Predictors of quality of life after hospital admission for heart attack or angina

Abstract

This study tests the hypothesis that it is possible to predict people who will have a low quality of life (QOL) 6 months after hospital admission for acute myocardial infarction (AMI) or angina. Among 424 patients discharged from hospital in the Hunter Region of New South Wales with a diagnosis of AMI or angina, follow-up questionnaires were received from 303 at 6 months. Baseline data collected during hospitalisation included demographic variables and the `emotional' factor of a disease-specific QOL measure using a modified and validated self-administered questionnaire. The full QOL measure comprises `emotional', `physical' and `social' factors, each factor being assessed at the 6-month follow-up. Only baseline `emotional' QOL score and sex predicted 6-month QOL scores in patients with AMI. Scores were consistently lower in patients with angina, in whom marital and employment status, having had a previous AMI, current cigarette smoking, the presence of cardiac failure and baseline emotional QOL were all significantly associated with the 6-month QOL scores. The assessment of simple measures during hospitalisation for angina can be helpful in predicting those who will have a low QOL 6 months later. They may represent a high-risk group at whom counselling could be directed.

Introduction

There is considerable evidence that a number of people experience psychosocial disturbance following acute myocardial infarction, and that these people have a worse prognosis than others 1, 2, 3.

We have modified 4, 5a previously developed Quality of Life (QOL) questionnaire [6]and used it as an outcome measure in two intervention trials following hospital admission for suspected heart attack 7, 8. The results of these trials, in common with other interventions to improve QOL in similar situations, have been disappointing with only small or no improvements observed 9, 10, 11. We therefore sought to examine the predictors of QOL scores following hospital admission with a view to identifying markers of later reduced QOL in order to help target interventions. The second of our trials allowed us to examine QOL during hospital admission and at 6 weeks and 6 months after discharge [8].

This study tested the hypothesis that QOL scores following hospital admission for suspected heart attack may be predicted by a number of factors including patient demographic characteristics and severity of disease (presence of cardiac failure, length of hospital stay and previous heart attack). Our previous analyses found QOL to be lower among those admitted to hospital with angina than those with a definite acute myocardial infarction (AMI) [8], hence we have tested this hypothesis separately among the two groups.