Gender differences and determinants of health related quality of life in coronary patients: a follow-up study

A Comparative Study on the Quality of Life of Survivors of Stroke and Acute Myocardial Infarction

BACKGROUND

Worldwide, cardiovascular diseases, particularly acute myocardial infarction and strokes, lead to significant fatalities. Survivors often experience profound impacts on various aspects of their lives, making the assessment of their Quality of Life crucial for understanding their condition and adaptation to the illness.

METHODS

A community-based, descriptive cross-sectional study was conducted to compare how survivors of stroke and acute myocardial infarction perceive their Quality of Life. The Portuguese version of the World Health Organization Quality of life instrument was administered to 204 acute myocardial infarction and stroke survivors. Clinical and sociodemographic variables were also compared.

RESULTS

Statistically significant differences (p < 0.05) were noted in overall, physical, and psychological aspects of Quality of Life between the two groups, with stroke survivors consistently showing lower values in these dimensions.

CONCLUSIONS

The Quality-of-Life perception of stroke and acute myocardial infarction survivors may be affected by several sociodemographic and clinical factors, and the results support the idea that the vascular event conditions the person's Quality of Life, particularly in variables related to the person's physical condition, functionality, and autonomy.

Factors associated with health-related quality of life in patients undergoing percutaneous coronary intervention: Thai PCI registry

Background

Percutaneous coronary intervention (PCI) has been shown to improve health-related quality of life (HRQoL) in patients with coronary artery disease (CAD). The objectives of this study were to assess the changes in HRQoL and factors influencing these changes in CAD patients after undergoing PCI.

Methods

Data from a nationwide PCI registry across 39 hospitals in Thailand were collected in 2018-2019, including baseline characteristics, comorbid diseases, angiographic CAD severity, procedural details, and type of health insurance. HRQoL, as measured by utility scores, was determined in all patients using the Thai version of EQ-5D-5l at admission, discharge, and 6 and 12 months after discharge. The effects of time after PCI procedure and various factors on mean utility scores were assessed using a mixed-effect linear regression model.

Results

A total of 19,701 patients were included in the analysis; they had a mean age of 64.2 ± 11.7 years and were predominantly (69.1%) male. Following PCI, the mean utility scores increased from 66.6 ± 19.6 at admission to 81.9 ± 13.8 at discharge, and remained stable at 6 and 12 months (86.1 ± 12.3 and 88.0 ± 11.7, respectively). After adjusting for potential confounding variables, several factors were found to be independently associated with improved HRQoL, including angiographic success, male gender, overweight status, dyslipidemia, and radial access. Six other factors were associated with less improved HRQoLs, including cardiogenic shock/IABP support, old age, CKD, clinical presentation (STEMI and NSTEMI), prior cerebrovascular disease, and heart failure. There were no associations of CAD severity and procedural details with HRQoL. No differences were found related to type of health insurance, except that patients who were uninsured or self-pay tended to have less improvement in HRQoL.

Conclusion

HRQoL improved significantly after PCI in these subjects, as observed through 1 year of follow-up. Identifying the factors influencing these improvements may assist clinicians in tailoring patient interventions to optimise quality of life after PCI.

Gender differences in health-related quality of life and psychological distress among coronary patients: Does comorbidity matter? Results from the ESC EORP EUROASPIRE V registry

AIMS

This study aimed to provide an overview on contemporary gender differences in HRQoL/psychological distress and their relationship with comorbidity burden among European coronary heart disease (CHD) patients.

METHODS

Analyses were based on the cross-sectional ESC EORP EUROASPIRE V survey. Consecutive patients (aged 18-80 years), hospitalized for a first or recurrent coronary event were included in this study. Data at hospital discharge and at follow-up (6 to 24 months after hospitalisation) were collected.

RESULTS

Data were available for 8261 patients of which 25.8% women. Overall, women reported a worse EQ-5D-5L index score (0.73 vs. 0.81; P < 0.001), EQ-VAS (63.1 vs. 66.0; P = 0.001), global HeartQoL (1.94 vs. 2.26; P < 0.001), physical HeartQoL (1.96 vs. 2.30; P < 0.001), emotional HeartQoL (1.88 vs. 2.18; P < 0.001), HADS-A (6.69 vs. 4.99; P < 0.001), and HADS-D (5.73 vs. 4.62; P < 0.001) compared to men. Also, women were more likely to have comorbidities compared to men (1 comorbidity: 38.7% vs. 35.0%, 2 comorbidities: 9.7% vs. 7.5%; P < 0.001). There is indication that heart failure (EQ-VAS) and diabetes (global HeartQoL, emotional HeartQoL, physical HeartQoL, and HADS-D) interacted with gender and modulate the relationship with HRQoL, in disfavour of women.

CONCLUSION

Substantial gender-based health inequalities in terms of HRQoL and psychological distress were found, in disfavour of women. Women had worse HRQoL and psychological distress outcomes when having comorbidities. To a limited extent, comorbidity and women had a negative/synergistic effect on HRQoL. Special attention should be given to this population groups within daily clinical practice.

Sex differences in quality of life of patients following percutaneous coronary intervention in Vietnam

PURPOSE

Data regarding the health-related quality of life (HRQoL) in men and women after percutaneous coronary intervention (PCI) in low-and-middle incomes countries remains scarce. To investigate sex difference in the HRQoL at 30 days and 12 months post PCI in Vietnam.

METHODS

We used data from a single percutaneous coronary registry established in the Vietnam National Heart Institute. The HRQoL was measured using the EQ-5D-3L instrument via telephone interviews, and information about demographics, clinical presentation and procedures was obtained through face-to-face interviews and medical records. The HRQoL between men and women were compared using independent samples t tests, the Mann-Whitney U test or univariate/multivariate logistic regression.

RESULTS

There were 866 patients included in this cohort, with the proportion of women being nearly half of men (32.1 vs 67.9%). Women were 3.5 years older, had lower income and educational levels but greater prevalence of cardiovascular risk factors. At 30 days, women significantly had more problems in mobility, personal care and pain/discomfort compared to men. At 12 months, women had more problem than men in usual activity. The geometric means of HRQoL was lower in women at 30 days, but not in 12 months. From 30 days to 12 months after discharge, women showed better recovery in mobility compared to men, but not in other dimensions.

CONCLUSIONS

In this first insight of sex differences in HRQoL following PCI in Vietnam, women appeared to have worse quality of life, especially at 30 days after discharge but they showed better recovery in mobility at 12 months compared to men.

Sex differences in health-related quality of life trajectories following myocardial infarction: national longitudinal cohort study

OBJECTIVES

To investigate sex-based differences in baseline values and longitudinal trajectories of health-related quality of life (HRQoL) in a large cohort of myocardial infarction (MI) survivors after adjusting for other important factors.

DESIGN

Longitudinal cohort study.

SETTING

Population-based longitudinal study the Evaluation of the Methods and Management of Acute Coronary Events study linked with national cardiovascular registry. Data were collected from 77 hospitals in England between 1 November 2011 and 24 June 2015.

PARTICIPANTS

9551 patients with MI. Patients were eligible for the study if they were ≥18 years of age.

PRIMARY AND SECONDARY OUTCOME MEASURES

HRQoL was measured by EuroQol five-dimension, visual analogue scale (EQ-5D, EQ VAS) survey at baseline, 1, 6 and 12 months after discharge. Multi-level linear and logistic regression models coupled with inverse probability weighted propensity scoring were used to evaluate sex differences in HRQoL following MI.

RESULTS

Of the 9551 patients with MI and complete data on sex, 25.1% (2,397) were women. At baseline, women reported lower HRQoL (EQ VAS (mean (SD) 59.8 (20.4) vs 64.5 (20.9)) (median (IQR) 60.00 (50.00-75.00) vs 70.00 (50.00-80.00))) (EQ-5D (mean (SD) 0.66 (0.31) vs 0.74 (0.28)) (median (IQR) 0.73 (0.52-0.85) vs 0.81 (0.62-1.00))) and were more likely to report problems in each HRQoL domain compared with men. In the covariate balanced and adjusted multi-level model sex differences in HRQoL persisted during follow-up, with lower EQ VAS and EQ-5D scores in women compared with men (adjusted EQ VAS model sex coefficient: -4.41, 95% CI -5.16 to -3.66 and adjusted EQ-5D model sex coefficient: -0.07, 95% CI -0.08 to -0.06).

CONCLUSIONS

Women have lower HRQoL compared with men at baseline and during 12 months follow-up after MI. Tailored interventions for women following an MI could improve their quality of life.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT04598048, NCT01808027, NCT01819103.

Family functioning and health-related quality of life of inpatients with coronary heart disease: a cross-sectional study in Lanzhou city, China

Background

A key outcome in coronary heart disease (CHD) is Health Related Quality of Life (HRQoL), and family functioning is important in the management of CHD. But few studies have examined both together, and little is known about them among inpatients with CHD in less developed areas of China. Therefore, this study aimed to assess the HRQoL and family functioning status of inpatients with CHD in Lanzhou from Northwest China, and identify the factors that affect their HRQoL.

Methods

A cross‑sectional study was conducted in 224 CHD inpatients at one major hospital. Sociodemographic data and disease information of CHD inpatients were collected by face-to-face using a structured questionnaire and data were also obtained from patient medical records. HRQoL was measured using the Sickness Impact Profile (SIP). Family functioning was measured using the family APGAR index. Multiple binary logistic regression analysis (MBLRA) was used to explore potential risk factors associated with HRQoL, and Pearson’s correlations were used to assess the relationship between family functioning and HRQoL.

Results

The overall, physical and psychosocial SIP scores were 25.03 ± 8.52, 18.61 ± 9.90 and 28.08 ± 9.64, respectively. The total family APGAR score was 6.11 ± 2.45. MBLRA found older age, poorer cardiac function and more severe disease were associated with poorer HRQoL, while better family functioning, higher monthly income, and urban living were associated with better HRQoL. Family functioning was weakly to moderately correlated with total and psychosocial HRQoL.

Conclusions

Older and less affluent inpatients with lower educational level, less family support and more severe CHD have poorest quality of life, and health care providers should consider interventions to support them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02844-x.

Health-Related Quality of Life in Spanish Schoolchildren and Its Association with the Fitness Status and Adherence to the Mediterranean Diet

Background: Health-related quality of life (HRQoL) allows knowing the subject’s feelings in distress and well-being, as well as perception of current and future health. Objective: To assess associations between health-related quality of life, fitness status, and adherence to the Mediterranean diet in Spanish children and adolescents. Methods: A cross-sectional study was carried out in a sample of 305 (47.2% women) children and adolescents aged between 8 and 16 years, in the primary and secondary schools of the province of Ávila (central Spain) (NCT05380674). Subjects were classified according to their quality of life: group 1 (highest quality of life) > group 2 (medium quality of life) > group 3 (lowest quality of life). Results: More participants in group 1 showed higher adherence to Mediterranean diet (70.8%) than other groups (group 2: 55.0%; group 3: 43.4%). It was less likely to find optimal levels of muscle strength as quality of life decreased (OR; 95% CI: group 2: 0.535; 0.303−0.955; and group 3: 0.424; 0.234−0.768). Similar trends were found for speed and agility, but only group 3 showed significant results (OR; 95% CI: group 3: 0.297; 0.162−0.545). Flexibility was also the worst in groups 2 and 3 (OR; 95% CI: G2: 0.403; 0.213−0.762; and group 3: 0.520; 0.282−0.958). Conclusion: High fitness status and adherence to the Mediterranean diet were associated with improved health-related quality of life in schoolchildren of central Spain.

Saffron (Crocus sativus L.) supplements improve quality of life and appetite in atherosclerosis patients: A randomized clinical trial

Background

Atherosclerosis is the most common cause of the cardiovascular disease. Saffron is a traditional food that affects many diseases and disorders. Therefore, the aim of this study was to identify the effects of Saffron (Crocus sativus L.) on quality of life (QOL) and appetite in patients with atherosclerosis.

Materials and Methods

This was a randomized, double-blind, placebo-controlled clinical trial. A total of 63 participants with atherosclerosis were recruited from Emam Sajjad Hospital, Valiasr Hospital, and Zafaranieyh Clinic in Tehran, Iran. The participants were divided randomly into two groups. Participants received 100 mg/d saffron or placebo capsule for 6 weeks. QOL and appetite levels were measured by the McNew QOL questionnaire, and visual analog scale questionnaire, respectively. Furthermore, anthropometric indices of participants were measured before and after the intervention.

Results

Statistical analysis showed that there was a statistically significant difference between atherosclerosis patients who received placebo and those who consumed saffron in terms of the physical domain (P = 0.008) and social domain (P = 0.012) of QOL. In the saffron group increased score in Total score Macnew (P < 0.001), physical domain (P = 0.025), and social domain (P < 0.001) was significant after the intervention. Moreover, the consumption of saffron did not significantly affect emotional domains of QOL, and appetite levels.

Conclusion

Saffron may be considered as a novel agent in patients with atherosclerosis to improve the QOL. A great deal of further research will be needed to critically validate the efficacy of saffron and its mechanisms in atherosclerosis.

Depressive symptoms, perceived control and quality of life among patients undergoing coronary artery bypass graft: a prospective cohort study

BACKGROUND

Coronary artery bypass graft surgery (CABG) is an intervention directed toward improving the Quality of Life (QoL) for patients with coronary artery disease. Depression can affect QoL negatively among this population. Perceived control (PC) decreased the effect of anxiety on QoL, however, this effect has not been well-studies regarding depression. Therefore, the purpose of this study was to check the effect of depression on QoL among CABG patients and to determine if preoperative PC moderates this effect.

METHODS

This was a prospective observational cohort study conducted on a consecutive sample of 200 patients from three hospitals in Amman, Jordan. Depression Anxiety and Stress Scale, Short-Form Health Survey-36, and Arabic version of the Control Attitude Scale-Revised were used to measure depressive symptoms, QoL and PC respectively. Data were analyzed using t test and step wise multiple regression followed by simple slope analysis.

RESULTS

Postoperative Physical Component Summary (PCS) was better than preoperative PCS (mean ± SD: 38.2 ± 9.4 vs. 36.6 ± 9.5, P < 0.001). Postoperative Mental Component Summary (MCS) was better than preoperative MCS (mean ± SD: 44.3 ± 11.5 vs. 41.4 ± 11.4, P < 0.001). Preoperative depression was higher than postoperative depression; (mean ± SD: 12.8 ± 6.8 vs.11.1 ± 6.7, P < 0.01). Simple slope analysis was significant (simple slope = 0.41, t = 6.1, P < 0.001), indicating the moderating effect of PC.

CONCLUSION

Patients undergoing CABG surgery had poor QoL and high levels of depression. Perceived control moderated this relationship and improve QoL. Assessing depression levels and implantation of interventions to enhance perceived control levels prior to operation might improve QoL.

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.

Health-related quality of life in men and women who experienced cardiovascular diseases: Tehran Lipid and Glucose Study

Background

Cardiovascular diseases (CVDs) are among the most common causes of death worldwide, including in Iran. Considering the adverse effects of CVDs on physical and psychosocial health; this study aims to investigate the association between experience of CVDs and health-related quality of life (HRQoL) in adult participants of the Tehran Lipid and Glucose Study (TLGS).

Methods

The participants of this cross-sectional study were 7009 adults (≥ 20 years) who participated in the TLGS during 2014–2017. Demographic information and HRQoL data was collected through validated questionnaires by trained interviewers. HRQoL was assessed by the Iranian version of the SF-12 questionnaire. Data was analyzed using the SPSS software.

Results

The mean age of participants was 46.8 ± 14.6 years and 46.1% of them were men. A total of 9.0% of men and 4.4% of women had CVDs. In men, the mean physical HRQoL summary score was significantly lower in those with CVDs compared to those without CVDs (46.6 ± 0.8 vs. 48.5 ± 0.7, p > 0.001). In women, the mean mental HRQoL summary scores was significantly lower in those with CVDs compared to those without CVDs (42.8 ± 1.0 vs. 45.2 ± 0.5, p = 0.009). In adjusted models, men with CVDs were more likely to report poor physical HRQoL compared to men without CVDs (OR(95%CI): 1.93(1.32–2.84), p = 0.001); whereas for women, the chance of reporting poor mental HRQoL was 68% higher in those with CVDs than those without CVDs (OR(95%CI): 1.68(1.11–2.54), p = 0.015).

Conclusion

The findings of the current study indicate poorer HRQoL in those who experienced CVDs compared to their healthy counterparts with a sex specific pattern. While for men, CVDs were associated with more significant impairment in the physical dimension of HRQoL, women experienced a similar impairment in the mental dimension of HRQoL.

Sociodemographic Factors Affecting Older People's Care Dependency in Their Daily Living Environment According to Care Dependency Scale (CDS)

The aim of the research was to determine the influence of sociodemographic factors on older people’s care dependency in their living environment according to the Care Dependency Scale (CDS). Methods: The research was conducted in a group of 151 older people staying in their own homes. The methods applied in the research included a sociodemographic questionnaire and scales including the Abbreviated Mental Test Score (AMTS), CDS, Katz Index of Independence in Activities of Daily Living (ADL), Lawton’s Instrumental Activities of Daily Living (I-ADL), Mini Nutritional Assessment (MNA), and Geriatric Depression Scale (GDS). Results: Gender had a significant impact on the level of care dependency. The surveyed females obtained the medium or high level of dependency more often than males (22.4% vs. 6.1%), and the low level of dependency was significantly more frequent among men than women (p = 0.006). Moreover, the age of the respondents determined their level of care dependency. The subjects with a medium or high level of care dependency were significantly older (p = 0.001). The subjects with a low level of care dependency were more likely to be married than people with a medium/high level (p < 0.001). The level of education had a significant impact on care dependency. A higher level of education correlated with a medium/high level of dependency (p = 0.003). Conclusions: The survey results confirmed that sociodemographic factors have a significant impact on the level of care dependency. When planning care in the home environment, special attention should be paid to older women, who are more likely to lose their independence than men. These women should be given additional support.

How gender-specific are predictors of post-MI HRQoL? A longitudinal study

Purpose

Extant research shows that health-related quality of life (HRQoL) differs between female and male survivors of myocardial infarction (MI), but the reasons for this are not fully understood. We aimed to examine the predictors of HRQoL in female and male survivors during the first year after MI.

Methods

At timepoints 1 and 2, the sample comprised 222 MI survivors (59 women and 163 men; mean age 53.84 years, range 24–65) referred for in-patient cardiac rehabilitation. This number dropped to 140 participants (42 women and 98 men) at the third timepoint, approximately one year after the MI. We examined the gender differences in various predictors of physical and mental HRQoL: demographic factors (e.g., age, education, marital status), disease-related factors (pre- and post-MI), personality and coping with stress.

Results

Initially, both physical and mental HRQoL were lower in women than men, but the differences disappeared at timepoint 3. Stepwise regressions performed separately for men and women revealed that the factors shaping HRQoL were different in both genders; they also changed over time. Substantially fewer factors predicted physical HRQoL in women than in men. Trait anxiety seems to play a similarly negative role in both genders.

Conclusions

The psychosocial resources that influence HRQoL were different for women and men. There were also differences concerning predictors of HRQoL dimensions. Further studies with a different or broader range of predictors are needed, especially among women.

Quality of life among patients with cardiac disease: the impact of comorbid depression

BACKGROUND

Patients with cardiac disease with or without depression may also have major physical and mental problems. This study assesses and compares the quality of life (QOL) of patients with cardiac disease with and without depression and accompanying comorbidities.

METHODS

A cross-sectional study was conducted with a convenience sample of 388 patients with cardiac disease. The 12-item Short-Form (SF-12)-patient was used to measure physical component scale (PCS) and mental component scale (MCS) QOL, and the Patient Health Questionnaire (PHQ-9) was used to measure depression. The Charlson Comorbidity Index was used to estimate 10-year survival probability. Descriptive statistics, analysis of covariance (ANCOVA), chi-square tests, and binary logistic regression were used for analysis.

RESULTS

The prevalence of minimal to mild depression was 65.7% [(95% CI (60.8, 70.4)] and that of moderate to severe depression was 34.3% [95% CI (29.6, 39.2)]. There was no significant association between the level of PHQ-categorised depression and age (p = 0.171), sex (p = 0.079), or ethnicity (p = 0.407). The overall mean PCS and MCS QOL was 32.5 [95% CI (24.4, 40.64)] and 45.4 [95% CI (44.4, 46.4)], respectively, with no significant correlation between PCS and MCS [r (Pearson's) = 0.011; p = 0.830)]. There were QOL differences among the five PHQ categories (PCS: p = 0.028; MCS: p ≤ 0.001) with both MCS and PCS decreasing with increasing depression. ANCOVA (with number of comorbidities as the covariate) showed a significant age × ethnicity interaction for PCS (p = 0.044) and MCS (p = 0.039), respectively. Young Indo-Trinidadians had significantly lower PCS than did Afro-Trinidadians, while the converse was true for MCS. Depression, age, and number of comorbidities were predictors of PCS, while depression, age, and sex were predictors of MCS.

CONCLUSIONS

Increasing severity of depression worsened both PCS and MCS QOL. Age and level of clinical depression predicted QOL, with number of comorbidities predicting only PCS and sex predicting only MCS. Efforts must be made to treat depression in all age groups of patients with cardiac disease.

Does sex predict quality of life after acute coronary syndromes: an Australian, state-wide, multicentre prospective cohort study

OBJECTIVE

Women have reported higher mortality and major adverse cardiovascular events (MACE) following acute coronary syndromes (ACSs) compared with men. With this in mind, we aimed to identify predictors of poor quality of life (QoL) post-ACS as our primary outcome. We examined predictors of MACE, major cerebrovascular events and major bleeding as our secondary outcome.

DESIGN

Prospective cohort study.

SETTING

30 metropolitan centres across the Victorian Cardiac Outcomes Registry network.

PARTICIPANTS

16 517 patients treated with percutaneous coronary intervention (PCI) for ACS (22.9% females). Selection/inclusion criteria: consecutive patients with successful or attempted PCI for ACS from 2013 to 2016, alive at 30 days post-PCI.

EXCLUSION CRITERIA

patients not fulfilling ACS criteria. At 30 days, 2497 (64.7% females) completed the QoL EQ-5D-3L instrument.

PRIMARY AND SECONDARY OUTCOME MEASURES

QoL, assessed using the EuroQo-5Dimensions (EQ-5D-3L) instrument by telephone at 30 days. Independent predictors of QoL were identified by univariate and multivariate logistic regression analyses.

RESULTS

Women were significantly older with more diabetes, cerebrovascular disease and renal failure. Regarding the primary outcome, female sex was independently associated with moderate/severe impairment in all EQ-5D-3L domains including mobility (OR 2.38, 95% CI 2.06 to 2.75, p<0.001), personal care (OR 2.14, 95% CI 1.73 to 2.66, p<0.001), activities of daily living (OR 1.84, 95% CI 1.63 to 2.08, p<0.001), pain/discomfort (OR 1.44, 95% CI 1.24 to 1.67, p<0.001) and anxiety/depression (OR 1.49, 95% CI 1.30 to 1.70, p<0.001). Women had significantly lower self-rated Visual Analogue Scale scores (80.0 for both groups, IQR 60-85 vs 70-90, p<0.001). There was no significant difference between the sexes in secondary outcomes.

CONCLUSIONS

Female sex was a predictor of poorer QoL following PCI for ACS including significantly higher pain, anxiety and depression. This was independent of age, comorbidities and ACS presentation. There is a clinical need for a tailored approach in female ACS management, for example, emphasis on management of depressive and anxiety symptoms.

Health-related quality of life and its associated factors among patients with angina in Jordan

BACKGROUND

Despite the negative impact of angina and its worsening symptoms on the quality of life of the affected patients, little research has evaluated the factors associated with poor health-related quality of life (HRQOL) among patients with angina.

OBJECTIVE

The study aim was to evaluate HRQOL and to explore factors associated with poor HRQOL in patients with angina in Jordan.

SETTING

The present study used data collected for patients attending the cardiology clinic at the Royal Medical Services (RMS) Hospital in Amman.

METHODS

In addition to collecting sociodemographic and clinical data, the EQ-5D questionnaire was used to assess HRQOL in outpatients with angina in the present study. Multiple linear regression analysis was conducted to build a model with variables that are significantly and independently associated with poor HRQOL.

MAIN OUTCOME MEASURE

HRQOL quantified using the EQ-5D.

RESULTS

The mean of the total EQ-5D score of the 500 participants was 0.392. Most of the patients reported 'some problems' through the five dimensions, with the highest percentage (66.6%) related to mobility domain. Regression analysis identified female gender (B = - 0.232; P < 0.05) elevated fasting blood sugar (FBS) (P < 0.05; B = - 0.219), and low high density lipoprotein (HDL) (B = - 0.183; P < 0.05) as being significantly associated with poor HRQOL.

CONCLUSIONS

The HRQOL has considerable scope for improvement for patients with angina in Jordan. Female gender, elevated FBS, and decreased HDL levels were significantly associated with poor HRQoL in the present study.

Interplay of Self-efficacy and Social Support in Predicting Quality of Life in Cardiovascular Patients in Pakistan

The primary objective of the present study was to assess independent and interactive relations of perceived social support and self-efficacy with four quality of life (QOL) domains namely physical, psychological, social, and environmental in cardiovascular disease (CVD) patients from a South Asian region. Participants were 172 (age 22-60 years) patients recruited from three major government sector hospitals from the fifth biggest city of South Asia. It was found that overall CVD patients had a better QOL in psychological and environmental domains compared to social and psychological. Furthermore, findings from hierarchical regression analyses indicated that perceived social support and self-efficacy were positively associated with the four QOL domains. Besides main effects, a synergistic interaction between social support and self-efficacy emerged indicating that perceived social support was strongly associated with physical and social QOL in CVD patients who had higher self-efficacy levels, while, perceived social support was weakly associated with the physical and social QOL in CVD patients who had lower self-efficacy levels.

Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences

Background: The association between age and health-related quality of life (HRQoL) is still under debate. While some research shows older age is associated with better HRQoL, other studies show no or negative association between age and HRQoL. In addition, while the association between age and HRQoL may depend on race, ethnicity, gender, and their intersections, most previous research on this link has been performed in predominantly White Middle Class. Objective: To explore gender differences in the association between age and mental and physical HRQoL in a sample of economically disadvantaged African American (AA) older adults. Methods: This cross-sectional survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 economically disadvantaged AA older adults (age ≥ 55 years) were enrolled in this study, using non-random sampling. This includes 266 AA men and 474 AA women. The independent variable of interest was age. Dependent variables of interest were physical component scores (PCS) and mental component scores (MCS), two main summary scores of the HRQoL, measured using Short Form-12 (SF-12). Gender was the moderator. Socioeconomic status (educational attainment and financial difficulty) were covariates. Linear regression models were used to analyze the data. Results: AA women reported worse PCS; however, gender did not impact MCS. In the pooled sample, high age was associated with better PCS and MCS. In the pooled sample, a significant interaction was found between gender and age on PCS, suggesting a stronger effect of age on PCS for AA men than AA women. In gender-stratified models, older age was associated with better PCS for AA men but not AA women. Older age was similarly and positively associated with better MCS for AA men and women. Conclusions: There may be some gender differences in the implications of ageing for the physical HRQoL of AA older adults. It is unclear how old age may have a boosting effect on physical HRQoL for AA men but not AA women. Future research should test gender differences in the effect of age on physical health indicators such as chronic disease as well as cognitive processes involved in the evaluation of own's health in AA men and women.

Comparing comorbidity measures and fatigue post myocardial infarction

PURPOSE/AIMS

The purpose of this study was to examine comorbidity measures that may relate to the symptom of fatigue post MI: self-reported comorbidities, medication-validated comorbidities, weighted comorbidities for fatigue, and number of comorbidities.

DESIGN

Using a cross sectional design, we interviewed a convenience sample of 98 adults, 65 and older, who were 6 to 8 months post myocardial infarction.

METHODS

Participants self-reported their comorbidities using a list of 23 comorbid conditions. All medications were visually inspected, and medications were reviewed by a geriatric pharmacist for a common side effect of fatigue. The Revised Piper Fatigue Scale was used to measure fatigue.

RESULTS

The mean age of the participants was 76 (SD = 6.3), and most of the sample were White (84%). Neither medication-validated comorbidities nor those medications with fatigue as a common side effect explained fatigue. When controlling for age, sex, and marital status, self-reported comorbidities explained 10% of the variance in fatigue (F (4, 93) = 2.65; p = 0.04). Having 5 or more self-reported comorbidities explained 7% of variance in fatigue scores (F (1, 96) = 7.53; p = 0.007).

CONCLUSION

Comorbidities are associated with fatigue post MI. Adults post MI with 5 or more comorbidities should be screened for fatigue.

Quality of life of patients with first-time AMI: a descriptive study

Background

Outcomes following acute myocardial infarction (AMI) may result in death, increased morbidity, and change in quality of life (QOL). This study explores health-related QOL of first-time patients following AMI.

Methods

This cross-sectional study used a sample of patients with first-time AMI experienced between April 2011 and March 2015 at a tertiary health institution. Recruited patients belonged to different post-AMI periods: 2–10 weeks, 5–22 months, and > 22 months to 4 years post AMI. Inclusion criteria were not confused and communicating freely. Exclusion criteria were non-contactable, refusing to participate, and deceased. One-on-one interviews were conducted using the validated and pre-tested Quality of Life after Myocardial Infarction (QLMI) questionnaire. QOL of patients after AMI was evaluated at each period. Descriptive, Mann–Whitney U, Kruskal–Wallis, and regression analyses were conducted using SPSS version 24.

Results

A total of 534 participant interviews (overall response rate 65.4%) were conducted. Interviewees were predominantly male (67%), aged 51–65 years (45%), Indo-Trinidadian (81.2%), NSTEMI (64.4%), and hypertensive (72.4%). Overall QOL improved over time and in all domains: Emotional, Physical, and Social. Lower QOL was found among women, patients with NSTEMI, and diabetics in all domains; in patients with hypertension and renal disease in the Physical and Social domains only; and in patients with ischaemic heart disease (IHD) in the Physical domain only. Self-reported stress and lack of exercise were associated with lower QOL while drinking alcohol and eating out were related to better QOL. Hypercholesterolemia, smoking, and ethnicity showed no association with QOL. Declining QOL in the Physical domain with age was also found. The leading components of QOL were self-confidence and social exclusion (early post AMI), lack of self-confidence (intermediate post AMI), and tearfulness (late post AMI).

Conclusions

QOL in AMI survivors improves over time. Female gender, NSTEMI, diabetes, hypertension, renal disease, stress, and lack of exercise were associated with lower QOL while hypercholesterolemia, smoking, and ethnicity showed no association with QOL. Cardiac rehabilitation and psychological support may enhance earlier increased QOL among survivors, particularly among vulnerable groups.

Differences between Slovak and Dutch patients scheduled for coronary artery bypass graft surgery regarding clinical and psychosocial predictors of physical and mental health-related quality of life

BACKGROUND

Differences in health-related quality of life in coronary artery disease patients and associated factors between patients of central and western European descent are rarely investigated. We aim to test differences between Dutch and Slovak health-related quality of life, whether nationality predicted health-related quality of life and if standardised beta weights of health-related quality of life determinants differ across countries.

DESIGN

An observational multicentre study at university cardiac centres in the Netherlands and Slovakia.

METHODS

In 226 coronary artery disease patients, health-related quality of life was measured by the Short Form Health Survey 36, anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and type D personality was assessed with the 14-item Type D Scale. Multivariate analysis was used to explore the effect of patient characteristics on the physical and mental component summaries. Estimates of each predictor's beta value of the physical and mental component summaries in the Slovak and Dutch patient sample were separately calculated using the Cummings criterion for comparison of two independent betas.

RESULTS

Stronger predictors of physical health-related quality of life in Slovak patients were educational level, current smoking, poor functional status, history of diabetes and amount of social support. In Dutch patients, only more symptoms of depression was a stronger predictor ( P<0.05). Regarding Slovak mental health-related quality of life, stronger predictors were educational level, current smoking and amount of social support. Female gender, history of myocardial infarction and more symptoms of depression were stronger predictors in Dutch patients ( P<0.05).

CONCLUSION

Descent and differences between both populations in determinants of health-related quality of life should be considered while planning care, follow-up, health education and rehabilitation.

Health related quality of life among myocardial infarction survivors in the United States: a propensity score matched analysis

Background

Little is known regarding the health-related quality of life among myocardial infarction (MI) survivors in the United States. The purpose of this population-based study was to identify differences in health-related quality of life domains between MI survivors and propensity score matched controls.

Methods

This retrospective, cross-sectional matched case-control study examined differences in health-related quality of life (HRQoL) among MI survivors of myocardial infarction compared to propensity score matched controls using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Propensity scores were generated via logistic regression for MI survivors and controls based on gender, race/ethnicity, age, body mass index (BMI), smoking status, and comorbidities. Chi-square tests were used to compare differences between MI survivors to controls for demographic variables. A multivariate analysis of HRQoL domains estimated odds ratios. Life satisfaction, sleep quality, and activity limitations were estimated using binary logistic regression. Social support, perceived general health, perceived physical health, and perceived mental health were estimated using multinomial logistic regression. Significance was set at p < 0.05.

Results

The final sample consisted of 16,729 MI survivors matched to 50,187 controls (n = 66,916). Survivors were approximately 2.7 times more likely to report fair/poor general health compared to control (AOR = 2.72, 95% CI: 2.43–3.05) and 1.5 times more likely to report limitations to daily activities (AOR = 1.46, 95% CI: 1.34–1.59). Survivors were more likely to report poor physical health >15 days in the month (AOR = 1.63, 95% CI: 1.46–1.83) and poor mental health >15 days in the month (AOR = 1.25, 95% CI: 1.07–1.46) compared to matched controls. There was no difference in survivors compared to controls in level of emotional support (rarely/never: AOR = 0.75, 95% CI: 0.48–1.18; sometimes: AOR = 0.73, 95% CI: 0.41–1.28), hours of recommended sleep (AOR = 1.14, 95% CI: 0.94–1.38), or life satisfaction (AOR = 1.62, 95% CI: 0.99–2.63).

Conclusion

MI survivors experienced lower HRQoL on domains of general health, physical health, daily activity, and mental health compared to the general population.

Treatment and outcomes of acute coronary syndromes in women: An analysis of a multicenter quality improvement Chinese study

BACKGROUND

Variations in care and outcomes by sex in patients with acute coronary syndrome (ACS) have been reported worldwide. The aims of this study are to describe ACS management according to sex in China and the effects of a quality improvement program in Chinese male and female ACS patients.

METHODS AND RESULTS

Clinical Pathways for Acute Coronary Syndromes - Phase 2 (CPACS-2) was a cluster randomized trial to test whether a clinical pathways-based intervention would improve ACS management in China. The study enrolled 15,141 hospitalized patients [4631 (30.6%) were women] from 75 hospitals throughout China between October 2007 and August 2010. The intervention included clinical pathway implementation and performance measurement using standardized indicators with 6 monthly audit-feedback cycles. Eight key performance indicators reflecting in hospital management of ACS were measured. After adjustment for differences in patient characteristics and comorbidities at presentation, women were significantly less likely to undergo coronary angiography when indicated (RR 0.88 [0.85 to 0.92], P<0.001), less likely to receive guideline recommended medical therapies at discharge (RR 0.94 [0.91 to 0.98], P=0.003) and more likely to be hospitalized for shorter (mean difference -0.42 [-0.73 to -0.12] days, P=0.007). However, in-hospital clinical outcomes did not differ by sex. There was no evidence of heterogeneity in the relative effects of the quality improvement initiative by sex.

CONCLUSIONS

Sex disparities were apparent in some key quality of care indicators for patients with suspected with ACS presenting to hospitals in China. The beneficial effect of the quality improvement program was consistent in women and men.

CLINICAL TRIAL REGISTRATION

http://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.

Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece

The high level of out of pocket (OOP) payments constitutes a major concern for Greece and several other European and OECD countries as a result of the significant down turning of their public health finances due to the 2008 financial crisis. The basic objective of this study is to provide empirical evidence on the effect of combining social health insurance (SHI) and private health insurance (PHI) on OOP payments. Further, this study examines the catastrophic impact of OOP payments on insured's welfare using the incidence and intensity methodological approach of measuring catastrophic health care expenditures. Conducting a cross-sectional survey in Greece in 2013, we find that the combination of SHI-PHI has a strong negative influence on insured OOP payments for inpatient health care in private hospitals. Furthermore, our results indicate that SHI coverage is not sufficient by itself to manage with this issue. Moreover, we find that poor people present a greater tendency to incur catastrophic OOP expenditures for hospital health care in private providers. Drawing evidence from Greece, a country with huge fiscal problems that has suffered the consequences of the economic crisis more than any other, could be a starting point for policymakers to consider the perspective of SHI-PHI co-operation against OOP payments more seriously.

Socioeconomic inequalities in health-related quality of life between men and women, 5 years after a coronary angiography

Background

The aim of this study is to measure gender differences in health-related quality of life (HRQOL) among men and women patients with cardiovascular diseases (CVD), and to assess the impact of socioeconomic factors on HRQOL between men and women, 5 years after a coronary angiography.

Methods

The study included 1,289 out of 4,391 patients who had undergone an angiography in the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg in 2008/2009. Four indicators of the WHOQOL-BREF questionnaire (Self-rated health, Quality of life, Physical health, and Psychological health) were used in this study as interest variables. To assess the socioeconomic inequalities in HRQOL between men and women, general linear models were constructed for every indicator, with educational level and living conditions as predictors, and demographic variables, cardiovascular risk factors, and cardiovascular events as covariates.

Results

Women were older than men (71.5 versus 68.1, p <0.0001) and less likely to be married. HRQOL was significantly different between men and women despite the fact they had the same socioeconomic status. The average score for overall health was 3.7/5 for men versus 3.5/5 for women; similarly, the life quality score was 3.8/5 for men versus 3.6/5 for women. Education level and living conditions were associated with lower HRQOL scores in men and women.

Conclusion

The findings showed that women have lower HRQOL than men regarding self-rated health, quality of life, and the WHOQOL-BREF physical and psychological domains 5 years after a coronary angiography. Socioeconomic inequalities affect HRQOL, and their influence was similar in both men and women. Socioeconomic inequalities in HRQOL in women and men with CVD are strong 5 years after a coronary angiography. Taking into account differences in gender and socioeconomic status in intervention strategies to substantially reduce the differences observed between women and men could help improve the effectiveness of secondary prevention.

Factors related to the evolution of Health Related Quality of Life in coronary patients. A longitudinal approach using Weighted Generalized Estimating Equations with missing data

BACKGROUND

The aim is to know the factors related to the evolution of Health Related Quality of Life (HRQL) in Coronary Patients (CP) from a longitudinal perspective using an appropriate method that handles missing data adequately when the mechanism of missingness is uncertain.

METHODS

Prospective study with repeated measures at baseline, 3 and 6months. 250 patients with acute myocardial infarction or unstable angina were studied. Sociodemographic and clinical data were collected at baseline. Mental health (GHQ-28) and HRQL (SF-36v1) were assessed during the follow-up. The missingness mechanism was tested. Friedman test and partial eta-squared were used to analyse changes in SF-36 scores and WGEE were used to identify the predictors of the evolution of HRQL.

RESULTS

95 dropped out after 3months and 72 after 6months. The missingness was likely to be at random. All the dimensions of the SF-36 improved over time, except PF. The factors related to the evolution of HRQL were: being woman (B=-23.9 in RE; B=-6.9 in MCS), older age (B=-0.5 in BP; B=-0.3 in VT), being single/separated (B=-14.5 in GH; B=-14.1 in SF; B=-23.3 in MH) and widow(er) (B=-23.2 PF; B=-29.8 in SF), hypertensive (B=-19.8 in RP; B=-8.9 in VT), worse mental health (B=-3 in PF; B=-2.8 in RP; B=-3.1 in BP; B=-1.2 in PCS; B=-3.8 in VT; B=-2.6 in SF), previous history of CHD (B=-12.5 in PF; B=-5.2 in PCS), and performing heart-healthy physical activities (B=13.9 in PF).

CONCLUSIONS

HRQL improves over time. A global approach, including age, marital status, performing physical activities or hypertension, is required to improve HRQL in CP.

Association between body mass index and mortality in a prospective cohort of Chinese adults

Obesity is associated with an increased risk of diabetes mellitus, hypertension, and coronary artery disease; however, the relation between body mass index (BMI) and the risk of all-cause mortality is controversial. We prospectively examined the relationship between BMI and all-cause mortality in 123,384 Chinese men and women who participated in the Kailuan health examination study from 2006 to 2007 and 2008 to 2009. Cases included 6218 deaths (5770 men and 448 women) that occurred during a mean follow-up period of 7.39 years. Relative risk was adjusted for factors such as age, serum lipid levels (ie, triglyceride, high-density lipoprotein, and low-density lipoprotein cholesterol), history of smoking and drinking, and physical activity, as well as a medical history of hypertension, diabetes, myocardial infarction, and stroke. Within the cohort, the lowest risk of all-cause mortality was seen among persons with a BMI of 24 to 28 kg/m in male, and the risk was elevated among persons with BMI levels lower or higher than that range. Moreover, all-cause mortality was greatest in the group with a BMI of <18.5 kg/m. In contrast, in female, a high BMI was associated with increased mortality, and a BMI of <18.5 kg/m was associated with the lowest risk. Further, a U-shaped association was seen between BMI and the risk of death from any cause among men and women, even after adjusting for confounding factors. In conclusion, underweight was associated with a substantially increased risk of all-cause mortality in males. The excess risk of all-cause mortality with a high BMI, however, was seen among females.

Comparison of health-related quality of life after percutaneous coronary intervention and coronary artery bypass surgery

BACKGROUND

Health-related quality of life (HRQOL) evaluation is an important measure of the impact of the disease. As more people with coronary heart disease (CHD) live longer, doctors and researchers want to know how they manage in day to day life. It looked like adults with CHD had a decrease QOL. The aim of this study was to comparison of HRQOL of patients who underwent percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) and to assess its main determinants in the whole sample of coronary artery disease (CAD) patients.

METHODS

The study was carried out to estimate HRQOL of 109 patients who underwent invasive coronary revascularization [PCI (n = 75) and CABG (n = 34)]. We applied HRQOL after 6 months and 2 years in both groups and scores were compared. The HRQOL data were obtained using MacNew Heart Disease questionnaire with dimensions emotional, physical and social that estimated. Data entry and analysis were performed by SPSS.

RESULTS

A total MacNew scale in CABG and PCI group in 6 months after treatment were 45.32 ± 13.75 and 53.52 ± 15.63, respectively (P = 0.010). After 2 years HRQOL mean changed to 51.176 ± 14.80 and 49.55 ± 16.22, respectively, in CABG and PCI group (P = 0.428). Our results in within-group analysis showed total MacNew scale and its subscales were changed significantly after 2 years in CABG and PCI group's scores were detected. We found in the whole sample of CAD patients those who had a higher level of income and education and were not either overweight or obese experienced better HRQOL.

CONCLUSION

Our results showed that patients who underwent PCI experienced significantly higher HRQOL in 6 months after revascularization but over 24 months follow-up no difference was observed between the two groups.

Profile and Correlates of Health-related Quality of Life in Chinese Patients with Coronary Heart Disease

BACKGROUND

Although coronary heart disease (CHD) is one of the major cardiovascular diseases, risk factors associated with the health-related quality of life (HRQoL) of CHD patients remain unclear. The present study was designed to determine the profile and significant factors of the HRQoL in CHD patients.

METHODS

A cross-sectional study was conducted in rural communities of Fangshan District, Beijing, China. Socio-demographic, lifestyle, and comorbidity information of CHD patients were collected by a structured questionnaire and medical records. HRQoL was measured using European Quality of Life 5-dimensions (EQ-5D) scale and EQ Visual Analog Scale (EQ-VAS). Multiple linear and logistic regressions were performed to explore the association of potential risk factors with HRQoL scores and each EQ-5D, respectively.

RESULTS

Totally, 1928 CHD patients (mean age 61.64 ± 9.24 years; female:male = 2.4:1) were enrolled in the study. The mean score of EQ-5D index and EQ-VAS were 0.889 ± 0.172 and 71.56 ± 17.65, respectively. Multiple linear regression revealed that marital status, physical activity, moderate alcohol drinking, and family's population were positive independent correlates of EQ-VAS, whereas diabetes mellitus and stroke were negative independent correlates (all P < 0.05). Age and stroke were negatively while physical activity, moderate alcohol drinking, family's population and household income were positively correlated with EQ-5D index (all P < 0.05) independently. In addition, each of the five HRQoL dimensions had various specific determinants, including obesity, underweight, smoking or education.

CONCLUSIONS

Findings of the study highlight certain socio-demographic, lifestyle factors, and comorbid stroke or diabetes mellitus as correlates of HRQoL in Chinese CHD patients. Large-scale cohort studies should be carried out to confirm our results in the future.

Acute Coronary Syndromes in Women: Recent Treatment Trends and Outcomes

In the USA and internationally, women experience farranging differences with respect to acute coronary syndrome (ACS) and myocardial infarction (MI). Women suffer from more comorbidities than men, such as smoking, obesity, hypertension, diabetes, and poor mental health. They some-times exhibit atypical MI presentation symptoms and are overall less likely to present with chest pain. Women are more likely than men to encounter delays between the onset of symptoms and arrival at the hospital or to guideline treatment. The use of various surgical and pharmacological treatments, including revascularization approaches, also differs. Women, on average, have worse outcomes than men following MI, with more complications, higher mortality rates, and poorer recovery. Internationally, outcomes are similar despite various differences in health care and culture in non-US countries. In this review, we detail differences regarding ACS and MI in women, describing their complex correlations and discussing their possible causes. Educational approaches that are tailored to women might help to reduce the incidence of ACS and MI, as well as outcomes following hospitalization. Although outcomes following acute MI have been improving over the years, women may require special consideration in order to see continued improvement.

Population-level differences in revascularization treatment and outcomes among various United States subpopulations

Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.

Sex differences in the quality of life of patients with acute coronary syndrome treated with percutaneous coronary intervention after a 3-year follow-up

BACKGROUND

The aims of this study were to analyze the dynamics of quality of life (QoL) changes after 36 months from the percutaneous coronary intervention (PCI) depending on sex and identify baseline predictors of the follow-up QoL of patients hospitalized for acute coronary syndrome (ACS) and subjected to PCI.

METHODS AND RESULTS

The study included 137 patients, females (n=67) and males (n=70), with ACS who underwent PCI. The QoL was assessed using the MacNew Heart Disease Health-Related Quality of Life questionnaire. The group of females scored lower in all the domains of the MacNew Heart Disease Health-Related Quality of Life questionnaire in the initial measurement (B 1), in the measurement after 6 months (B 2), and in the long-term follow-up measurement (36 months - B 3). Despite the fact that both groups achieved improved QoL, its values were higher in the males. The average growth rate of the QoL score in the period from the sixth month to 36th month was higher in females than in males. In the univariate and multivariate analyses, significant independent predictors with a negative influence on the long-term QoL score included female sex (ρ=-0.190, β=-0.21), age >60 years (ρ=-0.255, β=-0.186), and diabetes (ρ=-0.216, β=-0.216).

CONCLUSION

In a 36-month follow-up of ACS patients treated with PCI, there were no statistically significant differences in QoL between sexes. In the entire cohort, there was improvement in QoL, which was higher in the case of the females studied. For the entire group, significant independent determinants of lower QoL 3 years after ACS included female sex, age >60 years, and diabetes.

Predictors of change in sexual activity after cardiac diagnosis: Elements to inform sexual counseling

Safely returning to sexual activity after being diagnosed with a cardiac condition is at the core of sexual counseling strategies. To further inform sexual counseling, this study examined changes in sexual activity before and after a cardiac diagnosis. Logistic analysis was used to suggest factors that can contribute to a change in sexual activity among cardiac patients. Reduced frequency in sexual activity after a cardiac diagnosis was influenced by greater sexual concerns and a history of smoking, as well as by education and employment status. These findings suggest that cardiac patients experiencing significant concerns about resuming sexual activity need added support through the mental health system.

Predictive Factors of Hospital Mortality Due to Myocardial Infarction: A Multilevel Analysis of Iran's National Data

Background:

Regarding failure to establish the statistical presuppositions for analysis of the data by conventional approaches, hierarchical structure of the data as well as the effect of higher-level variables, this study was conducted to determine the factors independently associated with hospital mortality due to myocardial infarction (MI) in Iran using a multilevel analysis.

Methods:

This study was a national, hospital-based, and cross-sectional study. In this study, the data of 20750 new MI patients between April, 2012 and March, 2013 in Iran were used. The hospital mortality due to MI was considered as the dependent variable. The demographic data, clinical and behavioral risk factors at the individual level and environmental data were gathered. Multilevel logistic regression models with Stata software were used to analyze the data.

Results:

Within 1-year of study, the frequency (%) of hospital mortality within 30 days of admission was derived 2511 (12.1%) patients. The adjusted odds ratio (OR) of mortality with (95% confidence interval [CI]) was derived 2.07 (95% CI: 1.5–2.8) for right bundle branch block, 1.5 (95% CI: 1.3–1.7) for ST-segment elevation MI, 1.3 (95% CI: 1.1–1.4) for female gender, and 1.2 (95% CI: 1.1–1.3) for humidity, all of which were considered as risk factors of mortality. But, OR of mortality was 0.7 for precipitation (95% CI: 0.7–0.8) and 0.5 for angioplasty (95% CI: 0.4–0.6) were considered as protective factors of mortality.

Conclusions:

Individual risk factors had independent effects on the hospital mortality due to MI. Variables in the province level had no significant effect on the outcome of MI. Increasing access and quality to treatment could reduce the mortality due to MI.

Gender differences in pre-event health status of young patients with acute myocardial infarction: A VIRGO study analysis

AIMS

We assessed gender differences in pre-event health status (symptoms, functioning, quality of life) in young patients with acute myocardial infarction and whether or not this association persists following sequential adjustment for important covariates. We also evaluated the interaction between gender and prior coronary artery disease, given that aggressive symptom control is a cornerstone of care in those with known coronary disease.

METHODS AND RESULTS

A total of 3501 acute myocardial infarction patients (2349 women) aged 18-55 years were enrolled from 103 US/24 Spanish hospitals (2008-2012). Clinical/health status information was obtained by medical record abstraction and patient interviews. Pre-event health status was measured by generic (Short Form-12, EuroQoL) and disease-specific (Seattle Angina Questionnaire) measures. T-test/chi-square and multivariable linear/logistic regression analysis was utilized, sequentially adjusting for covariates. Women had more co-morbidities and significantly lower generic mean health scores than men (Short Form-12 physical health = 43 ± 12 vs. 46 ± 11 and mental health = 44 ± 13 vs. 48 ± 11); EuroQoL utility index = 0.7 ± 0.2 vs. 0.8 ± 0.2 and visual analog scale = 63 ± 22 vs. 67 ± 20, P < 0.0001 for all. Their disease-specific health status was also worse, with more angina (Seattle Angina Questionnaire angina frequency = 83 ± 22 vs. 87 ± 18), worse physical function (physical limitation = 78 ± 27 vs. 87 ± 21) and poorer quality of life (55 ± 25 vs. 60 ± 22, P<0.0001 for all). In multivariable analysis, the association between female gender and worse generic physical/mental health persisted, as well as worse disease-specific physical limitation and quality of life. The interaction between gender and prior coronary artery disease was not significant in any of the health status outcomes.

CONCLUSION

Young women have worse pre-event health status as compared with men, regardless of their coronary artery disease history. While future studies of gender differences should adjust for baseline health status, an opportunity may exist to better address the pre-event health status of women at risk for acute myocardial infarction.

Health-related quality of life in premature acute coronary syndrome: does patient sex or gender really matter?

Background

Limited data exist as to the relative contribution of sex and gender on health‐related quality of life (HRQL) among patients with acute coronary syndrome (ACS). This study aims to evaluate the effect of sex and gender‐related variables on long‐term HRQL among young adults with ACS.

Methods and Results

GENESIS‐PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond‐Premature Acute Coronary SYndrome) is a multicenter, prospective cohort study (January 2009 to August 2013) of adults aged 18 to 55 years, hospitalized with ACS. HRQL was measured at baseline, 1, 6, and 12 months using the Short Form‐12 and Seattle Angina Questionnaire (SAQ) among 1213 patients. Median age was 49 years. Women reported worse HRQL than men over time post‐ACS, both in terms of physical and mental functioning. Gender‐related factors were more likely to be predictors of HRQL than sex. Femininity score, social support, and housework responsibility were the most common gender‐related predictors of HRQL at 12 months. We observed an interaction between female sex and social support (β=0.44 [95% confidence interval, 0.01, 0.88]; P=0.047) for the physical limitation subscale of the SAQ.

Conclusions

Young women with ACS report significantly poorer HRQL than young men. Gender appears to be more important than sex in predicting long‐term HRQL post‐ACS. Specific gender‐related factors, such as social support, may be amenable to interventions and could improve the HRQL of patients with premature ACS.

Health-related quality of life in European women following myocardial infarction: a cross-sectional study

BACKGROUND

Coronary heart disease is a major contributor to women's health problems.

DESIGN

Self-perceived social support, well-being and health-related quality of life (HRQL) were documented in the cross-sectional HeartQoL survey of European women one and six months after a myocardial infarction.

METHODS

European women were recruited in 18 European countries and grouped into four geographical regions (Southern Europe, Northern Europe, Western Europe and Eastern Europe). Continuous socio-demographic variables and categorical variables were compared by age and region with ANOVA and χ(2), respectively; multiple regression models were used to identify predictors of social support, well-being and HRQL.

RESULTS

Women living in the Eastern European region rated social support, well-being and HRQL significantly lower than women in the other regions. Older women had lower physical HRQL scores than younger women. Eastern European women rated social support, well-being and HRQL significantly lower than women in the other regions. Prediction of the dependent variables (social support, well-being and HRQL) by socio-demographic factors varied by total group, in the older age group, and by region; body mass index and managerial responsibility were the most consistent significant predictors.

Evaluation of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease -- a randomised intervention study

AIMS AND OBJECTIVES

To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease.

BACKGROUND

Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity.

DESIGN

A randomised pretest-post-test control design.

METHODS

Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress.

RESULTS

At a three- to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group.

CONCLUSIONS

An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time.

RELEVANCE TO CLINICAL PRACTICE

Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients' needs, supported by a healthcare team and led by nurses, is important in clinical practice.

Predictors of physical and mental health-related quality of life outcomes among myocardial infarction patients

Background

Health-related quality of life (HRQoL) is an important outcome for patients diagnosed with coronary heart disease. This report describes predictors of physical and mental HRQoL at six months post-hospitalisation for myocardial infarction.

Methods

Participants were myocardial infarction patients (n=430) admitted to two tertiary referral centres in Brisbane, Australia who completed a six month coronary heart disease secondary prevention trial (ProActive Heart). Outcome variables were HRQoL (Short Form-36) at six months, including a physical and mental summary score. Baseline predictors included demographics and clinical variables, health behaviours, and psychosocial variables. Stepwise forward multiple linear regression analyses were used to identify significant independent predictors of six month HRQoL.

Results

Physical HRQoL was lower in participants who: were older (p<0.001); were unemployed (p=0.03); had lower baseline physical and mental HRQoL scores (p<0.001); had lower confidence levels in meeting sufficient physical activity recommendations (p<0.001); had no intention to be physically active in the next six months (p<0.001); and were more sedentary (p=0.001). Mental HRQoL was lower in participants who: were younger (p=0.01); had lower baseline mental HRQoL (p<0.001); were more sedentary (p=0.01) were depressed (p<0.001); and had lower social support (p=0.001).

Conclusions

This study has clinical implications as identification of indicators of lower physical and mental HRQoL outcomes for myocardial infarction patients allows for targeted counselling or coronary heart disease secondary prevention efforts.

Trial registration

Australian Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, CTRN12607000595415.

Relationships among circadian typology, psychological symptoms, and sensation seeking

Recently, attention has been focused on the relationship among circadian typology, psychiatric symptoms, and personality traits. This study analyzes the influence of circadian typology on psychological distress, and the sensation-seeking personality trait. Five hundred seventeen college students (173 males), aged 17 to 30, answered the Composite Scale of Morningness (CSM), the General Health Questionnaire 28-item version (GHQ-28), and the Sensation Seeking Scale-V (SSS-V). The evening-type subjects in our sample scored higher than the neither- and morning- type in the GHQ-28 total score, as well as in the four subscales that composed it (Psychosomatic Symptoms, Anxiety and Insomnia, Social Dysfunction, and Severe Depression) (p<0.02 in all cases). The evening-type subjects also had a larger proportion of psychiatric cases than the other two circadian typologies (p<0.0001 in all cases). Moreover, the evening-type subjects obtained higher scores in the SSS-V total score and in the subscales of Disinhibition and Boredom Susceptibility (p<0.001 in all cases). A positive correlation was observed between the GHQ-28 and the SSS-V total scores in the total sample, but only for the evening-type group (r=0.217; p<0.027). In the evening group, several relations were also found between the subscales of the GHQ-28 and the subscales of the SSS-V (r>0.206; p<0.036). All these data point to a relationship between evening-type subjects and the level of psychological distress and the sensation-seeking personality trait. They also suggest that eveningness could be related to developing psychological distress and personality traits that could, in turn, be related to developing other problems, such as drug consumption.

Sex differentiation with regard to coronary artery disease

Coronary artery disease was considered a male disease for many years. However, nowadays, coronary artery disease constitutes the leading cause of death in women, although there are a lot of gender-related differences regarding the presentation of acute myocardial infarction, its diagnosis, its treatment, short- and long-term mortality rates, and post-acute myocardial infarction complications. Generally, women have smaller and stiffer hearts and cardiac vessels, suffering a greater extent of atherosclerosis and endothelial and smooth muscle dysfunction. They are usually older than men and they have more comorbidities such as hypertension, renal impairment, and diabetes mellitus. Moreover, female coronary artery disease, the diagnosis of which is more complicated due to more false negative results of some diagnostic methods in women, is more often presented with atypical symptoms and women's symptoms of typical or atypical angina are more severe. Furthermore, women delay significantly more in seeking care and they are more frequently undertreated. Finally, women are associated with generally poorer in-hospital and long-term prognosis having almost two-fold higher early mortality and they are more prone to complications such as bleeding complications, shock, and heart failure, as well as to post-myocardial infarction depression and poorer physical function and mental health. In this review, we discuss these sex-related differences according to current literature.