Table 2.

Pertinent quotes for each theme

Distressing Symptoms	1) Patient: “Shortness of breath and chest pain, flown here a few days ago... I just couldn't get any air, so I went to local hospital to try to figure out if I just needed some oxygen or if something else was going on.”
Unavoidable Progression of Chronic Disease	2)Patient: “I am at the later stages of it now. They say my heart is getting real stiff.” 3)Patient: “Diabetes [has a] deteriorating effect on your life. If you have high blood pressure, that has to be controlled. So they all have an impact on weight. Weight gain puts pressure on your heart .... It's all integrated and interconnected and one has an effect on another down the stretch.”
Influence of Psychological and Social Environment Factors	4)Patient: “I have a problem getting to the pharmacy, and paying... am not working, without money, you can't buy medication.” 5)Caregiver; “It's impossible to eat a good, proper, nice balanced diet when you are trying to scrape and save every penny on food stamps. You don't have the luxury to be able to buy fresh vegetables.” 6)Patient: “When I think about it, it is when I'm depressed that I eat stuff I shouldn't and drink too much. ... I just want to feel better, I just want to get to some kind of normal life.”
Self-Care and Adherence with Medical Recommendations	7)Patient: “Yeah, I was meeting goals for most part, but did go over a few times. I'm not going to lie.” 8)Patient: “I eat more salt in the hospital than I do at home! I follow the rules always when doctor tells me what to eat. Salt is not my problem. Diet is not my problem. It is hard to limit my salt intake but not as hard as it was.”
Health System Factors	9)Caregiver; “Last time, he had been here 15 days and they just wanted to get us out. But he had already started to gain, 2lbs, before he even left. But it never stopped; it just kept going up and up and up.” 10)Patient: “When I left I thought I was ok, but doc said that in retrospect she should have kept me a few more days.” 11)Patient: “I wasn't ready, but there wasn't much they could do.” 12)Patient: “I had a PCP there and it was really easy to get back and forth from his office. So I went there and they had no idea what to do with me.” 13)Patient: “Patients are humans. Doctors forget, ... they are so into their routines and dealing with [sick] people every day, and spitting out orders ...” 14)Patient: “Biggest problem, our doc at home, he is a great communicator and talks to people up here before he does anything, but his lack of knowledge of heart disease, he doesn't do something or doesn't do something enough.”