對疾病的控制對NYHA與整體性生活品質之中介迴歸分析(N=76) 63
表4-5-6對疾病認知的一致性對NYHA與整體性生活品質之中介迴歸分析(N=76) 63
表4-5-7情緒詮釋對NYHA與整體性生活品質之中介迴歸分析(N=76) 64
表4-5-8疾病詮釋對於心臟衰竭病患與生活品質SOBEL TEST的中介效應檢測(N=76) 66
 
圖目錄
圖1 LEVENTHAL COMMON-SENSE MODEL 19
圖2 心臟衰竭病患疾病詮釋與生活品質之研究架構圖 28
圖3 中介效果路徑圖 58
圖4-5-3疾病詮釋對心臟衰竭病患與生活品質的中介效應路徑圖 67
圖4-5-2疾病詮釋對心臟衰竭病患與生活品質的中介效應路徑圖 67
圖4-5-1 疾病詮釋對心臟衰竭病患與生活品質的中介效應路徑圖 67
圖4-5-4疾病詮釋對心臟衰竭病患與生活品質的中介效應路徑圖 68
圖4-5-5疾病詮釋對心臟衰竭病患與生活品質的中介效應路徑圖 68

行政院衛生福利部 (2017)．民國 105 年衛生統計系列 ( 一 ) 死因統計年報．取自 http://www.mohw.gov.tw/cp-16-33598-1.html
王雁婷(2012)‧心臟衰竭病患疾病知覺與自我照顧行為相關性之探討‧未發表碩士論文‧私立台北醫學大學：台北市。
江碩儒、柯景塘(2007)‧心臟衰竭治療之新進展‧北市醫學雜誌，4(8)，38-48。
姚開屏（2002）‧健康相關生活品質概念與測量原理之簡介‧臺灣醫學，6（2），183-192。.
林秋菊、張淑真、吳佳珍(2009)‧Leventhal 疾病詮釋概念於臨床之應用‧護理雜誌，56(5)，87-92。
施孟綾、陳幸眉、周汎澔、黃玉雰、呂居學、簡慧卿(2010)‧心臟衰竭病患之生活品質及其相關因素‧護理雜誌，57(6)，61-71。
高佳霙、丁紀台、葉明珍、張彩秀(2008)‧全面性照護計畫改善心臟衰竭病患自我照顧、生活品質及再住院之成效探討‧實證護理，4(3)，233-242。
許榮城(2012)‧2012年歐洲心臟學會治療指引：急性及慢性心衰竭的診斷及治療(上)‧中華民國心臟學會雜誌，7-15。
陳夏蓮(2008)‧高血壓病患疾病知覺治療遵從行為關係之探討：結構方程式模式之驗證‧未發表博士論文‧取自國家圖書館。
賴文源、顏兆熊(2011)‧老人之心衰竭‧當代醫學，8(449)，175-184。
吳玲瑜、李碧娥、許靖岱、黃桂香、白玉玲(2014)‧外傷病患主要照
顧者的疾病意象、壓力與生活品質之探討‧護理暨健康照護研究，10(3)，199 – 210。DOI:10.6225/JNHR.10.3.199.
姚開屏（2000）•簡介與評論常用的一般性健康相關生活品質量表兼談對未來研究的建議•測驗年刊，47(2)，111−138。
Aalto, A.-M., Aro, A. R., Weinman, J., Heijmans, M., Manderbacka, K., & Elovainio, M. (2006). Sociodemographic, disease status, and illness perceptions predictors of global self-ratings of health and quality of life among those with coronary heart disease–one year follow-up study. Quality of Life Research, 15(8), 1307-1322.
Arnold, S., Herrick, L., Pankratz, V., & Mueller, P. (2007). Spiritual well-being, emotional distress, and perception of health after a myocardial infarction. The Internet Journal of Advanced Nursing Practice, 9(1), 4-11.
Alsen, P., Brink, E., Persson, L. O., Brandstrom, Y., & Karlson, B. W. (2010). Illness perceptions after myocardial infarction: relations to fatigue, emotional distress, and health-related quality of life. Journal of Cardiovascular Nursing, 25(2), E1-E10.
Blinderman, C. D., Homel, P., Billings, J. A., Portenoy, R. K., & Tennstedt, S. L. (2008). Symptom distress and quality of life in patients with advanced congestive heart failure. Journal of Pain and Symptom Management, 35(6), 594-603.
Bouvy, M., Heerdink, E., Leufkens, H., & Hoes, A.(2003). Predicting mortality in patients with heart failure: A pragmatic approach. Heart, 89(6), 605-609.
Brink, E., Karlson, B. W., & Hallberg, L. R.-M.(2002). To be stricken with acute myocardial infarction: A grounded theory study of symptom perception and care-seeking behaviour. Journal of Health Psychology, 7(5), 533-543.
Bullinger, M. (1996). Health related quality of life and subjective health. Overview of the status of research for new evaluation criteria in medicine. Psychotherapie, Psychosomatik, Medizinische Psychologie, 47(3-4), 76-91.
Carels, R. A. (2004). The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients. Quality of Life Research, 13(1), 63-72.
Carels, R. A., Musher-Eizenman, D., Cacciapaglia, H., Pérez-Benı́tez, C. I., Christie, S., & O'Brien, W. (2004). Psychosocial functioning and physical symptoms in heart failure patients: a within-individual approach. Journal of Psychosomatic Research, 56(1), 95-101.
Carlson, B., Riegel, B., & Moser, D. K. (2001). Self-care abilities of patients with heart failure. Heart & Lung: The Journal of Acute and Critical Care, 30(5), 351-359.
Cherrington, C. C., Lawson, T. N., & Clark, K. B. (2006). Illness representation of patients with systolic heart failure. Progress in Cardiovascular Nursing, 21(4), 190-195.
Chien, C.L., Lee, C.M., Wu, Y, Wen., Chen, T, A., &Wu, Y. T., (2008).Home-based exercise increases exercise capacity but notquality of life in people with chronic heart failure:a systematic review.Australian Journal of Physiotherapy, 54(2)87-93. doi: 10.1016/S0004-9514(08)70041-2.
Clerico, A., Vittorini, S., Passino, C., & Emdin, M. (2009). New and emerging biomarkers of heart failure. Critical Reviews in Clinical Laboratory Science, 46(3), 107-128.
Cooper, A., Lloyd, G., Weinman, J., et al. (1999). Why patients do not attendcardiac rehabilitation：Role of intentions and illness beliefs. Heart , 82(2), 234 - 236. doi:10.1136/hrt.82.2.234.
Dalstra, J. A. A., Kunst, A. E., & Mackenbach, J. P. (2006). A comparative appraisal of the relationship of education, income and housing tenure with less than good health among the elderly in Europe. Social Science &Medicine, 62(8), 2046-2060.
De Keulenaer, G. W., & Brutsaert, D. L. (2007). Systolic and diastolic heart failure: Different phenotypes of the same disease? European Journal of Heart Failure, 9(2), 136-143.
Diefenbach, M. A., & Leventhal, H. (1996). The common-sense model of illness representation: Theoretical and practical considerations. Journal of Social Distress and the Homeless, 5(1), 11-38.
Ekman, I., & Ehrenberg, A. (2002). Fatigued elderly patients with chronic heart failure: do patient reports and nurse recordings correspond? International Journal of Nursing Terminologies and Classifications, 13(4), 127-136.
Fan, S. Y., Eiser, C., Ho, M. C., & Lin, C. Y. (2013). Healthrelatedquality of life in patients with hepatocellularcarcinoma: The mediation effects of illness perceptionsand coping. Psycho-Oncology, 22(6), 1353−1360. doi:10.1002/pon.3146.
Faller, H., Störk, S., Schuler, M., Schowalter, M., Steinbüchel, T., Ertl, G., & Angermann, C. E. (2009). Depression and disease severity as predictors of health-related quality of life in patients with chronic heart failure—a structural equation modeling approach. Journal of Cardiac Failure, 15(4), 286-292.
Fowler, C., & Baas, L. S. (2006). Illness representations in patients with chronic kidney disease on maintenance hemodialysis. Nephrology nursing journal: Journal of the American Nephrology Nurses' Association, 33(2), 179-186.
Foxwell, R., Morley, C., & Frizelle, D. (2013). Illness perceptions, mood and quality of life: A systematic review of coronary heart disease patients. Journal of Psychosomatic Research,75(3), 211-222.
Franzén, K., Blomqvist, K., & Saveman, B.-I. (2006). Impact of chronic heart failure on elderly persons' daily life: A validation study. European Journal of Cardiovascular Nursing, 5(2), 137-145.
Freedland, K. E., Rich, M. W., Skala, J. A., Carney, R. M., Dávila-Román, V. G., & Jaffe, A. S. (2003). Prevalence of depression in hospitalized patients with congestive heart failure. Psychosomatic Medicine, 65(1), 119-128.
Goldberg, R. J., Ciampa, J., Lessard, D., Meyer, T. E., & Spencer, F. A. (2007). Long-term survival after heart failure: A contemporary population-based perspective. Archives of Internal Medicine, 167(5), 490-496.DOI: 10.1001/archinte.167.5.490.
Goodman, H., Firouzi, A., Banya, W., Lau-Walker, M., & Cowie, M. R. (2012). Illness perception, self-care behaviour and quality of life of heart failure patients: A longitudinal questionnaire survey. International Journal of Nursing Studies. 50(7), 945-953.
Goulding, L., Furze, G., & Birks, Y. (2010). Randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease: Systematic review. Journal of Advanced Nursing, 66(5), 946-961.
Grace, S. L., Krepostman, S., Brooks, D., Arthur, H., Scholey, P., Suskin, N., … Stewart, D. E. (2005). Illness perceptions among cardiac patients: relation to depressive symptomatology and sex. Journal of Psychosomatic Research, 59(3), 153-160.
Hagger, M. S., & Orbell, S. (2003). A meta-analytic review of the common-sense model of illness representations. Psychology and Health, 18(2), 141-184.
Hale, E., Treharne, G., & Kitas, G. (2007). The Common-Sense Model of self-regulation of health and illness: How can we use it to understand and respond to our patients’ needs? Rheumatology, 46(6), 904-906.
Hallas, C. N., Wray, J., Andreou, P., & Banner, N. R. (2011). Depression and perceptions about heart failure predict quality of life in patients with advanced heart failure. Heart & Lung: The Journal of Acute and Critical Care, 40(2), 111-121.
Harman, G., & Clare, L. (2006). Illness representations and lived experience in early-stage dementia. Qualitative Health Research, 16(4), 484-502.
Heo, S., Lennie, T. A., Okoli, C., & Moser, D. K. (2009). Quality of life in patients with heart failure: Ask the patients. Heart & Lung: The Journal of Acute and Critical Care, 38(2), 100-108.
Huang, C.-H., Chien, K.-L., Chen, W.-J., Sung, F.-C., Hsu, H.-C., Su, T.-C., & Lee, Y.-T. (2007). Impact of heart failure and left ventricular function on long-term survival—Report of a community-based cohort study in Taiwan. European Journal of Heart Failure, 9(6-7), 587-593.
Hunt, S. A., Abraham, W. T., Chin, M. H., Feldman, A. M.,Francis, G. S., Ganiats, T. G., et al. (2009). 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation. Journal of the American College of Cardiology, 53(15), e1-e90.doi: 10.1161/CIRCULATIONAHA.109.192065.
Ho,C.C., Clochesy, J.M., Madigan, E.(2007). Psychometric Evaluation of the Chinese Version of the Minnesota Living with Heart Failure Questonnaaire. Nursing Research, 56(6), 441-447.
Juenger, J., Schellberg, D., Kraemer, S., Haunstetter, A., Zugck, C., Herzog, W., & Haass, M. (2002). Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart, 87(3), 235-241.
Julie, M.I. (2014). An exploration of illness representations and treatment beliefs in heart failure. Journal of ClinicalNursing , 23(9-10), 1249 -1256. doi: 10.1111/jocn.12307
Koenig, H. G. (1998). Depression in hospitalized older patients with congestive heart failure. General Hospital Psychiatry, 20(1), 29-43.
Lau-Walker, M. (2006). A conceptual care model for individualized care approach in cardiac rehabilitation─combining both illness representation and self-efficacy. British Journal of Health Psychology, 11(Pt 1), 103-117. doi: 10.1348/135910705x41914
Lau‐Walker, M. (2004). Relationship between illness representation and self‐efficacy. Journal of Advanced Nursing, 48(3), 216-225.
Lau‐Walker, M. (2007). Importance of illness beliefs and self‐efficacy for patients with coronary heart disease. Journal of Advanced Nursing, 60(2), 187-198.
Lee, D. T., Doris, S., Woo, J., & Thompson, D. R. (2005). Health-related quality of life in patients with congestive heart failure. European Journal of Heart Failure, 7(3), 419-422.
Lett, H. S., Blumenthal, J. A., Babyak, M. A., Sherwood, A., Strauman, T., Robins, C., & Newman, M. F. (2004). Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosomatic Medicine, 66(3), 305-315.
Leventhal, H., Brissette, I., & Leventhal, E. A. (2003). The common-sense model of self-regulation of health and illness. The Self-Regulation of Health and Illness Behaviour, 1, 42-65.
Leventhal, H., Nerenz, D. R., & Purse, J. (1984). Illness Representations and Coping with Health Threats.
Lin, C.-C., Chen, M.-C., Hsieh, H.-F., & Chang, S.-C. (2013). Illness Representations and Coping Processes of Taiwanese Patients With Early-Stage Chronic Kidney Disease. Journal of Nursing Research, 21(2), 120-128. doi:10.1097/jnr.0b013e3182921fb8.
MacInnes, J. (2014). An exploration of illness representations and treatment beliefs in heart failure. Journal Of Clinical Nursing, 23(9/10), 1249-1256. doi:10.1111/jocn.12307.
Madhok, V., Falk, G., Rogers, A., Struthers, A., Sullivan, F., & Fahey, T. (2008). The accuracy of symptoms, signs and diagnostic tests in the diagnosis of left ventricular dysfunction in primary care: A diagnostic accuracy systematic review. BMC Family Practice, 9(1), 56.
Mendez, G. F., Betancourt, L., & Galicia-Mora, G. (2007). The impact of heart failure clinic in the improvement on quality of life of heart failure patients in Mexico. International Journal of Cardiology, 115(2), 242-243. doi:10.1016/j.ijcard. 2006.01.052.
Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L., & Buick, D. (2002). The revised illness perception questionnaire (IPQ-R). Psychology and Health, 17(1), 1-16.
Muller-Tasch, T., Peters-Klimm, F., Schellberg, D., Holzapfel, N., Barth, A., Jünger, J., et al. (2007). Depression is a major determinant of quality of life in patients with chronic systolic heart failure in general practice. Journal of Cardiac Failure, 13(10), 818-824.
Nouwen, A., Urquhart Law, G., Hussain, S., McGovern, S., & Napier, H. (2009). Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes. Psychology and Health, 24(9), 1071-1084. doi: 10.1080/08870440802254597.
Rector T, Cohn J. (1992). Assessment of patient outcome with theMinnesota Living With Heart Failure Questionnaire: reliabilityand validity during randomized, double blind,placebo-controlled trial of pimobendan. Am Heart J, 124(4),1017-1025.
Rector, T., & Cohn, J. (2004). Minnesota living with heart failure questionnaire.Retrivedfromhttp://www.queri.research.va.gov/chf/products/hf_toolkit/Minnesota-HF-Questionnaire_Rector.pdf
Rector, T. S. (2005). A conceptual model of quality of life in relation to heart failure. Journal of Cardiac Failure, 11(3), 173-176.
Rector, T. S., Anand, I. S., & Cohn, J. N. (2006). Relationships between clinical assessments and patients' perceptions of the effects of heart failure on their quality of life. Journal of Cardiac Failure, 12(2), 87-92.
Rozema, H., Vollink, T., & Lechner, L. (2009). The role of illness representations in coping and health of patients treated for breast cancer. Psycho-Oncology, 18(8), 849-857. doi: 10.1002/pon.1488.
Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in Heart FailureA Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes. Journal of the American College of Cardiology, 48(8), 1527-1537.
Schoormans, D., Mulder, B. J., van Melle, J. P., Pieper, P. G.,van Dijk, A. P., Sieswerda, G. T., ... Sprangers, M. A.(2014). Illnessperceptions of adults with congenital heartdisease and their predictive value for quality of life twoyears later. European Journal of Cardiovascular Nursing,13(1), 86−94. doi:10.1177/1474515113481908.
Sharpe, L., & Curran, L. (2006). Understanding the process of adjustment to illness. Social Science &Medicine, 62(5), 1153-1166.
Smith, T. W., & Ruiz, J. M. (2002). Psychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice. Journal of Consulting and Clinical Psychology, 70(3), 548-568.
Sriprasong, S., Hanucharurnkul, S., Panpukdee, O., Krittayaphong, R., Pongthavornkamol, K., & Vorapongsathorn, T. (2013). Functional status model: An empirical test among discharged acute myocardial infarction patients. Pacific Rim International Journal of Nursing Research, 13(4), 268-284.
Sung, K. T., Hung, C. L., Su, C. H., Hou, J.Y., Yeh, H. I. (2017)．Current Trends from Diagnosis to Treatment in Heart Failure．內科學誌，28（3），115 – 123。
Thompson, W. R., Gordon, N. F., & Pescatello, L. S. (2009). ACSM's guidelines for exercise testing and prescription: Hubsta Ltd.
Tung, H.-H., Jan, M.-S., Lin, C.-Y., Chen, S.-C., & Huang, H.-C. (2012). Mediating role of daily physical activity on quality of life in patients with heart failure. Journal of Cardiovascular Nursing, 27(1), 16-23.
Wang, C. C., Chen, J. H., Yu, W. C., Cheng, J. J., Yin, W. H., Wu, C. C., … Cherng, K. C. (2012). 2012 Guidelines of the Taiwan Society of Cardiology (TSOC) for the Diagnosis and Treatment of Heart Failure. Acta Cardiologica Sinica, 28(2), 161-195.
Weinman, J., Petrie, K. J., Moss-Morris, R., & Horne, R. (1996). The illness perception questionnaire: A new method for assessing the cognitive representation of illness. Psychology and Health, 11(3), 431-445.
While, A., & Kiek, F. (2009). Chronic heart failure: Promoting quality of life. British Journal of Community Nursing, 14(2), 54-59.
Yancy, C., Jessup, M., Bozkurt, B., Butler, J., Casey Jr, D., Drazner, M., … Januzzi, J. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College ofCardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure.Society of America Journal of the American College of Cardiology, Circulation , 136(6), e137 - e161. doi:10.1161/CIR.0000000000000509.
Yaraghchi, A., Rezaei, O., Mandegar, M. H., & Bagherian, R. (2012). The relationship between Illness perception and quality of life in Iranian patients with coronary artery bypass graft. Procedia-Social and Behavioral Sciences, 46, 3329-3334.
Zambroski, C. H. (2003). Qualitative analysis of living with heart failure. Heart & Lung: The Journal of Acute and Critical Care, 32(1), 32-40.
Piotr Ponikowski, Adriaan A. Voors, Stefan D. Anker, Héctor Bueno, John G. F. Cleland.(2016)2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure : The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the spec.European Journal of Heart Failure , 18(8), 891 – 975. doi:10.1002/ejhf.592.