Health-related quality of life after myocardial infarction is associated with level of left ventricular ejection fraction.

BACKGROUND: The objective was to explore the relationship between left ventricular ejection fraction (LVEF) assessed during hospitalization for acute myocardial infarction (MI) and later health-related quality of life (HRQoL). METHODS: We used multivariable linear regression to assess the relationship between LVEF and HRQoL in 256 MI patients who responded to the Kansas City Cardiomyopathy Questionnaire (KCCQ), the EQ-5D Index, and the EuroQol Visual Analogue Scale (EQ-VAS) 2.5 years after the index MI. RESULTS: 167 patients had normal LVEF (>50%), 56 intermediate (40%-50%), and 33 reduced (<40%). The mean (SD) KCCQ clinical summary scores were 85 (18), 75 (22), and 68 (21) (p <0.001) in the three groups, respectively. The corresponding EQ-5D Index scores were 0.83 (0.18), 0.72 (0.27), and 0.76 (0.14) (p = 0.005) and EQ-VAS scores were 72 (18), 65 (21), and 57 (20) (p = 0.001). In multivariable linear regression analysis age > or = 70 years, known chronic obstructive pulmonary disease (COPD), subsequent MI, intermediate LVEF, and reduced LVEF were independent determinants for reduced KCCQ clinical summary score. Female sex, medication for angina pectoris at discharge, and intermediate LVEF were independent determinants for reduced EQ-5D Index score. Age > or = 70 years, COPD, and reduced LVEF were associated with reduced EQ-VAS score. CONCLUSION: LVEF measured during hospitalization for MI was a determinant for HRQoL 2.5 years later.

Understanding sex differences in health-related quality of life following myocardial infarction.

BACKGROUND: The role of sex differences in health-related quality of life (HRQoL) after myocardial infarction (MI) remains controversial. METHODS: In total 408 Norwegian patients completed the Short Form 36 (SF-36) questionnaire 2.5 years after MI. We compared HRQoL between sexes and with national norms. Multiple linear regression analysis was used to explore the association of scores on the Physical (PCS) and Mental (MCS) component summary scales with clinical and sociodemographic variables. RESULTS: Women scored lower than norms on the Physical functioning, Role functioning-physical, General health, and Role functioning-emotional scales. Men scored higher on Bodily pain, and lower on the other 7 scales compared to norms. Women <70 years scored lower than men on 3 out of 8 scales and on PCS. Women >/=70 scored lower than men on 5 out of 8 scales and on PCS. Relative to sex- and age-specific norms, there were no sex-differences in SF-36 scores. Age, time since the index MI, chronic obstructive pulmonary disease (COPD), previous MI, and stroke predicted PCS scores in women. Education, COPD, infarct localization, number of indications for cardiovascular medication at discharge, medication for heart failure, and subsequent MI predicted PCS scores in men. Smoking status, education, and Q-wave MI were determinants for MCS scores in men. CONCLUSION: Patients had impaired HRQoL compared to sex- and age-specific norms 2.5 years after MI. Women had lower HRQoL scores than men, but relative to norms HRQoL was equally affected in both sexes. Men and women had different determinants of HRQoL.

Reliability and validity of the Kansas City cardiomyopathy questionnaire in patients with previous myocardial infarction.

BACKGROUND: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a recently developed disease-specific instrument for measuring health-related quality of life (HRQoL) in patients with chronic heart failure (CHF) regardless of aetiology. AIM: To assess the reliability and validity of the KCCQ in patients with previous myocardial infarction (MI). METHODS AND RESULTS: In 754 myocardial infarction patients who were discharged alive, we collected clinical data from the patients' medical records. Two and a half years after the acute myocardial infarction, we mailed a self-administered questionnaire to the 548 patients still alive. The response rate was 74%. Internal consistency reliability, assessed with Cronbach's alpha, ranged 0.66-0.95. Test-retest reliability, tested with an intraclass correlation coefficient (ICC), ranged 0.41-0.83. The pattern of association between similar and dissimilar scales of the KCCQ and Short Form 36 (SF-36) supported the convergent/divergent validity of the KCCQ. Four of the KCCQ scales and the two summary scores discriminated between patients with and without medication for heart failure, and between different levels of left ventricular ejection fraction (LVEF) supporting different groups validity. CONCLUSIONS: The Norwegian version of the KCCQ showed acceptable reliability and cross-sectional validity, which support the use of this questionnaire to measure health-related quality of life after myocardial infarction.

Association of changes in health-related quality of life in coronary heart disease with coronary procedures and sociodemographic characteristics.

BACKGROUND: Few studies have focused on the association between the sociodemographic characteristics of a patient with the change in health-related quality of life (HRQOL) following invasive coronary procedures, and the results remain inconclusive. The objective of the present study was to measure the temporal changes in HRQOL of patients with coronary heart disease, and assess how these changes are associated with invasive coronary procedures and sociodemographic characteristics. METHODS: This was a prospective study of 254 patients with angina pectoris and 90 patients with acute coronary syndrome. HRQOL was assessed with the multi-item scales and summary components of the SF-36, both 6 weeks and 2 years after baseline hospitalization in 1998. Paired t-tests and multiple regression analyses were used to assess temporal changes in HRQOL and to identify the associated factors. RESULTS: Physical components of HRQOL had improved most during the 2 years following invasive coronary procedures. Our findings indicated that patients with angina pectoris who were younger, male, and more educated were most likely to increase their HRQOL following invasive coronary procedures. When adjusting for baseline HRQOL scores, invasive coronary procedures and sociodemographic characteristics did not explain temporal changes in patients with acute coronary syndrome, possibly due to higher comorbidity. CONCLUSION: Sociodemographic characteristics should be taken into account when comparing and interpreting changes in HRQOL scores in patients with and without invasive coronary procedures.

Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study).

OBJECTIVES: 1. To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases (myocardial infarction, acute coronary syndrome, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). 2. To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group, in comparison with similar changes in the conventional care group. DESIGN: Randomized, controlled, parallel-group design (intervention/conventional care). SETTING: Akershus County, southeast of Oslo City, Norway. PARTICIPANTS: 500 patients, men and women, aged 40-85 years, who have sustained at least one of the above-mentioned cardiovascular diseases. INTERVENTIONS: 8 weeks of supervised, structured physical training of three periods of 20 min per week, targeting a heart rate of 60-70% of the individual's maximum; home-based physical exercise training with the same basic schedule as in the supervised period; quantification of patients' compliance with the exercise programme by the use of wristwatches, information stored in the watch memory being retrieved once a month during the 3-year follow-up period; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control.