Health related quality of life in coronary patients and its association with their cardiovascular risk profile: Results from the EUROASPIRE III survey

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Abstract

Background

Cardiovascular patients are likely to have an impaired health-related quality of life (HRQoL) due to functional and psycho-social limitations. The main objective of this study was to assess the distribution of HRQoL scores in coronary heart disease (CHD) patients across 22 European countries and to identify factors associated with the variation between patients.

Methods

Data from the EUROASPIRE III survey (European Action on Secondary and Primary Prevention by Intervention to Reduce Events), on 8734 patients, were used. Patients with a diagnosis of CHD (coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) or myocardial ischemia) were interviewed and examined at least 6 months after their acute coronary event. Quality of life of each patient was measured using 2 standardized questionnaires: the EuroQoL-5D (EQ-5D) and the 12-item short-form health survey (SF-12v2).

Results

HRQoL values differed significantly across countries. Lower HRQoL estimates were found in women, older patients, less educated patients, patients with myocardial infarction or ischemia as recruiting diagnosis, patients with a history of stroke and patients who suffered from a recurring CHD event. In addition, HRQoL was significantly associated with current smoking, central obesity, lack of exercise and inappropriate HbA1c control in patients with diabetes. Furthermore the number of risk factors is inversely associated with HRQoL.

Conclusion

Overall, a large heterogeneity was observed in HRQoL values between countries and patient groups. There seems to be a significant association between quality of life and patient characteristics with lifestyle risk factors as important determinants of HRQoL.

Introduction

Cardiovascular disease (CVD) remains the most common cause of disease burden in Europe, with coronary heart disease (CHD) being the single most important cause of death [1]. Conventional treatment focuses mainly on functional outcomes, survival and extending life. However, morbidity and mortality rates are incomplete measures of outcome, since they do not reflect all aspects of health. Many patients consider the quality of the additional life years gained equally important as the length of life. Indeed, the goal of today's medicine should be to increase both patients' quantity and quality of life [2]. In response, assessment of health-related quality of life (HRQoL) has been increasingly integrated in daily clinical practice. HRQoL is a subjective measure of overall well-being and reflects how a disease and its symptoms are perceived by a patient. Although there is no universal agreement on what constitutes HRQoL, current assessment focuses on the domains of social functioning, physical functioning and psychological functioning [3].

CHD patients are known to have an impaired HRQoL [4]. Recent studies have shown a significant influence of HRQoL on long-term outcomes. Poor HRQoL has been shown to predict morbidity and mortality in patients with CHD, even when controlling for standard risk factors [5], [6], [7].

The aim of our study was to examine the relationship between the cardiovascular profile of coronary patients and their HRQoL. Data were derived from the EUROASPIRE III (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) survey wherein two commonly used instruments were employed to assess patient's HRQoL: the EQ-5D (EuroQol-5D) and the SF-12v2 (12-item short-form health survey).

Section snippets

Study population and data collection

The details of the EUROASPIRE III study have been reported elsewhere [8]. In brief, EUROASPIRE III, performed in 2006–07 in patients with established CHD, was a cross-sectional study to determine whether the European recommendations on CVD prevention were being followed in everyday clinical practice. Patients aged between 18 and 80 years, hospitalized for coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) or myocardial ischemia,

Results

HRQoL data (full information on at least 1 HRQoL instrument) were available for 8734 patients (Table 1). About three quarters (74.6%) of patients included in our analyses were males (n = 6516). The average age of patients was 63.2 years (SD = 9.5). About 60% of patients included, had a cardiac revascularization as recruiting diagnosis, 19.5% was diagnosed with AMI.

The overall mean PCS-12 and MCS-12 were 42.14 (SD = 10.15) and 49.15 (SD = 10.22) respectively. For the EQ-VAS a mean value of 66.42 (SD = 

Discussion

In this study, including 8734 stabilized CHD patients from 22 European countries, we aimed to analyze the association between HRQoL and patient characteristics. As expected the overall HRQoL scores in our cohort of CHD patients were lower compared to the general population [13] and similar to previously reported results [4]. Furthermore, consistent with previous research and compared to the general population, having CHD seemed to have a limited influence on the mental health status, in

Acknowledgment

We thank the administrative staff, physicians, nurses, and other personnel at the hospitals in which the study was carried out, and all the patients who participated in the EUROASPIRE studies.

The EUROASPIRE survey was supported with the aid of unrestricted educational grants, which were given to the European Society of Cardiology by the following companies: main sponsors: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, Sanofi-Aventis, and Servier; sponsors: Merck/Schering-Plough and

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