Health related quality of life after conservative or invasive treatment of inducible postinfarction ischaemia. DANAMI study group

Cost-effectiveness of percutaneous coronary intervention versus medical therapy in patients with acute myocardial infarction: real-world and lifetime-horizon data from Taiwan

Although some studies have assessed the cost-effectiveness of percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI), there has been a lack of nationwide real-world studies estimating life expectancy (LE), loss-of-LE, life-years saved, and lifetime medical costs. We evaluated the cost-effectiveness of PCI versus non-PCI therapy by integrating a survival function and mean-cost function over a lifelong horizon to obtain the estimations for AMI patients without major comorbidities. We constructed a longitudinal AMI cohort based on the claim database of Taiwan's National Health Insurance during 1999–2015. Taiwan's National Mortality Registry Database was linked to derive a survival function to estimate LE, loss-of-LE, life-years saved, and lifetime medical costs in both therapies. This study enrolled a total of 38,441 AMI patients; AMI patients receiving PCI showed a fewer loss-of-LE (3.6 versus 5.2 years), and more lifetime medical costs (US$ 49,112 versus US$ 43,532). The incremental cost-effectiveness ratio (ICER) was US$ 3488 per life-year saved. After stratification by age, the AMI patients aged 50–59 years receiving PCI was shown to be cost-saving. From the perspective of Taiwan's National Health Insurance, PCI is cost-effective in AMI patients without major comorbidities. Notably, for patients aged 50–59 years, PCI is cost-saving.

Multivessel Versus Culprit Vessel-Only Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction: Insights From the TRANSLATE-ACS Observational Study

Background

Among patients with acute myocardial infarction (MI) who have multivessel disease, it is unclear if multivessel percutaneous coronary intervention (PCI) improves clinical and quality‐of‐life outcomes compared with culprit‐only intervention. We sought to compare clinical and quality‐of‐life outcomes between multivessel and culprit‐only PCI.

Methods and Results

Among 6061 patients with acute MI who have multivessel disease in the TRANSLATE‐ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study, we used inverse probability‐weighted propensity adjustment to study the associations between multivessel and culprit‐only intervention during the index PCI and major adverse cardiovascular events, unplanned all‐cause readmission, and angina frequency at 6 weeks and 1 year. Multivessel PCI was performed in 1208 (20%) of patients with MI who had multivessel disease. Relative to the culprit‐only intervention, patients receiving multivessel PCI were similarly aged and more likely to be seen with non–ST‐segment elevation MI or cardiogenic shock. At 6 weeks, the initial multivessel PCI strategy was associated with lower major adverse cardiovascular events and unplanned readmission risks, whereas angina frequency was not significantly different between multivessel and culprit‐only PCI. At 1 year, major adverse cardiovascular event risk was persistently lower in the multivessel PCI group (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72–0.99), whereas long‐term readmission risk (adjusted hazard ratio, 0.94; 95% confidence interval, 0.84–1.04) and angina frequency were similar between groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.82–1.24). Similar associations were seen when patients with ST‐segment elevation MI and non–ST‐segment elevation MI were examined separately.

Conclusions

Among patients with acute MI who have multivessel disease, multivessel PCI was associated with lower risk of all‐cause readmission at 6 weeks and lower risk of major adverse cardiovascular events at 6 weeks and 1 year. However, similar short‐ and long‐term angina frequencies were noted.

Myocardial revascularization for the elderly: current options, role of off-pump coronary artery bypass grafting and outcomes

The increase in life expectancy has confronted cardiac surgery with a rapidly growing population of elderly patients requiring surgical myocardial revascularization. Recent advances in surgical and anesthetic techniques and improvements in postoperative care have made coronary artery bypass grafting an established therapeutic option for the treatment of coronary artery disease in this group of patients. However, conventional coronary artery bypass grafting on cardiopulmonary bypass is associated with significant risk and related morbidity and mortality in the elderly. In recent years off-pump coronary artery bypass grafting has emerged as a safe and less invasive strategy for surgical myocardial revascularization. Off-pump coronary artery bypass grafting by avoiding the deleterious effects of cardiopulmonary bypass can offer potential benefits to elderly patients requiring surgical myocardial revascularization. This review article provides an overview of the age-related cardiovascular changes, epidemiology of coronary artery disease in the elderly and focuses on outcomes of surgical myocardial revascularization with special emphasis on the impact of off-pump coro-nary artery bypass surgery in the elderly.

Peer-led diabetes self-management programme for community-dwelling older people in China: study protocol for a quasi-experimental design

AIM

A protocol for a new peer-led self-management programme for community-dwelling older people with diabetes in Shanghai, China.

BACKGROUND

The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self-management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising.

DESIGN

Quasi-experimental.

METHODS

This study is a non-equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self-efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self-efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self-efficacy, social support, self-management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks.

DISCUSSION

This theory-based programme tailored to Chinese patients has potential for improving diabetes self-management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks, is especially promising considering healthcare resource shortage in China.

Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial)

OBJECTIVES

The purpose of this study was to compare health-related quality of life (HRQOL) outcomes in patients treated with carotid artery stenting (CAS) versus carotid endarterectomy (CEA).

BACKGROUND

In CREST (Carotid Revascularization Endarterectomy versus Stenting Trial), the largest randomized trial of carotid revascularization to date, there was no significant difference in the primary composite endpoint, but rates of stroke and myocardial infarction (MI) differed between CAS and CEA. To help guide individualized clinical decision making, we compared HRQOL among patients enrolled in the CREST study. We also performed exploratory analyses to evaluate the association between periprocedural complications and HRQOL.

METHODS

We measured HRQOL at baseline, and after 2 weeks, 1 month, and 1 year among 2,502 patients randomly assigned to either CAS or CEA in the CREST study. The HRQOL was assessed using the Medical Outcomes Study Short-Form 36 (SF-36) and 6 disease-specific scales designed to study HRQOL in patients undergoing carotid revascularization.

RESULTS

At both 2 weeks and 1 month, CAS patients had better outcomes for multiple components of the SF-36, with large differences for role physical function, pain, and the physical component summary scale (all p < 0.01). On the disease-specific scales, CAS patients reported less difficulty with driving, eating/swallowing, neck pain, and headaches but more difficulty with walking and leg pain (all p < 0.05). However, by 1 year, there were no differences in any HRQOL measure between CAS and CEA. In the exploratory analyses, periprocedural stroke was associated with poorer 1-year HRQOL across all SF-36 domains, but periprocedural MI or cranial nerve palsy were not.

CONCLUSIONS

Among patients undergoing carotid revascularization, CAS is associated with better HRQOL during the early recovery period as compared with CEA-particularly with regard to physical limitations and pain-but these differences diminish over time and are not evident after 1 year. Although CAS and CEA are associated with similar overall HRQOL at 1 year, event-specific analyses confirm that stroke has a greater and more sustained impact on HRQOL than MI. (Carotid Revascularization Endarterectomy versus Stenting Trial [CREST]; NCT00004732)

Health-related quality of life one month after thrombolysis or primary PCI in patients with ST-elevation infarction. A DANAMI-2 sub-study

OBJECTIVES

To evaluate the health-related quality of life (HRQoL) following Primary percutaneous coronary intervention (PCI) or thrombolytic treatment for ST-elevation myocardial infarction (STEMI).

DESIGN

A questionnaire based study on patients randomised in the DANAMI-2 study to Primary PCI or thrombolysis for STEMI. A total of 1 351 patients (93.2% response rate) randomised in the DANAMI-2 study completed the HRQoL questionnaire one month after the infarction.

RESULTS

With respect to the primary end-points (SF-36 physical component score, angina pectoris, and dyspnoea), patients randomised to primary PCI scored better on the SF-36 physical component score (PCS) (p=0.007), and reported significantly less angina pectoris (p=0.010) and dyspnoea (p=0.010). Higher scores among PCI patients were also found on the SF-36 scales physical functioning (p=0.015), role-physical (p=0.017), and general health (p=0.009).

CONCLUSION

The results in this study support the hypothesis that primary PCI is superior to thrombolysis in treating STEMI, not only in clinical outcome, but also in quality of life outcome.

One-year health status outcomes of unstable angina versus myocardial infarction: a prospective, observational cohort study of ACS survivors

BACKGROUND

Unstable angina (UA) patients have lower mortality and reinfarction risks than ST-elevation (STEMI) or non-ST elevation myocardial infarction (NSTEMI) patients and, accordingly, receive less aggressive treatment. Little is known, however, about the health status outcomes (angina, physical function, and quality of life) of UA versus MI patients among survivors of an ACS hospitalization.

METHODS

In a cohort of 1,192 consecutively enrolled ACS survivors from two Kansas City hospitals, we evaluated the associations between ACS presentation (UA, NSTEMI, and STEMI) and one-year health status (angina, physical functioning and quality of life), one-year cardiac rehospitalization rates, and two-year mortality outcomes, using multivariable regression modeling.

RESULTS

After multivariable adjustment for demographic, hospital, co-morbidity, baseline health status, and treatment characteristics, UA patients had a greater prevalence of angina at 1 year than STEMI patients (adjusted relative risk [RR] = 1.42; 95% CI [1.06, 1.90]) and similar rates as NSTEMI patients (adjusted RR = 1.1; 95% CI [0.85, 1.42]). In addition, UA patients fared no better than MI patients in Short Form-12 physical component scores (UA vs. STEMI score difference -0.05 points; 95% CI [-2.41, 2.3]; UA vs. NSTEMI score difference -1.91 points; 95% CI [-4.01, 0.18]) or Seattle Angina Questionnaire quality of life scores (UA vs. STEMI score difference -1.39 points; 95% CI [-5.63, 2.85]; UA vs. NSTEMI score difference -0.24 points 95% CI [-4.01, 3.54]). Finally, UA patients had similar rehospitalization rates as MI patients (UA vs. STEMI adjusted hazard ratio [HR] = 1.31; 95% CI [0.86, 1.99]; UA vs. NSTEMI adjusted HR = 1.03; 95% CI [0.73, 1.47]), despite better 2-year survival (UA vs. STEMI adjusted HR = 0.51; 95% confidence interval (CI) [0.28, 0.95]; UA vs. NSTEMI adjusted HR = 0.40; 95% CI [0.24, 0.65]).

CONCLUSION

Although UA patients have better survival rates, they have similar or worse one-year health status outcomes and cardiac rehospitalization rates as compared with MI patients. Clinicians should be aware of the adverse health status outcome risks for UA patients and consider close monitoring for the opportunity to improve their health status and minimize the need for subsequent rehospitalization.

Psychological and social impacts of automated external defibrillators (AEDs) in the home

BACKGROUND

The majority of cardiac arrests occur in the home. The placement of AEDs in the homes of at-risk patients may save lives through early defibrillation. However, the impact of having an AED in the home on psychological outcomes and quality-of-life is unknown.

OBJECTIVE

The purpose of this research was to determine whether training in the use of and possessing an automated external defibrillator (AED) has an effect on a patient at risk's quality of life.

METHODS

We investigated the psychological consequences of AED training and possession of such a device for patients who recently experienced an acute ischemic event. One hundred fifty eight patients and their family members were assigned at random to receive cardiopulmonary resuscitation (CPR) training (N=66) or AED/CPR training and possession of the device after training (N=92). We measured quality of life using the Short-Form (SF-36) survey and a 9-item survey we developed specifically for this study to measure differences in social activities and worries about being left alone. Participants answered these questions at enrollment, 2 weeks, 3 months, and 3 months after enrollment.

RESULTS

Patients in the AED group reported lower (worse) scores on most SF-36 subscales at all periods, particularly in those subscales relating to social functioning. The differences were most often small and probably not clinically meaningful. The social activities/worry scales also favored the CPR group at all periods, but with no significant differences.

CONCLUSIONS

Physicians counselling patients about AEDs should be aware of the potential effects the device may have on a patient's social functioning.

Health-related quality of life as a predictor of mortality among community-dwelling older persons

Health-related quality of life (HRQOL) measures predict cause-specific mortality, but few studies have explored whether generic self-reported HRQOL measures are independently associated with mortality in community-dwelling older persons. We postulated that a general measure of HRQOL, the short form 36-item questionnaire (SF-36), would be independently predictive of mortality among community-dwelling older persons. To evaluate this hypothesis, we followed a fixed cohort of 4,424 community-dwelling older persons recruited from a 2000 population-based survey in Taiwan until 2003 and investigated whether HRQOL was predictive of 3-year mortality, even after adjusting for traditional clinical risk variables. The data were collected via a door-to-door survey, and interviewers collected information on the subjects' demographics, medical history, utilization of health services, functional ability, falls, and self-reported physical and mental symptoms. Of the 6053 eligible subjects, 4,424 residents agreed to participate in the baseline survey and were contacted in 2003. During the 3-year period, the 3-year cumulative mortality rate for the study population was 5%. Mortality was significantly higher among males (5.57% vs. 4.27%, p = 0.049), and cumulative mortality increased with age (chi (2)-test for trend; chi (2) = 7.734, p = 0.001). For all scales except bodily pain, there was a significant relationship between a 10-point lower baseline score and mortality. Our primary multivariate risk model, which included two summary measures of HRQOL and significant clinical variables, demonstrated that a 10-point decrease in either the baseline Physical Component Summary (PCS) score or the baseline Mental Component Summary (MCS) score was associated with higher mortality (PCS: RR: 1.60, 95% CI: 1.39-1.83; p < 0.001; MCS: RR: 1.16, 95% CI: 1.01-1.34; p = 0.036). The findings suggested that low baseline PCS and MCS scores were important independent risk factors for 3-year mortality among community-dwelling older persons, even after adjusting for other risk factors.

Quality of life improves after renal artery stenting

Although treatment of renal artery stenosis (RAS) with stents has been shown to improve blood pressure (BP) and renal function in some patients, little is known about the effect on health-related quality of life. A composite quality of life survey was administered in a cross-sectional cohort fashion to 149 patients presenting with angiographically and hemodynamically confirmed RAS either before (baseline, n = 37) or after (follow-up, n = 112) stent revascularization. BP, renal function, and antihypertensive medication use were also assessed. Systolic BP was lower in the revascularized patients (166 +/- 23 vs. 153 +/- 26, p < .01). The Short Form-36 Physical Component Summary (PCS) scores were higher (better) in revascularized patients (37 +/- 9 vs. 31 +/- 9, p < .01), whereas Mental Component Summary scores were equivalent (49 +/- 13 vs. 51 +/- 11, p = ns). Sleep dysfunction scores were lower (better) in the revascularized patients (32 +/- 26 vs. 48 +/- 32, p < .001), whereas self-reported appetite was higher (better; 62% +/- 29% vs. 73% +/- 27%,p < .05). After matching for age and gender, Short Form-36 PCS remained higher in the revascularized cohort (37 +/- 8 vs. 32 +/- 8, p < .05). Importantly, in multivariate analysis, revascularization was the most significant determinant of a higher PCS score (r2 = .07, beta = 5.21, p < .01). The current data suggest that renal artery stenting may improve health-related quality of life in patients with renovascular disease.

Determinants of health-related quality of life in patients with coronary artery disease

BACKGROUND

Health-related quality of life (HRQL) is increasingly being assessed as an outcome parameter, especially in chronic diseases such as coronary artery disease (CAD), in which the goal of treatment is not only to prolong life but also to relieve symptoms and improve function.

DESIGN

This study was carried out as a non-randomized prospective multicentre study.

METHODS

Patients (N = 432) with CAD were assessed at baseline, 1 and 3 months after treatment assignment [medication, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)]. HRQL was assessed using the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) and the Short Form 36 (SF-36). Depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale. Routine clinical data including disease severity were collected.

RESULTS

The short and intermediate-term results revealed HRQL differences between PCI and CABG in the month immediately after intervention despite the almost identical reduction in angina severity over the first month in both groups. PCI was associated with a relatively rapid increase in HRQL in the first month, with little further change by 3 months. In contrast, after CABG there was an initial deterioration in HRQL, which then improved significantly. The change in depression and anxiety score uniquely accounted for most of the change in the SF-36 (6%, 64%) and MacNew scales (4%, 69%), whereas treatment accounted for less than 1% in any HRQL scale score changes.

CONCLUSIONS

There appears to be evidence suggesting that HRQL changes after treatments in patients with CAD may be more strongly influenced by mood disturbance than by treatment methods.

Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non–ST-segment elevation myocardial infarction

OBJECTIVES

We sought to compare the effects of an early interventional strategy (IS) versus a conservative strategy (CS) on health-related quality of life (HRQOL) in patients with non-ST-segment elevation acute coronary syndromes (ACS).

BACKGROUND

The third Randomized Intervention Trial of unstable Angina (RITA-3) evaluated early IS (n = 895) versus CS (n = 915). We report one-year results of the RITA-3 trial concerning HRQOL.

METHODS

The patients' HRQOL was assessed with the Short Form-36 (SF-36) and Seattle Angina Questionnaire (SAQ) at four-month and one-year follow-up, and the EuroQOL Visual Analogue Scale (EQ-VAS) and EuroQOL 5-Dimensional Classification (EQ-5D) also measured at baseline. Analysis was performed using the two-sample t test and analysis of co-variance.

RESULTS

Mean changes from baseline EQ-VAS scores were better for IS than for CS at four months (treatment difference of 3.0, p < 0.001) and one year (2.3, p < 0.01). The EQ-5D utility scores were also higher for IS at four months (treatment difference: 0.036, p < 0.01) and at one year (0.016, p = 0.20). For SF-36, IS scored significantly better at four months for physical function, physical role function, emotional role function, social function, vitality, and general health. The SAQ scores for exertional capacity, anginal stability and frequency, treatment satisfaction, and disease perception were better for IS at four months. These treatment differences were present but attenuated by one-year follow-up. Improvements in HRQOL for IS could be attributed to improvements in anginal symptoms.

CONCLUSIONS

In patients with non-ST-segment elevation ACS, an early IS provides greater gains in HRQOL, as compared with CS, mainly due to improvements in angina grade.

Lasting impact on health-related quality of life after a first myocardial infarction

AIMS

To investigate if the previously reported lack of recovery in Health-Related Quality of Life (HRQOL), in myocardial infarction, patients, would be long lasting.

METHODS

Of 72 consecutive patients (19% women) with a mean age of 59 years, 65 consented to participate in a follow-up 1 and 2 years after their first myocardial infarction. HRQOL was assessed by self-administered questionnaires (SF-36, Cardiac Health Profile and Zung Depression Inventory).

RESULTS

For the age group <59 years, there was no statistically significant recovery in SF-36 Mental Component Summary scores over time. There were improvements in Physical Component Summary scores, from baseline to 12 and to 24 months (p=0.006 and p<0.001, respectively) and from 6 to 24 months (p=0.044). This group reached community norms in Physical Component Summary scores after 2 years but scored significantly below norms in Mental Component Summary scores throughout with an effect size of -0.5 (CI -0.88 to -0.14) at 2 years. In patients > or =59 years, no changes took place after 6 months. At 2 years, factors Emotional and Social Functioning in the Cardiac Health Profile showed statistically significant differences between groups (p=0.03 and p=0.05, respectively) demonstrating poorer quality of life in the age group <59 years.

CONCLUSIONS

In younger patients, a clinically important poorer effect on Health-Related Quality of life is still present 2 years after an acute myocardial infarction.

Randomized comparison of rapid ambulation using radial, 4 French femoral access, or femoral access with AngioSeal closure

Radial access and closure devices are associated with improved quality of life (QOL) after cardiac catheterization. Whether this is related to the access site or time to ambulation is unknown. Seventy-five patients undergoing cardiac catheterization were randomized to femoral 6 Fr with AngioSeal closure (F+C), femoral 4 Fr without closure, and radial (R) access. All patients were ambulated at 1 hr. QOL was measured utilizing visual analogue scales and Short Form-36 at baseline, 1 day, and 1 week. Time to ambulation and discharge were equivalent, as was postprocedure QOL. However, angiographic quality was lower in the 4 Fr group (P < 0.0001) and catheterization costs were higher in the F+C group (P < 0.0001). Ambulation 1 hr after catheterization can be accomplished utilizing radial, femoral 6 Fr with closure device, or femoral 4 Fr access with equivalent outcomes and QOL. However, this is achieved at a higher cost with a closure device, or lesser angiographic quality with 4 Fr catheters.

Adaptation of the MacNew quality of life questionnaire after myocardial infarction in an Iranian population

BACKGROUND

Health-related quality of life (HRQL) assessment is an important measure of the impact of a wide range of disease process on an individual. To date, no HRQL tool has been evaluated in an Iranian population with cardiovascular disorders, specifically myocardial infarction, a major cause of mortality and morbidity. The MacNew Heart Disease Health-related Quality of Life instrument is a disease-specific HRQL questionnaire with satisfactory validity and reliability when applied cross-culturally.

METHOD

A Persian version of MacNew was prepared by both forward and backward translation by bilinguals after which a feasibility test was performed. Consecutive patients (n = 51) admitted to a coronary care unit with acute myocardial infarction were recruited for measurement of their HRQL with retest one month after discharge in the follow-up clinic. Principal components analysis, intra-class correlation reliability, internal consistency, and test-retest reliability were assessed.

RESULTS

Trivial rates of missing data confirmed the acceptability of the tool. Principal component analysis revealed that the three domains, emotional, social and physical, performed as well as in the original studies. Internal consistency was high and comparable to other studies, ranging from 0.92 for the emotional and physical domains, to 0.94 for the social domain, and to 0.95 for the Global score. Domain means of 5, 5.3 and 4.9 for emotional, physical and social respectively indicate that our Iranian population has similar emotional and physical but worse social HRQL scores. Test-retest analysis showed significant correlation in emotional and physical domains (P < 0.05).

CONCLUSION

The Persian version of the MacNew questionnaire is comparable to the English version. It has high internal consistency and reasonable reproducibility, making it an appropriate specific quality of life tool for population-based studies and clinical practice in Iran in patients who have survived an acute myocardial infraction. Further studies are needed to confirm its validity in larger populations with cardiovascular disease.

Health-related quality of life in patients 7 months after a myocardial infarction: factors affecting the Short Form-12

We assessed patients' health-related quality of life after myocardial infarction and identified related variables. Clinical data were obtained retrospectively from medical records of consecutive patients admitted to a Midwestern university-affiliated medical center with diagnosis of myocardial infarction from July 1999-July 2000. Telephone interviews 7 months after discharge were made to administer the Short Form-12 (SF-12) and obtain patient, disease, drug, and intervention data. Complete information was obtained from 200 patients (mean age 63.4 +/- 13.1 yrs, 68% men). The mean Physical Component Summary (PCS)-12 score was 40.6 +/- 12.0, and the mean Mental Component Summary (MCS)-12 score was 52.1 +/- 10.0. Based on univariate analyses, low PCS-12 scores were associated with women; non-Q-wave infarctions; greater number of illnesses; history of myocardial infarction, chronic heart failure (CHF), transient ischemic attack (TIA), renal disease, peripheral vascular disease, or percutaneous coronary intervention (PCI); rehospitalization during the interim period; and unscheduled PCI since index myocardial infarction. Low MCS-12 scores were associated with age below 65 years, low overall self-reported drug therapy compliance, low self-reported compliance with angiotensin-converting enzyme inhibitor and lipid-lowering therapy, no history of coronary artery bypass graft, and no stress test since index myocardial infarction. A multivariate regression model for PCS-12 kept the following variables: greater number of illnesses, history of CHF or TIA, and rehospitalization since index myocardial infarction. The MCS-12 model contained age below 65 years, low overall compliance, and low compliance with lipid-lowering therapy. Further work is necessary to determine noncardiovascular predictors of quality of life and whether interventions for these patients will result in improved quality of life.