Aim To define trajectories of perceived health-related quality of life (HRQoL) among survivors of acute myocardial infarction (AMI) and identify factors associated with trajectories.
Methods Data on HRQoL among 9566 survivors of AMI were collected from 77 National Health Service hospitals in England between 1 November 2011 and 24 June 2015. Longitudinal HRQoL was collected using the EuroQol five-dimension questionnaire measured at hospitalisation, 1, 6 and 12 months post-AMI. Trajectories of perceived HRQoL post-MI were determined using multilevel regression analysis and latent class growth analysis (LCGA).
Results One or more percieved health problems in mobility, self-care, usual activities, pain/discomfort and anxiety/depression was reported by 69.1% (6607/9566) at hospitalisation and 59.7% (3011/5047) at 12 months. Reduced HRQoL was associated with women (−4.07, 95% CI −4.88 to −3.25), diabetes (−2.87, 95% CI −3.87 to −1.88), previous AMI (−1.60, 95% CI −2.72 to −0.48), previous angina (−1.72, 95% CI −2.77 to −0.67), chronic renal failure (−2.96, 95% CI −5.08 to −0.84; −3.10, 95% CI −5.72 to −0.49), chronic obstructive pulmonary disease (−3.89, 95% CI −5.07 to −2.72) and cerebrovascular disease (−2.60, 95% CI −4.24 to −0.96). LCGA identified three subgroups of HRQoL which we labelled: improvers (68.1%), non-improvers (22.1%) and dis-improvers (9.8%). Non-improvers and dis-improvers were more likely to be women, non-ST-elevation myocardial infarction (NSTEMI) and have long-term health conditions, compared with improvers.
Conclusions Quality of life improves for the majority of survivors of AMI but is significantly worse and more likely to decline for women, NSTEMI and those with long-term health conditions. Assessing HRQoL both in hospital and postdischarge may be important in determining which patients could benefit from tailored interventions.
- Growth modelling
- Health-related quality-of-life
- Outcomes research
- myocardial infarction
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Contributors TM analysed the data and drafted the manuscript. CPG contributed to the design of the study, provided clinical expert advice in interpretation of the results, and was involved in manuscript writing. MH and OA were involved in design of the study, data management, and writing the manuscript. RW provided statistical advice, interpreted data, and was involved in manuscript writing. MP and TBD were involved in manuscript writing and interpretation of the results. GO was involved as a patient advisor in the interpretation of the research and the writing of the manuscript. AH contributed to the design of the study and manuscript writing. All authors made critical revisions and provided intellectual content to the manuscript, approved the final version to be published and agreed to be accountable for all aspects of the work. CPG and TM are the guarantors for this study.
Funding This research was funded by the National Institute for Health Research (NIHR/CS/009/004) and BHF Project Grant no. PG/19/54/34511. CPG was funded by the National Institute for Health Research (NIHR/CS/009/004). TBD and MH were funded by the British Heart Foundation (PG/13/81/30474).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval EMMACE-3 and 4 were given a favourable ethical opinion by the Leeds (West) and West Midlands Research Ethics committees (REC reference: 10/H131374 and 12/WM/0431) are registered on ClinicalTrials.gov (NCT01808027and NCT01819103), and were adopted onto the National Institute for Health Research Comprehensive Research Network portfolio (9102).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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