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Quality of life in patients with ischaemic heart disease: a prospective controlled study
L Westin1, R Carlsson, B Israelsson
1Department of Cardiology, University of Lund, University Hospital, Malmö, Sweden.
Insights
Quality of life is significantly impacted after cardiac events like acute myocardial infarction (AMI), coronary artery by-pass grafting surgery (CABG), and percutaneous transluminal coronary angioplasty (PTCA). While improvements occur over time, residual distress remains a challenge for patient rehabilitation.
Area of Science:
- Cardiology
- Health Outcomes Research
- Quality of Life Studies
Background:
- Cardiac events such as acute myocardial infarction (AMI), coronary artery by-pass grafting surgery (CABG), and percutaneous transluminal coronary angioplasty (PTCA) significantly impact patient well-being.
- Assessing the long-term quality of life (QL) following these interventions is crucial for comprehensive patient care and rehabilitation.
Purpose of the Study:
- To evaluate and compare the quality of life (QL) in patients who have undergone AMI, CABG, or PTCA with that of healthy controls.
- To identify specific dimensions of QL affected by these cardiac events and track changes over time.
Main Methods:
- A longitudinal study design involving self-administered questionnaires.
- Data collected at 1 month and 1 year post-intervention from 296 AMI, 99 CABG, 18 PTCA patients, and 88 healthy controls.
- QL assessed across multiple domains including general health, pain, breathlessness, arrhythmia, psychological distress (anxiety, depression), self-esteem, social life, and sexual function.
Main Results:
- Patients demonstrated significantly poorer QL in both psychological and somatic aspects compared to controls at 1 month post-event.
- Specific differences noted: AMI patients reported more anxiety than CABG patients; CABG patients experienced poorer sexual function than AMI patients.
- At 1-year follow-up, differences between patient groups diminished, primarily manifesting as residual somatic symptoms. Patients seeking emergency care for angina or cardiac decompensation reported higher thoracic pain and breathlessness at 1 month.
Conclusions:
- Quality of life is substantially affected following cardiac events, particularly in the initial recovery phase.
- While QL improves significantly over the first year, persistent psychological and somatic distress presents a challenge for complete patient rehabilitation.
- Clinicians must address residual symptoms to ensure optimal long-term outcomes for cardiac patients.
Objectives:
To assess quality of life in patients after acute myocardial infarction (AMI), coronary artery by-pass grafting surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) as compared with healthy controls.
Design:
Self-administered questionnaires were completed 1 month and 1 year after the event.
Setting:
Department of Cardiology, University Hospital, Malmö, Sweden; 1989-1992.
Subjects:
296 AMI, 99 CABG, 18 PTCA patients and 88 randomly selected healthy controls were included; 349 patients completed the entire programme.
Main Outcome Measures:
Quality of life in the dimensions of perceived general health, thoracic pain, breathlessness, feeling of arrhythmia, anxiety, depression, self-esteem, experience of social life and sex life.
Results:
Patients differed from controls in both psychological and somatic aspects of QL after 1 month. Furthermore, 1 month after the event AMI patients experienced more anxiety (P = 0.001) than CABG patients, whilst CABG patients experienced a poorer sex life (P < 0.001) than AMI patients. One year after the event patients differed from controls primarily in somatic symptoms: no significant differences were found across patient groups. Patients who sought emergency out-patient care during the follow-up year for clinically diagnosed angina pectoris or cardiac incompensation had reported higher levels of thoracic pain (P < 0.001) and breathlessness (P < 0.001) at 1 month follow-up than patients who did not seek such care.
Conclusions:
Quality of life is considerably affected in patients following a cardiac event, especially during the initial recovery phase. Although substantial improvement in quality of life occurs over time, the persistence of residual distress at 1-year follow-up is a challenge for clinicians concerned with the full rehabilitation of the cardiac patient.