Trajectories of Health-Related Quality of Life in Coronary Artery Disease

Assessment of Health-Related Quality of Life and Its Associated Factors Among Cardiovascular Disease Patients at a Teaching Hospital in Northwest Ethiopia: A Cross-Sectional Study

Background: Health-related quality of life (HRQoL) has become a widely recognized outcome measure to assess the impact of illnesses or effectiveness of treatments. This study was carried out to investigate HRQoL and associated factors among cardiovascular disease patients. Method: This is a cross-sectional study and was carried out from July 01 to August 30, 2021. The patients were recruited using systematic random sampling technique and data was collected using EQ-5D five-level (EQ-5D-5L) questionnaires and EQ visual analog scale (EQ VAS). Utility index values were calculated using disutility weights set in Ethiopian context. Mann-Whitney U and Kruskal-Wallis tests were employed to compare the median index values and EQ VAS scores across subgroups. Tobit regression analysis was performed to determine factors associated with HRQoL. Results: Performing usual activities (76.8%) and pain/discomfort (74.9%) were the first and the second dimensions of most frequently reported health problems, respectively. The overall median (interquartile range) EQ-5D-5L index value and VAS score were 0.82 (0.65-0.92) and 70.0 (60.0-80.0), respectively. Older age, multiple CVD diagnoses, and adherence problems to medications were found to be negatively associated with HRQoL. Conclusion: In conclusion, performing usual activities and pain/discomfort were the dimensions with the most frequently reported problems. This finding dictates the importance of giving special attention to these dimensions in managing CVD patients. Besides, older age, multiple CVDs, and nonadherence to medications were negatively associated with HRQoL. Thus, acting in consideration of these factors in patient management may have positive implications in improving their HRQoL.

Exercise type and settings, quality of life, and mental health in coronary artery disease: a network meta-analysis

BACKGROUND AND AIMS

Individuals with coronary artery disease have poorer mental health, health-related quality of life (HR-QoL), and cognition compared with (age-matched) controls. Exercise training may attenuate these effects. The aim is to systematically review and meta-analyse the effects of different exercise types and settings on brain structure/function, cognition, HR-QoL, mental health (e.g. depression, anxiety), and sleep in patients with coronary artery disease.

METHODS

A systematic search was conducted and a network meta-analysis compared (i) exercise types, high-intensity interval training (HIIT), HIIT + resistance (HIIT + R), moderate-intensity training (MIT), MIT + R and stretching-toning-balance training, and (ii) exercise settings, in-person and home-based.

RESULTS

A total of 42 randomized controlled trials with a parallel group design were identified, of which 36 were included in the meta-analysis. Few studies included cognition (n = 2), sleep (n = 2), and none brain structure/function (n = 0). Most studies examined HR-QoL (n = 30), depression (n = 15), and anxiety (n = 9), in which outcomes were meta-analysed. HIIT + R, HIIT, and MIT were associated with improved HR-QoL vs. no exercise (i.e. usual care) [standardized mean difference, SMD: 1.53 (95% confidence interval 0.83; 2.24), 0.44 (0.15; 0.73), and 0.44 (0.20; 0.67), respectively]. In-person exercise was associated with larger and significant improvements [HR-QoL SMD: 0.51 (0.28; 0.74), depressive SMD: -0.55 (-1.03; -0.07), and anxiety symptoms SMD: -1.16 (-2.05; -0.26)] compared with no exercise, whereas home-based programmes were not significantly associated with improvements in these outcomes. Findings were robust in secondary (i.e. intervention duration and volume) and sensitivity analyses excluding high risk of bias studies.

CONCLUSIONS

Exercise training, especially in-person sessions, was associated with improved HR-QoL, depression and anxiety, independently of exercise type. However, this study raises concern about the effectiveness of home-based programmes in improving these outcomes.Study protocol was registered in PROSPERO (ID: CRD42023402569).

Quality of Life Predictors in Patients with Acute Lower Limb Ischemia Quality of Life in Acute Limb Ischemia

BACKGROUND

While existing literature has established factors associated with improved health-related quality of life (HRQOL) in patients with chronic limb-threatening ischemia, similar work has not been done in individuals with acute lower limb ischemia (ALLI). This study aims to identify the factors associated with HRQOL in patients presenting with ALLI.

METHODS

Using a prospectively collected registry, all patients who received treatment for ALLI between May 2016 and July 2023 at a quaternary medical center were identified and invited to complete two HRQOL questionnaires: the Vascular Quality of Life Questionnaire-6 (VascuQoL-6) and the EuroQol 5-Dimension 5-Level (EQ-5D-5L). Simple linear regression followed by multivariate analysis using multiple linear regression were used to determine the patient variables independently associated with HRQOL.

RESULTS

Of the 216 eligible patients treated for ALLI during the study period, 47 (20%) of patients with a mean age of 58 ± 10 years completed the HRQOL questionnaires. Questionnaires were completed at a median time of 16.5 months after the episode of ALLI. On multiple linear regression, higher age was associated with higher VascuQoL-6 (P = 0.037) and EQ-5D-5L (P = 0.041) scores, while hypertension and nonambulatory status were significant predictors of lower VascuQoL-6 (P = 0.006, P = 0.013) and EQ-5D-5L (P = 0.009, P = 0.026) scores. Any ambulation had a significantly higher HRQOL compared to nonambulatory status, but no significant HRQOL difference was observed between patients with any type of ambulation (unhindered ambulation, ambulation with pain, and ambulation using a prosthesis).

CONCLUSIONS

This study demonstrates that the ability to ambulate after ALLI, and not amputation per se, is an important predictor of HRQOL. As such, early rehabilitation strategies should be a focus of post-ALLI care. Further exploration of factors that shape HRQOL after ALLI is needed.

Self-care trajectories of patients with coronary heart disease: a longitudinal, observational study

AIMS

To determine if distinct trajectories of coronary heart disease (CHD) self-care behaviours could be identified, linked to differences in quality of life (QoL), and predicted based on baseline characteristics.

METHODS AND RESULTS

A secondary analysis of a prospective, longitudinal, observational study. Patients with CHD answered questionnaires at study enrolment and six months later: Self-Care of Coronary Heart Disease Inventory (three subscales: maintenance, management, and confidence, scored 0-100, higher score = better self-care), Hospital Anxiety and Depression Scale, 12-Item Short Form Survey, 16-Item European Health Literacy Survey Questionnaire, and CHD Education Questionnaire. Latent growth mixture modelling was used to identify distinct self-care trajectories over time. On average, patients (n = 430, mean age 64.3 ± 8.9, 79% male) reported inadequate self-care (maintenance 61.6 ± 15.4, management 53.5 ± 18.5) at enrolment. Two distinct trajectories of self-care behaviours were identified: first, an 'inadequate-and-worsening' (IN-WORSE) trajectory (57.2%), characterized by inadequate self-care, improvement in maintenance (4.0 ± 14.5-point improvement, P < 0.001), and worsening of management over time (6.3 ± 24.4-point worsening, P = 0.005). Second, an 'inadequate-but-maintaining' (IN-MAIN) trajectory (42.8%), characterized by inadequate self-care, improvement in maintenance (5.0 ± 16.2-point improvement, P < 0.001), and stability in management over time (0.8 ± 21.9-point worsening, P = 0.713). In comparison, patients in the IN-WORSE trajectory had less favourable characteristics (including lower health literacy, knowledge, confidence) and significantly lower QoL. Not attending rehabilitation (OR 2.175; CI 1.020-4.637, P = 0.044) and older age (OR 0.959; CI 0.924-0.994, P = 0.024) predicted (IN-WORSE) trajectory inclusion.

CONCLUSION

Two self-care trajectories were identified, both suboptimal. Rehabilitation predicted membership in the more favourable trajectory and some positive characteristics were identified among patients in that group. Therefore, interventions supporting these factors may benefit patients' self-care and QoL.

Effects of Different Exercise Interventions on Cardiorespiratory Fitness, as Measured by Peak Oxygen Consumption in Patients with Coronary Heart Disease: An Overview of Systematic Reviews

BACKGROUND

Exercise is an important component of rehabilitation care for people with coronary heart disease (CHD).

OBJECTIVES

The aim of this study was to critically analyze and summarize the existing evidence from published systematic reviews (SRs) and meta-analyses of randomized controlled trials (RCTs) that have evaluated the effects of different types of exercise interventions on cardiorespiratory fitness, as measured by peak oxygen consumption in people with CHD.

METHODS

Electronic databases (Cochrane Library, Medline/PubMed, EMBASE, and PEDro) were searched for SRs of exercise interventions of people with CHD. Two reviewers assessed the quality of SRs using the AMSTAR-2 tool and evaluated the strength of evidence quality with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system for relevant outcome measures. Mean difference (MD) and 95% confidence intervals (CIs) were calculated.

RESULTS

Thirty-one SRs (with 125 RCTs) met the study criteria, including 33,608 patients. Compared with usual care, continuous aerobic exercise produced an improvement in peak oxygen consumption, MD of 3.8 mL kg-1 min-1 (95% CI: 3.204.4, I2 = 67%); high-intensity interval training, MD 6.1 mL kg-1 min-1 (95% CI: 0.4-11.8, I2 = 97%); resistance training, MD of 2.1 mL kg-1 min-1 (95% CI: 0.98-3.2, I2 = 60%); combined aerobic and resistance training, MD of 3.0 mL kg-1 min-1 (95% CI: 2.5-3.4, I2 = 0%); and water-based exercise, MD of 4.4 mL kg-1 min-1 (95% CI, 2.1-6.7; I2 = 2%).

CONCLUSION

Exercise interventions improve peak oxygen consumption in people with CHD. However, there was moderate to very-low certainty for the evidence found.

Efficacy and Safety of Inclisiran in Patients with Polyvascular Disease: Pooled, Post Hoc Analysis of the ORION-9, ORION-10, and ORION-11 Phase 3 Randomized Controlled Trials

PURPOSE

Patients with polyvascular disease (PVD) are at very high cardiovascular risk and require intensive lipid-lowering therapy. This analysis describes the lipid-lowering efficacy and safety of inclisiran versus placebo in patients with and without PVD.

METHODS

In this post hoc analysis of the ORION-9, ORION-10, and ORION-11 trials, patients were randomized 1:1 to receive 284 mg inclisiran (300 mg inclisiran sodium) or placebo on day 1, day 90, and 6-monthly thereafter. Percentage change in low-density lipoprotein cholesterol (LDL-C) from baseline to day 510 and corresponding time-adjusted change from day 90 and up to day 540 were evaluated per patients' PVD status. Safety was assessed over 540 days.

RESULTS

Of 3454 patients, 470 (13.6%) had PVD, and 2984 (86.4%) did not. Baseline characteristics were generally balanced between the treatment arms in both cohorts. A greater proportion of patients with PVD had comorbidities versus those without. The mean (95% confidence interval [CI]) placebo-corrected LDL-C percentage change from baseline to day 510 was -48.9% (-55.6 to -42.2) in patients with PVD and -51.5% (-53.9 to -49.1) in patients without. Proportions of patients with reported treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events were similar between treatment arms, irrespective of PVD status, except for an excess of mild or moderate clinically relevant TEAEs at the injection site with inclisiran.

CONCLUSION

Twice-yearly inclisiran dosing (after the initial and 3-month doses) was well tolerated and provided effective and sustained lipid-lowering in patients, irrespective of PVD status.

Moderating Effect of Sex on the Relationship Between Physical Activity and Quality of Life in Coronary Heart Disease Patients in China

PURPOSE

The aim of this study was to investigate the moderating effect of sex on the relationship between physical activity (PA) and quality of life (QoL) in Chinese patients with coronary heart disease (CHD) not participating in cardiac rehabilitation.

METHODS

Chinese patients with CHD (aged 18-80 yr) were selected 12 mo after discharge from three Hebei Province tertiary hospitals. The International Physical Activity Questionnaire was used to assess PA in metabolic equivalents of energy (METs) and the Chinese Questionnaire of Quality of Life in Patients With Cardiovascular Disease was used to assess QoL. Data were analyzed using Student's t test and the χ 2 test, multivariant and hierarchical regression analysis, and simple slope analysis.

RESULTS

Among 1162 patients with CHD studied between July 1 and November 30, 2017, female patients reported poorer QoL and lower total METs in weekly PA compared with male patients. Walking ( β= .297), moderate-intensity PA ( β= .165), and vigorous-intensity PA ( β= .076) positively predicted QoL. Hierarchical regression analysis showed that sex moderates the relationship between walking ( β= .195) and moderate-intensity PA ( β= .164) and QoL, but not between vigorous-intensity PA ( β= -.127) and QoL. Simple slope analysis revealed the standardized coefficients of walking on QoL were 0.397 (female t  = 8.210) and 0.338 (male t = 10.142); the standardized coefficients of moderate-intensity PA on QoL were 0.346 (female, t  = 7.000) and 0.175 (male, t = 5.033).

CONCLUSIONS

Sex moderated the relationship between PA and QoL among patients with CHD in China. There was a greater difference in QoL for female patients reporting higher time versus those with lower time for both walking and moderate-intensity PA than for male patients.

Some types of exercise interventions are more effective than others in people with coronary heart disease: systematic review and network meta-analysis

QUESTION

What are the effects of different types of exercise treatments on oxygen consumption, quality of life and mortality in people with coronary heart disease?

DESIGN

Systematic review with network meta-analysis of randomised controlled trials.

PARTICIPANTS

Adults with coronary heart disease.

INTERVENTION

Exercise interventions including aerobic (continuous or high-intensity interval) training, resistance training, respiratory muscle exercises, water-based exercises, yoga, Tai chi, Qigong exercises and a combination of different types of exercise.

OUTCOME MEASURES

Oxygen consumption, quality of life and mortality.

RESULTS

This review included 178 randomised controlled trials with 19,143 participants. Several exercise interventions improved peak oxygen consumption (mL/kg/min): high-intensity interval training (MD 4.5, 95% CI 3.7 to 5.4); combined water-based exercises and moderate-intensity continuous training (MD 3.7, 95% CI 1.3 to 6.0); combined aerobic and resistance exercise (MD 3.4, 95% CI 2.5 to 4.3); water-based exercises (MD 3.4, 95% CI 0.6 to 6.2); combined respiratory muscle training and aerobic exercise (MD 3.2, 95% CI 0.6 to 5.8); Tai chi (MD 3.0, 95% CI 1.0 to 5.0); moderate-intensity continuous training (MD 3.0, 95% CI 2.3 to 3.6); high-intensity continuous training (MD 2.7, 95% CI 1.6 to 3.8); and resistance training (MD 2.2, 95% CI 0.6 to 3.7). Quality of life was improved by yoga (SMD 1.5, 95% CI 0.5 to 2.4), combined aerobic and resistance exercise (SMD 1.2, 95% CI 0.6 to 1.7), moderate-intensity continuous training (SMD 1.1, 95% CI 0.6 to 1.6) and high-intensity interval training (SMD 0.9, 95% CI 0.1 to 1.6). All-cause mortality was reduced by continuous aerobic exercise (RR 0.67, 95% CI 0.53 to 0.86) and combined aerobic and resistance exercise (RR 0.58, 95% CI 0.36 to 0.94). Continuous aerobic exercise also reduced cardiovascular mortality (RR 0.56, 95% CI 0.42 to 0.74).

CONCLUSION

People with coronary heart disease may use a range of exercise modalities to improve oxygen consumption, quality of life and mortality.

REGISTRATION

PROSPERO CRD42022344545.

Do Clinical Outcomes and Quality of Life Differ by the Number of Antianginals for Stable Ischemic Heart Disease? Insights from the BARI 2D Trial

Medical therapy, including antianginal treatment, is the cornerstone in the management of stable ischemic heart disease (SIHD). However, it remains unclear whether combining antianginal agents provides benefits beyond monotherapy in terms of quality of life (QoL) and cardiovascular outcomes. We used data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, which compared cardiovascular and QoL outcomes in patients with SIHD and diabetes mellitus randomized to revascularization with intensive medical therapy or intensive medical therapy alone. We categorized patients into 3 groups: ≥2 versus 1 versus 0 antianginals. We compared patient characteristics, QoL metrics, and cardiovascular end points at baseline and at 5 years, creating a multivariable model to adjust for key clinical confounders. Of 2,368 patients, 348 patients (14.7%) were on 0 antianginals, 1,020 patients (43.1%) were on 1 antianginal, and 1,000 patients (42.2%) were on ≥2 antianginals at baseline. The most common antianginal class was β blockers. At baseline, patients on 0 antianginals had better QoL metrics (self-health score, Duke activity status index, and energy rating) than patients on ≥2 antianginals. However, at the 1-year follow-up, patients taking only 1 antianginal showed greater QoL improvement than those taking 0 antianginal, without any incremental benefit in QoL metrics seen in patients taking ≥2 antianginal agents, even after adjusting for multiple covariates such as age, heart failure, diabetes control, and myocardial jeopardy index. Lastly, at the 5-year follow-up, after adjustment, there were no differences in all-cause mortality, major adverse cardiovascular events, or myocardial infarction between patients taking different numbers of antianginals. Adults on a single antianginal for SIHD and diabetes mellitus had similar or better improvements in QoL than those on 2 or more antianginal agents at 1 year of follow-up. These findings merit further research to better understand the impact of medical therapy intensity on QoL in patients with SIHD and associated co-morbidities.

Response shift in coronary artery disease

PURPOSE

Patients with coronary artery disease (CAD) experience significant angina symptoms and lifestyle changes. Revascularization procedures can result in better patient-reported outcomes (PROs) than optimal medical therapy (OMT) alone. This study evaluates the impact of response shift (RS) on changes in PROs of patients with CAD across treatment strategies.

METHODS

Data were from patients with CAD in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease (APPROACH) registry who completed the 16-item Canadian version of the Seattle Angina Questionnaire at 2 weeks and 1 year following a coronary angiogram. Multi-group confirmatory factor analysis (MG-CFA) was used to assess measurement invariance across treatment groups at week 2. Longitudinal MG-CFA was used to test for RS according to receipt of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical therapy (OMT) alone.

RESULTS

Of the 3116 patients included in the analysis, 443 (14.2%) received CABG, 2049(65.8%) PCI, and the remainder OMT alone. The MG-CFA revealed a partial-strong invariance across the treatment groups at 2 weeks (CFI = 0.98, RMSEA [90% CI] = 0.05 [0.03, 0.06]). Recalibration RS was detected on the Angina Symptoms and Burden subscale and its magnitude in the OMT, PCI, and CABG groups were 0.32, 0.28, and 0.53, respectively. After adjusting for RS effects, the estimated target changes were largest in the CABG group and negligible in the OMT group.

CONCLUSION

Adjusting for RS is recommended in studies that use SAQ-CAN to assess changes in patients with CAD who have received revascularization versus OMT alone.

Liver stiffness as a cornerstone in heart disease risk assessment

Metabolic dysfunction-associated steatotic liver disease (MASLD) typically presents with hepatic fibrosis in advanced disease, resulting in increased liver stiffness. A subset of patients further develops liver cirrhosis and hepatocellular carcinoma. Cardiovascular disease is a common comorbidity in patients with MASLD and its prevalence is increasing in parallel. Recent evidence suggests that especially liver stiffness, whether or not existing against a background of MASLD, is associated with heart diseases. We conducted a narrative review on the role of liver stiffness in the prediction of highly prevalent heart diseases including heart failure, cardiac arrhythmias (in particular atrial fibrillation), coronary heart disease, and aortic valve sclerosis. Research papers were retrieved from major scientific databases (PubMed, Web of Science) until September 2023 using 'liver stiffness' and 'liver fibrosis' as keywords along with the latter cardiac conditions. Increased liver stiffness, determined by vibration-controlled transient elastography or hepatic fibrosis as predicted by biomarker panels, are associated with a variety of cardiovascular diseases, including heart failure, atrial fibrillation, and coronary heart disease. Elevated liver stiffness in patients with metabolic liver disease should lead to considerations of cardiac workup including N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptide determination, electrocardiography, and coronary computed tomography angiography. In addition, patients with MASLD would benefit from heart disease case-finding strategies in which liver stiffness measurements can play a key role. In conclusion, increased liver stiffness should be a trigger to consider a cardiac workup in metabolically compromised patients.

A comparison of quality of life between older adults living in high and low altitude areas

Background

High altitude is known to have a significant impact on human physiology and health, therefore, understanding its relationship with quality of life is an important research area. This study compared the quality of life (QOL) in older adults living in high and low altitude areas, and examined the independent correlates of QOL in those living in a high altitude area.

Methods

Older adults living in three public nursing homes in Xining (high altitude area) and one public nursing home in Guangzhou (low altitude area) were recruited. The WHOQOL-BREF was used to measure the QOL.

Results

644 older adults (male: 39.1%) were included, with 207 living in high altitude and 437 living in low altitude areas. After controlling for the covariates, older adults living in the high altitude area had higher QOL in terms of physical (P = 0.035) and social domains (P = 0.002), but had lower QOL in psychological (P = 0.009) domain compared to their counterparts living in the low altitude area. For older adults living in the high altitude area, smoking status was associated with higher social QOL (P = 0.021), good financial status was associated with higher physical QOL (P = 0.035), and fair or good health status was associated with higher physical (p < 0.001) and psychological QOL (P = 0.046), while more severe depressive symptoms were associated with lower QOL.

Conclusion

Appropriate interventions and support to improve depressive symptoms and both financial and health status should be developed for older adults living in high altitude areas to improve their QOL.

The quality of long-term counselling for percutaneous coronary intervention patients: A cross-sectional study

AIM

To compare the long-term counselling quality among the patients visited and not visited at cardiac nurse after percutaneous coronary intervention (PCI) and related factors one to two years after PCI.

DESIGN

An explorative, register-based cross-sectional study.

METHODOLOGY METHODS

A sample was drawn from the one university hospital's procedure register consisted of the patients undergone a PCI (n = 977). The data was collected by Counselling Quality Instrument (CQI) questionnaire by mail, and analysed by basic and multivariate methods.

FINDINGS RESULTS

Of the respondents (n = 459), less than half the patients (48.4%) visited at cardiac nurse one to two years after PCI as instructed in the national current care guidelines. Patients, who visited the nurse (n = 194) had higher satisfaction for counselling than the ones not visited (n = 70). Nevertheless, patients, especially those who had no dyslipidemia, had Unstable Angina Pectoris or Non-ST-elevated myocardial infarction or were out of the workforce, were unsatisfied with counselling, and needed more social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. A half of the PCI patients (51.6%) did not visit the cardiac nurse at the primary health care.

PATIENT OR PUBLIC CONTRIBUTION

Cardiac nurses assisted the members of research group by assessing the questionnaire prior sending it to the patients and patients contributed by completing the questionnaires. We thank both parties for their contribution.

IMPLICATION FOR PROFESSION AND PATIENT CARE

This study demonstrated, that patients out of the workforce and having emergency PCI are in need for better quality counselling, concentrating on social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. Those patients, who did not visit the cardiac nurse, should be offered easier access to cardiac nurse for example, by novel digital solutions.

What's love got to do with it? Relationship quality appraisals and quality of life in couples facing cardiovascular disease

Objective

Changes in couples' relationship quality are common post-cardiac event but it is unclear how relationship quality is linked to patients' and spouses' quality of life (QoL). The purpose of the present study was to examine the association between relationship quality on QoL in patient-spouse dyads within six months of a cardiac event.

Methods

Participants (N = 181 dyads; 25.9% female patients), recruited from a large cardiac hospital, completed validated questionnaires measuring demographic, relationship (Dyadic Adjustment Scale; DAS) and QoL variables (Heart-QoL & Quality of life of Cardiac Spouses Questionnaire). An Actor-Partner Interdependence Model was used to investigate actor (i.e. responses influencing their own outcome) and partner effects (responses influencing their partner's outcome) of relationship quality and QoL.

Results

Patients' and spouses' perceptions of relationship quality were in the satisfied range (DAS > 108; 65% of sample) and, as expected, patients reported lower general physical QoL than did their spouse (t(180) = -10.635, p < .001). Patient and spouse relationship quality appraisals were positively associated with their own physical (patient β = .25; spouse β = .05) and emotional/social (patient β = .21; spouse β = .04) QoL. No partner effects were identified.

Conclusion

High quality relationship appraisals appear to matter for patients' and spouses' QoL after the onset of CVD.

Does coping with pain help the elderly with cardiovascular disease? The association of sense of coherence, spiritual well-being and self-compassion with quality of life through the mediating role of pain self-efficacy

BACKGROUND

Population ageing is considered one of the biggest challenges facing the world, and the status of the elderly in society and their quality of life (QOL) have proved to be a concern in professional and scientific research circles. As a result, the current study sought to investigate the role of pain self-efficacy (PSE) as a moderator in the relationship between sense of coherence (SOC), spiritual well-being, and self-compassion with QOL in Iranian elderly with cardiovascular disease (CVD).

METHOD

This was a correlational study of the path analysis type. The statistical population included all elderly people with CVD who were at least 60 years of age in Kermanshah Province, Iran, in 2022, of whom 298 (181 men and 117 women) were selected using convenience sampling and according to the inclusion and exclusion criteria. The participants answered questionnaires from the World Health Organization on QOL, Paloutzian and Ellison's spiritual well-being, Nicholas's PSE, Antonovsky's SOC, and Raes et al.'s self-compassion.

RESULTS

The results of path analysis demonstrated that the hypothesized model of this study has a good fit in the studied sample. There were significant paths between SOC (β = 0.39), spiritual well-being (β = 0.13) and self-compassion (β = 0.44) with PSE. Although there were significant paths between SOC (β = 0.16) and self-compassion (β = 0.31) with QOL, there was no significant path between spiritual well-being and QOL (β = 0.06). Besides, there was a significant path between PSE and QOL (β = 0.35). Finally, PSE was found to mediate the relationship of SOC, spiritual well-being and self-compassion with QOL.

CONCLUSION

The results may provide psychotherapists and counselors working in this field of inquiry with advantageous information to choose or create a useful therapeutic method to work with the elderly with CVD. Meanwhile, other researchers are suggested to examine other variables which may serve a mediating role in the mentioned model.

Loneliness predicts physical and mental health-related quality of life over 9 months among patients with coronary heart disease

This study investigated whether loneliness would predict physical and mental health-related quality of life (HRQoL) over 9 months and examined whether medical adherence would mediate their associations in patients with coronary heart disease (CHD). The overall design is a three-wave longitudinal study. A sample of 255 outpatients with CHD was recruited from a community-based cardiac rehabilitation programme. Participants, with a mean age of 63 years, completed measures assessing loneliness, depression and physical and mental HRQoL at baseline. Medical adherence was assessed at 3 months, and physical and mental HRQoL were reassessed at 9 months. A total of 88% of participants reported moderate or high loneliness. Baseline loneliness predicted physical and mental HRQoL at 9 months after adjusting for baseline physical and mental HRQoL, respectively. The effects remained significant when depression was also adjusted. Medical adherence at 3 months partially mediated the associations of baseline loneliness with 9-month physical and mental HRQoL. Findings underline the necessity of assessing loneliness for CHD patients to promote long-term medical adherence and further improve physical and mental HRQoL.

Effect of a mutual goal-based continuous care program on self-management behaviour and health outcomes in patients after percutaneous coronary intervention: A randomized controlled trial

AIMS

To evaluate the effects of mutual goal-based continuous care program on the outcomes of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).

DESIGN

A single-blinded randomized controlled trial.

METHODS

87 patients with CHD after PCI in Hangzhou, Zhejiang, China, were randomly divided into study (n = 42) and control (n = 45) groups. The control group received 12-week cardiac rehabilitation and routine care. The study group received routine care and cardiac rehabilitation and the 12-week intervention program developed according to the goal attainment theory, including the mutual goal-based face-to-face guidance, and every-2-week telephone follow-ups. The self-management behaviour, quality of life, unscheduled readmission rate, and satisfaction of patients were examined.

RESULTS

For the patients subjected to the developed continuous nursing program based on mutual goals, achievement rates of all dimension mutual goals were at high levels (from 80.21% to 98.41%), except for the weight control (60.94%). Moreover, according to the comparable base data, compared with the control group, the self-management behaviour (study group 93.43 vs. control group 76.00), quality of life (QoL), and patients' satisfaction (study group 4.64 vs. control group 4.11) were higher, while the unscheduled readmission rate (study group 4.76% vs. control group 22.22%) was lower, in the study group, with statistically significant differences.

Colchicine and quality of life in patients with acute coronary syndromes: Results from the COPS randomized trial

BACKGROUND

Recent data suggest that colchicine may reduce cardiovascular events among patients presenting with acute coronary syndromes. This sub-study of the Australian COPS trial aimed to assess whether colchicine affects health status outcomes.

METHODS

Health status was assessed at baseline and 12-months using the EuroQol-5 Dimension 5-level (EQ-5D-5L) score and the full 19-question Seattle Angina Questionnaire (SAQ). Data were available for 786 patients (388 randomized to colchicine, 398 to placebo).

RESULTS

Baseline characteristics were well matched between groups; mean age was 60.1 (SD 14.8) years, and 20 % were female. Baseline health status scores were impaired, and most parameters demonstrated significant improvement from baseline to 12-months (EQ-5D-5L Visual Analogue Score [VAS] 69.3 to 77.7; SAQ angina frequency score 83.0 to 95.3, both p < 0.001). No significant differences in adjusted mean score change among any of the EQ-5D-5L or SAQ dimensions were observed between treatment groups in either intention-to-treat or per-protocol analysis. There were borderline interactions in EQ-5D-5L scores for those with previous MI vs not, and in SAQ scores for those with obesity vs not. In categorical analysis using observed data, patients treated with colchicine were more likely to have clinically significant improvement in physical limitation score over the period (36 % improved vs. 28 %, p < 0.05). Baseline health status scores were not associated with the primary endpoint at 12 months.

CONCLUSIONS

Treatment with colchicine did not appear to affect change in measures of health status following acute coronary syndromes, but it did lead to a greater likelihood of improvement in physical limitation scores.

TRIAL REGISTRATION

ACTRN, ACTRN12615000861550. Registered 18/08/2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368973.

Impact of economic factors, social health and stressful life events on physical health-related quality of life trajectories in older Australians

PURPOSE

Physical health-related quality of life (HRQoL) is associated with adverse health outcomes, including hospitalizations and all-cause mortality. However, little is known about how physical HRQoL changes over time in older people and the predictors of this trajectory. This study (a) identified trajectories of physical HRQoL among older people and (b) explored whether economic factors, social health or stressful life events impact physical HRQoL trajectories.

METHOD

A cohort of 12,506 relatively 'healthy' community-dwelling Australians aged ≥ 70 years (54.4% females), enrolled in the ASPREE Longitudinal Study of Older Persons (ALSOP) study and was followed for six years. Economic factors, social health and life events in the last 12 months were assessed through a questionnaire at baseline. Physical HRQoL was measured by using the 12-item short form at baseline and annual follow-ups. Growth mixture and structural equation modelling were used to identify physical HRQoL trajectories and their predictors.

RESULTS

Four physical HRQoL trajectories were identified-stable low (7.1%), declining (9.0%), stable intermediate (17.9%) and stable high (66.0%). Living in more disadvantaged areas, having a lower household income, no paid work, no voluntary work, loneliness and stressful life events (i.e. spousal illness, friend/family illness, financial problem) were associated with a 10%-152% higher likelihood of being in the stable low or declining physical HRQoL trajectory than the stable high group.

CONCLUSION

Specific stressful life events had a greater impact on adverse physical HRQoL trajectories in older people than other factors. Volunteering may prevent physical HRQoL decline and requires further investigation.

Validation of the PROMIS-29v2 Health-Related Quality-of-Life Questionnaire in Patients With Coronary Heart Disease Participating in Remote Cardiac Rehabilitation

PURPOSE

The aim of this study was to validate the 29-item Patient-Reported Outcomes Measurement Information System version 2.0 (PROMIS-29v2) health-related quality-of-life (HRQL) questionnaire for use in patients with coronary heart disease (CHD) participating in remotely delivered cardiac rehabilitation (CR).

METHODS

Patients commencing remote CR across four sites in New South Wales, Australia, answered the PROMIS-29v2 and 12-item Short Form Health Survey version 2.0 (SF-12v2) questionnaires at CR entry and completion (6 wk). The data were analyzed for validity, reliability, and responsiveness to change.

RESULTS

Patients (N = 89) had a mean age of 66.9 ± 9.3 yr; 83% were male and were referred to CR for elective percutaneous coronary intervention (PCI) (42%), myocardial infarction (36%), and coronary artery bypass grafting (22%). Internal consistency reliability was adequate, with the Cronbach α ranging from 0.78-0.98. Convergent validity between the PROMIS-29v2 and SF-12v2 summary scores showed significantly strong correlations for physical (r = 0.62) and moderate for mental (r = 0.36) health. Discriminant validity was confirmed for sex (women reported lower physical and mental health) and referral diagnosis (patients who had elective PCI reported better physical health). Effect size (ES) comparisons confirmed responsiveness to change from CR entry to completion in physical health (ES = 0.51) and demonstrated evidence of more responsiveness than SF-12v2 for mental health (ES = 0.70).

CONCLUSION

The PROMIS-29v2 is reliable, valid, and responsive to changes in patients with CHD attending remotely delivered CR and allows for baseline HRQL assessment, between-diagnosis comparisons, and evaluation of changes over time.

European Society of Cardiology methodology for the development of quality indicators for the quantification of cardiovascular care and outcomes

AIMS

It is increasingly recognized that tools are required for assessing and benchmarking quality of care in order to improve it. The European Society of Cardiology (ESC) is developing a suite of quality indicators (QIs) to evaluate cardiovascular care and support the delivery of evidence-based care. This paper describes the methodology used for their development.

METHODS AND RESULTS

We propose a four-step process for the development of the ESC QIs. For a specific clinical area with a gap in care delivery, the QI development process includes: (i) the identification of key domains of care by constructing a conceptual framework of care; (ii) the construction of candidate QIs by conducting a systematic review of the literature; (iii) the selection of a final set of QIs by obtaining expert opinions using the modified Delphi method; and (iv) the undertaking of a feasibility assessment by evaluating different ways of defining the QI specifications for the proposed data collection source. For each of the four steps, key methodological areas need to be addressed to inform the implementation process and avoid misinterpretation of the measurement results.

CONCLUSION

Detailing the methodology for the ESC QIs construction enables healthcare providers to develop valid and feasible metrics to measure and improve the quality of cardiovascular care. As such, high-quality evidence may be translated into clinical practice and the 'evidence-practice' gap closed.

Association of multimorbidity and changes in health-related quality of life following myocardial infarction: a UK multicentre longitudinal patient-reported outcomes study

BACKGROUND

Multimorbidity is prevalent for people with myocardial infarction (MI), yet previous studies investigated single-health conditions in isolation. We identified patterns of multimorbidity in MI survivors and their associations with changes in HRQoL.

METHODS

In this national longitudinal cohort study, we analysed data from 9566 admissions with MI from 77 National Health Service hospitals in England between 2011 and 2015. HRQoL was measured using EuroQol 5 dimension (EQ5D) instrument and visual analogue scale (EQVAS) at hospitalisation, 6, and 12 months following MI. Latent class analysis (LCA) of pre-existing long-term health conditions at baseline was used to identify clusters of multimorbidity and associations with changes in HRQoL quantified using mixed effects regression analysis.

RESULTS

Of 9566 admissions with MI (mean age of 64.1 years [SD 11.9], 7154 [75%] men), over half (5119 [53.5%] had multimorbidities. LCA identified 3 multimorbidity clusters which were severe multimorbidity (591; 6.5%) with low HRQoL at baseline (EQVAS 59.39 and EQ5D 0.62) which did not improve significantly at 6 months (EQVAS 59.92, EQ5D 0.60); moderate multimorbidity (4301; 47.6%) with medium HRQoL at baseline (EQVAS 63.08, EQ5D 0.71) and who improved at 6 months (EQVAS 71.38, EQ5D 0.76); and mild multimorbidity (4147, 45.9%) at baseline (EQVAS 64.57, EQ5D 0.75) and improved at 6 months (EQVAS 76.39, EQ5D 0.82). Patients in the severe and moderate groups were more likely to be older, women, and presented with NSTEMI. Compared with the mild group, increased multimorbidity was associated with lower EQ-VAS scores (adjusted coefficient: -5.12 [95% CI -7.04 to -3.19] and -0.98 [-1.93 to -0.04] for severe and moderate multimorbidity, respectively. The severe class was more likely than the mild class to report problems in mobility, OR 9.62 (95% confidence interval: 6.44 to 14.36), self-care 7.87 (4.78 to 12.97), activities 2.41 (1.79 to 3.26), pain 2.04 (1.50 to 2.77), and anxiety/depression 1.97 (1.42 to 2.74).

CONCLUSIONS

Among MI survivors, multimorbidity clustered into three distinct patterns and was inversely associated with HRQoL. The identified multimorbidity patterns and HRQoL domains that are mostly affected may help to identify patients at risk of poor HRQoL for which clinical interventions could be beneficial to improve the HRQoL of MI survivors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01808027 and NCT01819103.

Measurement invariance of the Seattle Angina Questionnaire in coronary artery disease

PURPOSE

The Seattle Angina Questionnaire (SAQ) is a widely used patient-reported measure of health status in patients with coronary artery disease. Comparisons of SAQ scores amongst population groups and over time rely on the assumption that its factorial structure is invariant. This study evaluates the measurement invariance of the SAQ across different demographic and clinical groups and over time.

METHODS

Data were obtained from the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease registry, a registry of patients who received coronary angiogram in Alberta, Canada. The study cohort consists of adult patients who completed the paper-based version of the 16-item Canadian version of the SAQ (SAQ-CAN) 2 weeks and 1-year post-coronary angiogram between 2009 and 2016. Multi-group confirmatory factor analysis was used to assess configural, weak, strong, and strict measurement invariance across age groups, sex, angina type, treatment, and over time. Model fit was assessed using the comparative fit index and root mean square error of approximation.

RESULTS

Of the 8101 patients included in these analysis, 1300 (16.1%) were at least 75 years old, while 1755 (21.7%) were female, 5154 (63.6%) were diagnosed with acute coronary syndrome, 1177 (14.5%) received coronary artery bypass graft treatment, and 3279 had complete data on the SAQ-CAN at both occasions. There was evidence of strict invariance across age, sex, and angina type, and treatment groups, but partial strict invariance was established over time.

CONCLUSION

SAQ-CAN can be used to compare the health status of coronary artery disease patients across population groups and over time.

Assessment of utility values and QALYs after primary PCI with DP-Xience and BP-Biomatrix stents

BACKGROUND

Primary percutaneous coronary intervention (PPCI) is the recommended treatment in ST elevated myocardial infarction (STEMI). The determination of Quality of life (QoL) for various options of coronary revascularization is important for establishment of a comprehensive care plan. Studies of QoL in interventional cardiology are scarce. Our study has compared utility scores and quality adjusted life year (QALY) of 2nd and 3rd generation drug eluting stents (DES).

METHODS

An observational cohort study was conducted to evaluate QoL and QALY using EQ-5D-5L questionnaire. Patients undergoing PPCI between July-Dec 2019 were evaluated after completion of one year of procedure.

RESULTS

Total 334 patients were evaluated, study population consisted of a greater number of males (87.13%) than females. Mean utility value was more in 3rd G Biomatrix stents; 0.829 ± 0.11 than 2nd G Xience stents; 0.794 ± 0.11 (p < 0.05). Visual analogue scale (VAS) value was also high in 3rd G DES (81.84 ± 8.29) as compared to 2nd G DES (77.81 ± 9.01); p< 0.05. A significant association was found between utility scores/VAS and age, DM, HTN, Current smoking, family history and CAD diagnosis. There was a gain of 0.035 QALY with the use of Biomatrix DES.

CONCLUSION

Health related quality of life (HRQOL) is a leading support in the decision making of therapeutic interventions. Our study has found that Biodegradable polymer (BP) Biomatrix DES are superior to the Durable polymer (DP) Xience DES having better QoL and QALY.

Exercise tolerance and quality of life in patients with known or suspected coronary artery disease

BACKGROUND

Coronary artery disease (CAD) is known to impact on patients' physical and mental health. The relationship between performance on treadmill exercise tolerance test (ETT) and health-related quality of life (HRQL)has never been specifically investigated in the setting of CAD.

METHODS

Consecutive patients undergoing an ETT with the Bruce protocol during a diagnostic workup for CAD (n = 1,631, age 55 ± 12 years) were evaluated. Exercise-related indices were recorded. Detailed information on cardiovascular risk factors and past medical history were obtained. HRQLwas assessed with the use of the validated 36-Item Short Form Survey (SF-36) questionnaire.

RESULTS

Increasing age and the presence of cardiovascular risk factors and comorbidities correlated with lower scores on the physical and mental health component of SF-36(all P < 0.05). Subjects with arrhythmias during exercise and slow recovery of systolic blood pressure had lower scores on the physical health indices or the Social Role Functioning component (P < 0.05). Achieved target heart rate and good exercise tolerance were independently associated with better scores of the physical and mental health domains of SF-36 and overall HRQLscores (β = 0.05 for target HR and PCS-36, β = 1.86 and β = 1.66 per increasing stage of exercise tolerance and PCS-36 and MCS-36, respectively, P < 0.001 for all associations). Ischemic ECG changes were associated with worse scores on Physical Functioning (β = - 3.2, P = 0.02) and Bodily Pain (β = - 4.55, P = 0.026).

CONCLUSION

ETT parameters are associated with HRQL indices in patients evaluated for possible CAD. Physical conditioning may increase patient well-being and could serve as a complementary target in conjunction with cardiovascular drug therapy.

Psychosocial Risk Factors in Cardiac Rehabilitation: Time to Screen Beyond Anxiety and Depression

Background

Although it is well acknowledged that psychosocial risk factors (PSRF) such as low socio-economic status, stress, social isolation, negative emotions and negative personality patterns may contribute to the development and adverse outcome of cardiovascular disease (CVD), screening for PSRF in CVD patients is usually limited to anxiety and depression, mainly for feasibility reasons. We therefore aimed to develop a user-friendly screening battery for routine assessment of PSRFs and to evaluate this instrument regarding feasibility of application, PSRF results and attendance of psychological counselling if recommended to cardiac rehabilitation (CR) patients.

Methods

This is a prospective single center cohort study including 609 consecutive CR patients. We first developed a screening instrument based on seven validated scales for the most relevant PSRFs with totally 90 questions presented in a uniform graphical design to facilitate completion called Psychocardiogram® (PCG) and applied the instrument in consecutive patients attending CR. Patients with positive screening results were invited to a psychological counseling session.

Results

Six hundred and nine consecutive patients, aged 34 to 86 years (mean 60.7 years), 85% men, entering the CR program at the Bern University Hospital with ischemic heart failure (CHF), coronary artery disease (CAD) or peripheral artery disease, were included in this study. Eighty-three point three percent of the patients completed the PCG within 40 minutes. Vital exhaustion and Type-D personality were the most prevalent PSRFs (56.9% and 51.1%, respectively), whereas low social support (14.4%) and elevated depressive symptoms (15.9%), were the least prevalent ones. After screening, 120 patients (52.86%) with at least one PSRF made use of psychological counseling.

Conclusions

We found the PCG to be a useful screening tool for PSRF in CR patients with the potential to get new insights into the prevalence of particular PSRF in specific populations and to better study their impact on occurrence and outcome of CVD.

Predictors of patient-reported health following cardiac surgery

BACKGROUND

Patient-reported health status is one of the most important aspects of cardiovascular outcomes. The aim of this study was to assess patient-reported health and its determinants following cardiac surgery.

METHODS

Cross-sectional study was performed among 128 patients (mean age: 66.02; 35.9% women). Three months after surgery patients filled in The Short Form 12 Health Survey (SF-12) and Brief-Illness Perception Questionnaire (B-IPQ). Patient-reported health was assessed using SF-12 General Health component.

RESULTS

The mean General Health score was 47.34 (SD=20.94). General Health was significantly positively correlated with SF-12 Physical and Mental Component Summary (P<0.01). Significant negative correlations were noted between General Health and European System for Cardiac Operative Risk Factor (EuroSCORE) (P=0.012) and Body Mass Index (BMI) (P=0.026). Higher scores on B-IPQ Consequences, Timeline, Identity, Emotional Response (P<0.01) and Concern (P=0.03) were related to worse General Health. Higher perceived effectiveness of surgery (P<0.01) and Treatment control (P=0.003) were associated with higher General Health score. More negative illness perception was significantly related to lower General Health (P<0.01). No significant associations between General Health and mode and weight of the procedure, myocardial infarction, previous percutaneous coronary intervention, New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) class and postsurgical complications were noted. Structural equation modeling (SEM) revealed that illness perception domains, BMI and EuroSCORE are the main determinants of General Health.

CONCLUSIONS

Modifiable factors, especially illness perception are important determinants of patient-reported health after cardiac surgery. Evaluation of illness perception seems vital since it may lead to address patients' concerns and improve outcomes.

Quality of life measured by EQ-5D at different treatment time points for coronary artery disease: protocol for a systematic review and meta-analysis

INTRODUCTION

Cardiovascular disease is estimated to affect 423 million people globally. It caused 18 million deaths in 2017 and is projected to cost US$1 trillion by 2030 worldwide. Coronary artery disease (CAD) is the most common type of cardiovascular disease; CAD treatments can affect patients' quality of life. Valuations of quality of life or health utilities are important for economic evaluations to ascertain relative health benefit when comparing treatments, and can be expected to change for individuals over time. The purpose of this systematic review is to estimate the quality of life of patients with CAD reported through the EuroQol 5 Dimension (EQ-5D) questionnaire, from short to longer term time points following different treatments.

METHODS AND ANALYSIS

PubMed, Embase, Web of Science, the Cochrane Database of Systematic Reviews and the EuroQol website will be systematically searched from January 2003-March 2020. Published, peer-reviewed, English language studies assessing quality of life of patients with CAD using the EQ-5D will be included. One researcher will conduct the search; two researchers will independently screen titles and abstracts for potential inclusion. Full texts of potentially eligible studies will be retrieved for a second round of independent screening against inclusion and exclusion criteria by two researchers. The final list of included studies will be assessed for risk of bias using the RoB 2 and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tools for randomised and non-randomised studies, respectively. Data extraction will be done by one researcher, with data extraction for a random 10% of included studies checked by a second researcher. Mean utility weights for individual studies will be combined using random effects model meta-analyses. A model will be run separately for each time point and treatment. Treatment time points of interest include baseline, 30 days, 6 months, 12-24 months and more than 24 months. Subgroup analysis of patients with diabetes who received interventional treatments-coronary artery bypass graft or percutaneous coronary intervention with or without stents, will be conducted for the same selected time points.

ETHICS AND DISSEMINATION

Ethics approval is not required for systematic reviews. Results of the review will be disseminated via publication in a peer-reviewed journal.

Effects of nicorandil infusion on ECG parameters in patients with unstable angina pectoris and percutaneous coronary intervention

BACKGROUND

Percutaneous coronary intervention (PCI) is effective in treating patients with acute coronary syndrome (ACS) but is associated with some serious complications. Nicorandil is an anti-anginal agent acting to improve microvascular circulation and to increase coronary blood flow. The objective of this article is to evaluate the effects of intracoronary injection followed with continuous intravenous injection of nicorandil on ECG parameters in patients with unstable angina pectoris (UA) undergoing PCI.

METHODS

A single-center, self-controlled clinical trial was conducted at the Second Hospital of Tianjin Medical University between January 2019 and April 2019. Sixty-three consecutive patients with UA who received coronary angiography and selective PCI were enrolled. ECG was recorded and analyzed before and 24 hr after nicorandil infusion.

RESULTS

Patients were divided into three groups: control group (n = 23, aged 63.43 ± 12.55 years), short-term, and prolonged use with nicorandil group (n = 20 and 20, aged 66.45 ± 8.06 years and 65.80 ± 9.49 years, respectively). Clinical characteristics and ECG parameters were similar before PCI among three groups (p > .05). In nicorandil treatment groups, intervals of QTd and Tp-e in patients post-PCI were significantly shorter than that in control and pre-PCI (p < .05).

CONCLUSIONS

Nicorandil infusion reduces QTd and Tp-e interval in patients with UA. Further studies will be needed to determine whether these electrophysiological changes are associated with a reduction of ventricular arrhythmias and improved outcomes.

Gender differences in quality of life in coronary artery disease patients with comorbidities undergoing coronary revascularization

In comparison to male patients with coronary artery disease, female patients suffer from more comorbidities, experience symptoms of coronary artery disease differently and report poorer health-related quality of life (HRQoL) after coronary revascularization. However, there is limited data on the impact of comorbidity burden on the recovery in HRQoL in female and male patients. We investigated the impact of comorbidity burden on the change in HRQoL following coronary revascularization in female patients versus male patients. 230 patients (60 female) with coronary artery disease were assessed before, and two weeks, three months and six months after coronary revascularization. Disease-specific HRQoL was measured with the Short-Form Seattle Angina Questionnaire. Physical and mental health was measured with the Short-Form Health Survey. Comorbidity burden was assessed by the total number of identified comorbidity conditions and by the Charlson comorbidity score. Linear mixed models were used to estimate the effects of time, gender and comorbidity burden on HRQoL. Whereas HRQoL improved after coronary revascularization in all patients, female patients reported poorer physical health and disease-specific HRQoL and their physical health improved more slowly than male patients. A higher comorbidity burden was related with poorer physical health and disease-specific HRQoL in male patients, but not in female patients. A higher comorbidity burden was associated with slower improvement in HRQoL for both female and male patients. Female patients reported poorer HRQoL and their physical health improved more slowly after coronary revascularization, irrespective of comorbidity burden. Higher comorbidity burden was associated with poorer physical health and disease-specific HRQoL in male patients only. Our results indicate that female and male patients recover differently after coronary revascularization. These findings highlight the importance of comorbidity- and gender-specific approaches for evaluating coronary artery disease and coronary revascularization procedures.

Quality of life trajectories in survivors of acute myocardial infarction: a national longitudinal study

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.

TRIAL REGISTRATION

NCT01808027 and NCT01819103.

Hypothetical model of perceived adherence to treatment among patients with coronary heart disease after a percutaneous coronary intervention

Aim

To test the hypothetical model of adherence to treatment among patients with coronary disease after percutaneous coronary intervention.

Design

A descriptive, explanatory, cross-sectional survey.

Methods

The study was conducted in 2013 with 416 patients in five hospitals in Finland. The adherence of patients with chronic disease instrument, the adherence visual analogue scale, the social support for people with coronary heart disease instrument, the EuroQoL five-dimensional scale and EuroQoL visual analogue scale were used. The data were analysed using descriptive statistic. The hypothetical model was tested using structural equation modelling.

Results

The hypothetical model explained 30% of perceived adherence to treatment. Structural equation modelling confirmed that motivation, support from physicians and next of kin had direct associations with adherence. Indirectly, informational support, results of care, perceived health, anxiety and depression were associated with adherence. The background variables associated with adherence were gender, relationship, physical activity, consumption of vegetables and consumption of alcohol.

Health Status Benefits of Successful Chronic Total Occlusion Revascularization Across the Spectrum of Left Ventricular Function: Insights From the OPEN-CTO Registry

OBJECTIVES

This study sought to describe the association between chronic total occlusion (CTO) revascularization (CTO percutaneous coronary intervention [PCI]) and health status in patients with and without cardiomyopathy.

BACKGROUND

Prior PCI trials for cardiomyopathy have excluded CTO patients. Whether patients with reduced left ventricular ejection fraction (LVEF) receive similar health status benefit from CTO-PCI compared with patients with normal LVEF is unclear.

METHODS

We assessed health status change, using the Seattle Angina Questionnaire (SAQ) Summary, SAQ Angina Frequency, and Rose Dyspnea Scale scores, among patients undergoing successful CTO PCI in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion) Registry. Participants were classified by LVEF (normal, ≥50%; mild-moderate, 30% to 49%; and severe, <30%), with higher SAQ and lower Rose Dyspnea Scale scores indicating better health status. Differences in 1-year outcomes were compared using hierarchical multivariable regression.

RESULTS

Of 762 patients, 506 (66.4%), 193 (25.3%), and 63 (8.3%) had normal, mild-moderate, and severely reduced LVEF. SAQ Summary score improvements were observed in each group (27.1 ± 20.4, 26.7 ± 21.2, and 20.3 ± 18.1, respectively). Compared with patients with LVEF ≥50%, those with LVEF <30% had less improvement in SAQ Summary Score (-5.2 points; 95% confidence interval: -9.0 to -1.5; p = 0.01) and Rose Dyspnea Scale (+0.5 points; 95% confidence interval: 0.1 to 0.8; p = 0.01), with no difference in odds of angina (odds ratio: 1.3; 95% confidence interval: 0.6 to 3.0; p = 0.48). Health status improvement was similar between patients with LVEF ≥50% and LVEF 30% to 49%.

CONCLUSIONS

Although health status improvement was less in patients with severely reduced LVEF compared with those with normal LVEF, each group experienced large health status improvements after CTO-PCI.

Correlation between exercise, personal income level and health-related quality of life in patients with newly diagnosed stable angina

BACKGROUND

Stable angina is one of the most common clinical types of coronary artery disease (CAD) and associated with poor health-related quality of life (HRQL). However, few studies have evaluated the risk factors associated with HRQL in patients with newly diagnosed stable angina.

METHODS

A cross-sectional survey was conducted with 342 consecutive outpatients with newly diagnosed stable angina from October 2017 to January 2018 at the Second Affiliated Hospital of Army Medical University, Chongqing, China. Eight dimensions of HRQL were evaluated via the 36-item Short-Form Health Survey, including physical functioning, role limitation due to physical problems, bodily pain, general health, vitality, social functioning, role limitation due to emotional problems, and mental health. Physical and mental component summaries were calculated. Multiple stepwise regression was performed to determine the factors associated with HRQL.

RESULTS

Patients who were older, were females, did not exercise, had lower educational levels, had lower monthly incomes, had smoking/drinking habits, and had diabetes, hypertension, or hyperlipemia showed lower physical HRQL scores, while those who were older with lower educational levels and lower monthly incomes showed lower mental HRQL scores. The results of the multiple stepwise regression analyses showed that physical and mental HRQL were positively correlated with exercise and monthly income and negatively associated with age. Patients with monthly income ≥5000 Yuan showed higher HRQL scores than those with monthly income < 5000 Yuan. Sleep quality and drinking were negatively associated with physical, but not mental HRQL.

CONCLUSIONS

Our findings indicated that exercise and personal income level, both modifiable factors, were positively associated with physical and mental HRQL. These findings could have implications for clinical suggestions and strategies to improve HRQL in patients with stable angina.

Depression, Anxiety, Perceived Stress, and Their Changes Predict Greater Decline in Physical Health Functioning over 12 Months Among Patients with Coronary Heart Disease

BACKGROUND

Although the deleterious impact of psychological distress on patients with coronary heart disease (CHD) is recognized, few studies have examined the influence of change in psychological distress on health outcomes over time. This study investigated whether three common manifestations of distress (depression, anxiety, and perceived stress) and their changes predicted the decline in physical functioning in CHD patients over 12 months. In addition, perceived social support was examined as a buffer of psychological distress or a direct predictor of physical functioning.

METHODS

Participants were 255 CHD patients with a mean age of 63 (SD = 8.65) years, including 208 men and 47 women. Psychological distress and physical functioning were assessed at baseline, 6 months and 12 months. Hierarchical regression analyses were conducted to examine the influences of psychological factors on physical functioning over 12 months. All models were adjusted for baseline physical functioning, age, gender, marital status, education, BMI, and length of participation at a wellness center.

RESULTS

For each psychological distress variable (depression, anxiety, or perceived stress), both the baseline (βs = - 0.19 to - 0.32, ps = 0.008 to < 0.001) and its respective change over time (βs = - 0.17 to - 0.38, ps = 0.020 to < 0.001) independently and significantly predicted greater decline in physical functioning at 6 and 12 months, after adjusting for covariates. Perceived social support predicted greater improvement in physical functioning at 12 months (β = 0.13, p = 0.050), but it did not buffer impact of psychological distress.

CONCLUSIONS

Findings underscore the importance of monitoring various forms of psychological distress continuously over time for CHD patients.

Regular exercise and the trajectory of health-related quality of life among Taiwanese adults: a cohort study analysis 2006-2014

Background

Physical activity is related to health-related quality of life, but little evidence from multiple waves of panel data in Asian countries area available. This study aims to explore the impacts of different degree of regular exercise on the trajectories of physical and mental dimensions of health-related quality of life (HRQOL) for community-dwelling Taiwanese adults during 2006–2014.

Methods

Data were derived from the “Landseed Integrated Outreaching Neighborhood Screening (LIONS)” study, with 6182 adults enrolled at the baseline and subsequently followed up to three times till 2014. Linear mixed-effects modeling approach was employed to evaluate the growth curve models of HRQOL (with 16,281 observations) by linear & quadratic time effects, regular exercise (5-level moderate-intensity physical activity), and major influential factors of HRQOL.

Results

Regular exercise showed significantly positive dose-response effects on physical HRQOL (β =1.27~2.54), and regular exercise of 150 min or more showed positive effects on mental HRQOL (β = 1.55~2.03). Besides, irregular exercise could also improve both physical and mental HRQOL (β = 1.27 & β = 0.87). However, such effects were not significant over time (at time slope) on HRQOL. In addition, physical and mental HRQOL improved across time (β = 1.01 and 1.49, respectively), but the time quadratic effect would significantly offset a little bit on physical dimension (β = − 0.22). Moreover, being female, increasing age, living alone, or poorer health status were related to lower physical HRQOL; and being younger, living alone, or poorer health status were associated with lower mental HRQOL.

Conclusions

The positive dose-response relationship between regular exercise and HRQOL or its domains was demonstrated for community-dwelling Taiwanese adults. Thus, a regular exercise habit (better ≧150 min per week) is advised for community-based healthcare professionals and the government to incorporate into health promotion strategies and plans.

Atherosclerosis

Atherosclerosis, the formation of fibrofatty lesions in the artery wall, causes much morbidity and mortality worldwide, including most myocardial infarctions and many strokes, as well as disabling peripheral artery disease. Development of atherosclerotic lesions probably requires low-density lipoprotein, a particle that carries cholesterol through the blood. Other risk factors for atherosclerosis and its thrombotic complications include hypertension, cigarette smoking and diabetes mellitus. Increasing evidence also points to a role of the immune system, as emerging risk factors include inflammation and clonal haematopoiesis. Studies of the cell and molecular biology of atherogenesis have provided considerable insight into the mechanisms that link all these risk factors to atheroma development and the clinical manifestations of this disease. An array of diagnostic techniques, both invasive (such as selective coronary arteriography) and noninvasive (such as blood biomarkers, stress testing, CT and nuclear scanning), permit assessment of cardiovascular disease risk and targeting of therapies. An expanding armamentarium of therapies that can modify risk factors and confer clinical benefit is available; however, we face considerable challenge in providing equitable access to these treatments and in maximizing adherence. Yet, the clinical application of the fruits of research has advanced preventive strategies, enhanced clinical outcomes in affected individuals, and improved their quality of life. Rapidly accelerating knowledge and continued research promise to provide further progress in combating this common chronic disease.

Socioeconomic Inequalities in Health-Related Quality of Life among Patients with Cardiovascular Diseases in Vietnam

Purpose

This study aims to explore the sociodemographic differences in health-related quality of life (HRQOL) among Vietnamese patients with cardiovascular diseases (CVD).

Methods

A cross-sectional survey of 600 cardiovascular disease patients (300 inpatients and 300 outpatients) being treated at the Hanoi Heart Hospital was completed between July and December 2016. Data about HRQOL were collected by using the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) and EuroQOL-visual analogue scale (VAS). Sociodemographic characteristics were collected. A multivariate Tobit regression was used to detect the correlations between HRQOL and sociodemographic factors.

Results

Our sample had an average EQ-5D index of 0.82 (SD=0.21) and VAS score of 77.8 (SD=13.6). Participants were most likely to report problems in pain/discomfort (38.8%) and anxiety/depression (35.2%) and were least likely to report problems related to self-care (19.8%). Age and sex were strongly associated with the EQ-5D index and the VAS. Having health insurance and the number of hospital visits were negatively associated with HRQOL, while participation in the chronic disease management program had the positive relationship.

Conclusions

HRQOL among patients with CVD was moderately lower compared to the Vietnamese general population. Sociodemographic characteristics were strongly associated with HRQOL suggesting that addressing these inequalities should be prioritized in delivering services. Patients should also be encouraged to participate in the chronic disease management program due to its positive effects on quality of life.

Type D Personality as a Risk Factor in Coronary Heart Disease: a Review of Current Evidence

PURPOSE OF THE REVIEW

This review article synthesizes recent research findings on the psychological context of Type D personality and the mechanisms through which Type D affects disease progression and prognosis among patients with coronary heart disease (CHD).

RECENT FINDINGS

One in four patients with CHD has a Distressed (Type D) personality, which is characterized by two stable traits: social inhibition and negative affectivity. Type D personality predicts increased mortality and morbidity burden, and poorer health-related quality of life. Type D is part of a family of psychosocial risk factors that affect CHD prognosis. The pattern of co-occurrence of these psychosocial factors and intra-individual differences in psychosocial profiles may affect risk prediction accuracy. Multiple biological and behavioral processes have been associated with Type D personality. Identifying pathways explaining the observed associations between Type D personality and CHD is important to improve etiological and pathophysiological knowledge and to design personalized interventions, and targeting specific risk-associated pathways.