Date of Graduation


Document Type


Degree Type



School of Nursing


Adult Health

Committee Chair

Jennifer Mallow

Committee Co-Chair

Georgia Narsavage

Committee Member

R David Parker

Committee Member

Carl Shrader


Background: Heart failure is becoming more prevalent in the United States due to our aging population. More than 10% of people over the age of 70 have heart failure. Risk factors include coronary artery disease (CAD), which includes myocardial infarction and angina. Hypertension precedes heart failure in 75% of cases. Risk factors for CAD include obesity, high glycemic intake, high dietary sodium intake, sedentary lifestyle, and cigarette smoking. In West Virginia, the heart failure death rate is 32.6 per 100,000 population, accounting for 3% of all deaths. The highest rates of hospitalization for heart failure in the nation are found in Appalachia yet a gap exists in the literature on how modifiable risk factors are related to the well-being of people living in this region.;Aims: The aims of this study were to determine the relationship between nutrition, obesity, physical activity, and smoking on physical, social, and emotional well-being among Appalachian patients with heart failure.;Methods: A cross-sectional, descriptive, correlational study using a convenience sample of 115 patients from a nursing home, two outpatient clinics, and a tertiary-care hospital was conducted to examine the relationship between modifiable risk factors and well-being as measured by the Minnesota Living With Heart Failure Questionnaire (MLHFQ). Modifiable risk factors were measured using (1) the American Heart Association Life's Simple 7 Questionnaire to assess nutrition habits, (2) BMI as a measure of obesity, (3) the Duke Activity Status Index (DASI) for physical activity, and (4) the Global Adult Tobacco Survey (GATS) to determine smoking status. Bivariate and descriptive analyses were performed and nonparametric analogs were used to examine the relationship between predictor and outcome variables. One-way analysis of variance (ANOVA) tests were used to further analyze risk factors in relation to levels of well-being.;Results: A majority of participants in this study were older, white, obese or overweight, and of lower socioeconomic status and had New York Heart Association (NYHA) class III or IV disease. Statistically significant findings included higher levels of physical activity being related to enhanced levels of physical, social, and emotional well-being. Nutritional status was found to be significantly related to higher levels of social well-being.;Conclusion: Knowledge of modifiable risk factors and their relationship to the well-being of individuals with heart failure in Appalachia is necessary to develop appropriate secondary prevention measures aimed at reducing or eliminating these risk factors. Physical activity programs may have the greatest impact on physical, social, and emotional well-being in this study population. Identifying resources in rural areas of Appalachia is necessary to promote behavior modification to reduce modifiable risks to ultimately minimize disease progression.