1
|
Gąsecka A, Rzepa B, Skwarek A, Ćwiek A, Pluta K, Szarpak Ł, Jaguszewski MJ, Mazurek T, Kochman J, Opolski G, Filipiak KJ, Gąsecki K. Health-related Quality of Life Increases After First-time Acute Myocardial Infarction: a Population-based Study. Zdr Varst 2022; 61:24-31. [PMID: 35111263 PMCID: PMC8776287 DOI: 10.2478/sjph-2022-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) affects patients' health-related quality of life (HRQOL). AMI may decrease HRQOL, thus negatively affecting QOL. However, the improvements in interventional treatment and early rehabilitation after AMI may have a positive effect on HRQOL. AIM We evaluated HRQOL in patients after the first AMI treated in a reference cardiology centre in Poland and assessed which clinical variables affect HRQOL after AMI. MATERIAL AND METHODS We prospectively evaluated HRQOL in 60 consecutive patients suffering after their first AMI during the index hospitalisation and again after 6 months, using: (i) MacNew, (ii) World Health Organization Quality of Life (WHOQOL) BREF, and (iii) Short Form (SF) 36. RESULTS As measured by the MacNew questionnaire, global, social, and physical functioning did not change (p≥0.063), whereas emotional functioning improved 6 months after AMI, compared to index hospitalisation (p=0.002). As measured by WHOQOL BREF, physical health, psychological health, and environmental functioning did not change (p≥0.321), whereas social relationships improved 6 months after AMI (p=0.042). As assessed by SF-36, the global HRQOL improved after AMI (p=0.044). Patients with improved HRQOL in SF-36 often had a higher baseline body mass index (p=0.046), dyslipidaemia (p=0.046), and lower left ventricle ejection fraction (LVEF; p=0.013). LVEF<50% was the only variable associated with improved HRQOL in multivariate analysis (OR 4.463, 95% CI 1.045 - 19.059, p=0.043). CONCLUSIONS HRQOL increased 6 months after the first AMI, especially in terms of emotional functioning and social relationships. Patients with LVEF<50% were likely to have improved HRQOL.
Collapse
Affiliation(s)
- Aleksandra Gąsecka
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Stefana Banacha 1a, Warsaw, Masovian, Poland
| | | | - Aleksandra Skwarek
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Stefana Banacha 1a, Warsaw, Masovian, Poland
| | - Agata Ćwiek
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Stefana Banacha 1a, Warsaw, Masovian, Poland
| | - Kinga Pluta
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Stefana Banacha 1a, Warsaw, Masovian, Poland
| | - Łukasz Szarpak
- Bialystok Oncology Center, Bialystok, Poland
- Polish Society of Disaster Medicine, Warsaw, Poland
- Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Miłosz J. Jaguszewski
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Stefana Banacha 1a, Warsaw, Masovian, Poland
| | - Tomasz Mazurek
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Stefana Banacha 1a, Warsaw, Masovian, Poland
| | - Janusz Kochman
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Stefana Banacha 1a, Warsaw, Masovian, Poland
| | - Grzegorz Opolski
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Stefana Banacha 1a, Warsaw, Masovian, Poland
| | | | - Krzysztof Gąsecki
- University of Warmia and Mazury, Faculty of Social Sciences, Chair of Social Pedagogy and Educational Research Methodology, Olsztyn, Poland
| |
Collapse
|
2
|
Minami HR, Itoga NK, George EL, Garcia-Toca M. Cost-effectiveness analysis of ankle-brachial index screening in patients with coronary artery disease to optimize medical management. J Vasc Surg 2021; 74:2030-2039.e2. [PMID: 34175383 DOI: 10.1016/j.jvs.2021.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Screening for peripheral artery disease (PAD) with the ankle-brachial index (ABI) test is currently not recommended in the general population; however, previous studies advocate screening in high-risk populations. Although providers may be hesitant to prescribe low-dose rivaroxaban to patients with coronary artery disease (CAD) alone, given the reduction in cardiovascular events and death associated with rivaroxaban, screening for PAD with the ABI test and accordingly prescribing rivaroxaban may provide additional benefits. We sought to describe the cost-effectiveness of screening for PAD in patients with CAD to optimize this high-risk populations' medical management. METHODS We used a Markov model to evaluate the ABI test in patients with CAD. We assumed that all patients screened would be candidates for low-dose rivaroxaban. We assessed the cost of ABI screening at $100 per patient and added additional charges for physician visits ($100) and rivaroxaban cost ($470 per month). We used a 30-day cycle and performed analysis over 35 years. We evaluated quality-adjusted life years (QALYs) from previous studies and determined the incremental cost-effectiveness ratio (ICER) according to our model. We performed a deterministic and probabilistic sensitivity analyses of variables with uncertainty and reported them in a Tornado diagram showing the variables with the greatest effect on the ICER. RESULTS Our model estimates decision costs to screen or not screen at $94,953 and $82,553, respectively. The QALYs gained from screening was 0.060, generating an ICER of $207,491 per QALY. Factors most influential on the ICER were the reduction in all-cause mortality associated with rivaroxaban and the prohibitively high cost of rivaroxaban. If rivaroxaban cost less than $95 per month, this would make screening cost-effective based on a willingness to pay threshold of $50,000 per QALY. CONCLUSIONS According to our model, screening patients with CAD for PAD to start low-dose rivaroxaban is not currently cost-effective due to insufficient reduction in all-cause mortality and high medication costs. Nevertheless, vascular surgeons have a unique opportunity to prescribe or advocate for low-dose rivaroxaban in patients with PAD to improve cardiovascular outcomes.
Collapse
Affiliation(s)
- Hataka R Minami
- Undergraduate Medical Education, Saint Louis University School of Medicine, St Louis, Mo.
| | - Nathan K Itoga
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, Calif
| | - Elizabeth L George
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, Calif
| | - Manuel Garcia-Toca
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, Calif
| |
Collapse
|
3
|
Health-Related Quality of Life and Associated Factors among Myocardial Infarction Patients at Cardiac Center, Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021. [DOI: 10.1155/2021/6675267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction. Myocardial infarction is the most frequent manifestation of coronary heart disease and one of the leading causes of death worldwide. The sudden and often profound physiological and psychological effect of the acute onset of myocardial infarction hurts the health-related quality of life. Objective. To assess health-related quality of life and associated factors among myocardial infarction patients at Cardiac Center, Ethiopia, Addis Ababa, Ethiopia, 2020. Method. Institution-based cross-sectional study was conducted from April 10 to June 25, 2020, at the Cardiac Center-Ethiopia, Addis Ababa, Ethiopia. The sample consisted of 421 myocardial infarction patients. Data were collected through an interviewer-administered structured questionnaire by using the World Health Organization Quality of Life Questionnaire. Samples were selected using a consecutive sampling technique. The linear regression analysis model was fitted using SPSS 26 and STATA 14, and the unstandardized beta (𝛽) coefficient with a 95% confidence interval was used. A
value <0.05 was considered statistically significant for all analyses. Results. The mean score of the overall health-related quality of life was found to be
, and the mean score for the physical domain was
; for the psychological domain, it was
, and for environmental and social relationship domains, it was
and
, respectively. In the multiple regression analysis, increased age, living in a rural area, heart failure, and hypertension were inversely associated with overall health-related quality of life, while secondary and higher education were associated with better overall health-related quality of life. Conclusion. Patients with myocardial infarction at Cardiac Center, Ethiopia, had lower health-related quality of life. Hence, the finding of this study suggests the implementation of a cardiac rehabilitation program and comprehensive service given by healthcare providers.
Collapse
|
4
|
Almamari RSS, Muliira JK, Lazarus ER. Self-reported sleep quality and depression in post myocardial infarction patients attending cardiology outpatient clinics in Oman. Int J Nurs Sci 2019; 6:371-377. [PMID: 31728388 PMCID: PMC6838964 DOI: 10.1016/j.ijnss.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/06/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to examine the sleep quality and prevalence of depression in post myocardial infarction patients attending cardiology outpatient clinics of selected hospitals in Oman. METHODS A descriptive cross-sectional design was used to collect data from patients (n = 180) who were at least 4 weeks post myocardial infarction diagnosis and receiving follow-up care in the outpatient clinic. The Arabic version of the Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9 were used to assess sleep quality and depressive symptoms, respectively. RESULTS The sample mean age was 62.0 ± 11.3 years. Poor sleep quality affected 61.1% of the participants. The significant predictors of poor sleep quality were gender (P ≤ 0.05), body mass index (P ≤ 0.05), and self-reported regular exercise (P ≤ 0.01). The most impacted domains of sleep quality were sleep latency, sleep duration, and sleep disturbances. The prevalence of major depression was low (5%) and the rate of re-infarction was 27.2%. The prevalence of minimal to mild major depression with a potential of transitioning into major depression overtime was very high. Self-reported regular exercise (P ≤ 0.01) was the only significant predictor of depressive symptoms. CONCLUSION The sleep quality of post myocardial infarction patients was poor and the prevalence of depression was low. There was no significant relationship between sleep quality or depression with re-infarction.
Collapse
Affiliation(s)
| | - Joshua Kanaabi Muliira
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Oman
| | | |
Collapse
|
5
|
Mahesh PKB, Gunathunga MW, Jayasinghe S, Arnold SM, Haniffa R, De Silva AP. Pre-event quality of life and its influence on the post-event quality of life among patients with ST elevation and non-ST elevation myocardial infarctions of a premier province of Sri Lanka. Health Qual Life Outcomes 2017; 15:154. [PMID: 28764724 PMCID: PMC5540486 DOI: 10.1186/s12955-017-0730-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pre-event Quality of Life (QOL) reflects the true social circumstances in which people live prior to the onset of myocardial infarctions. It is believed to be a predictor of the post-event QOL. The aim of this study was to describe the pre-event QOL and its influence on the post-event Quality of Life among patients with ST elevation (STEMI) and Non-ST elevation myocardial infarctions (NSTEMI) using Short Form-36 (SF-36), a generic QOL tool with 8 domains. Documented literature is rare in this regard in Sri Lanka, which is a lower-middle-income country. METHODS A cross-sectional study with a 28-day post-discharge follow-up was carried out in 13 hospitals. Three hundred and forty-four patients who were diagnosed with STEMI or NSTEMI were recruited during the hospital stay. The pre-event QOL was measured using an interviewer-administered questionnaire which included the SF-36 QOL tool and medical details. Follow-up QOL was gathered using a questionnaire that was filled and posted back by participants. Of the recruited sample, 235 responded for the follow-up component. Analysis was conducted for associations between pre- and post-discharge QOL. Furthermore, comparisons were made between the STEMI and NSTEMI groups. Mann Whiney U test, Wilcoxon signed rank test and chi square test were used in the analysis. RESULTS The post-event QOL was lower in seven out of eight domains than the pre-event QOL (p < 0.05). The NSTEMI group had more risk factors and a significantly lower pre-event QOL for seven domains (p < 0.05), when compared to the STEMI group. For seven domains, the post-discharge QOL was not significantly different (p > 0.05) between the STEMI and NSTEMI groups. Post-discharge general-health QOL domain score was higher than the pre-MI score (p = 0.028) and was higher in the STEMI group compared to the NSTEMI group (p = 0.042). Regression analysis showed a significant beta coefficient between pre- and post-QOL for five domains in STEMI and for all domains in NSTEMI groups when adjusted for the disease severity. The R square values ranged from 12.3 to 62.3% for STEMI and 7.3 to 64.8% for NSTEMI. CONCLUSIONS Pre-event QOL is lower in the NSTEMI group compared to the STEMI group. Patients do not regain the previous QOL within one month post-discharge. Post-discharge QOL can be predicted by the pre-event QOL for most domains.
Collapse
Affiliation(s)
- P. K. B. Mahesh
- Office of Regional Director of Health Services, Colombo, Sri Lanka
| | - M. W. Gunathunga
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - S. M. Arnold
- Office of Regional Director of Health Services, Colombo, Sri Lanka
| | - R. Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | |
Collapse
|
6
|
Abimanyi-Ochom J, Watts JJ, Borgström F, Nicholson GC, Shore-Lorenti C, Stuart AL, Zhang Y, Iuliano S, Seeman E, Prince R, March L, Cross M, Winzenberg T, Laslett LL, Duque G, Ebeling PR, Sanders KM. Changes in quality of life associated with fragility fractures: Australian arm of the International Cost and Utility Related to Osteoporotic Fractures Study (AusICUROS). Osteoporos Int 2015; 26:1781-90. [PMID: 25792491 PMCID: PMC4468793 DOI: 10.1007/s00198-015-3088-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/23/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED We investigated change in health-related quality of life due to fracture in Australian adults aged over 50 years. Fractures reduce quality of life with the loss sustained at least over 12 months. At a population level, the loss was equivalent to 65 days in full health per fracture. PURPOSE We aimed to quantify the change in health-related quality of life (HRQoL) that occurred as a consequence of a fracture using the EQ-5D-3 L questionnaire. METHODS Adults aged ≥50 years with a low to moderate energy fracture were recruited from eight study centres across Australia. This prospective study included an 18-month follow-up of participants recruited within 2 weeks of a fracture (hip, wrist, humerus, vertebral and ankle). Information collected at baseline and 4, 12 and 18 months included characteristics of participants such as income level, education and prior fracture status. At 12 months post-fracture, the cumulative loss of quality of life was estimated using multivariate regression analysis to identify the predictors of HRQoL loss. RESULTS Mean HRQoL for all participants before fracture was 0.86, with wrist fracture having the highest pre-fracture HRQoL (0.90), while vertebral fracture had the lowest (0.80). HRQoL declined to 0.42 in the immediate post-fracture period. Only participants with a wrist, humerus or ankle fracture returned to their pre-fracture HRQoL after 18 months. An increased loss of HRQoL over 12 months was associated with HRQoL prior to the fracture, hospitalisation, education and fracture site. The multiple regression explained 30 % of the variation in the cumulative HRQoL loss at 12 months post-fracture for all fractures. CONCLUSION Low to moderate energy fractures reduce HRQoL, and this loss is sustained for at least 12 months or, in the case of hip and spine fractures, at least 18 months. At a population level, this represents an average loss of 65 days in full health per fragility fracture. This significant burden reinforces the need for cost-effective fracture prevention strategies.
Collapse
Affiliation(s)
- J Abimanyi-Ochom
- Deakin Health Economics, Population Health Strategic Research Centre, Deakin University, Burwood, VIC, Australia.
| | - J J Watts
- Deakin Health Economics, Population Health Strategic Research Centre, Deakin University, Burwood, VIC, Australia
| | - F Borgström
- LIME/MMC, Karolinska Institutet, Solna, Sweden
| | - G C Nicholson
- Australian Institute of Musculoskeletal Science, Department of Medicine, The University of Melbourne-Western Health, Melbourne, VIC, Australia
- Rural Clinical School, The University of Queensland, Toowoomba, QLD, Australia
| | - C Shore-Lorenti
- Australian Institute of Musculoskeletal Science, Department of Medicine, The University of Melbourne-Western Health, Melbourne, VIC, Australia
| | - A L Stuart
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Y Zhang
- Australian Institute of Musculoskeletal Science, Department of Medicine, The University of Melbourne-Western Health, Melbourne, VIC, Australia
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - S Iuliano
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, VIC, Australia
| | - E Seeman
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, VIC, Australia
| | - R Prince
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - L March
- Institute of Bone and Joint Research, University of Sydney-Royal North Shore Hospital, Sydney, NSW, Australia
| | - M Cross
- Institute of Bone and Joint Research, University of Sydney-Royal North Shore Hospital, Sydney, NSW, Australia
| | - T Winzenberg
- Menzies Research Institute Tasmania, University of Tasmania, Tasmania, TAS, Australia
| | - L L Laslett
- Menzies Research Institute Tasmania, University of Tasmania, Tasmania, TAS, Australia
| | - G Duque
- Ageing Bone Research Program, Sydney Medical School, Nepean Hospital, University of Sydney, Sydney, NSW, Australia
| | - P R Ebeling
- Australian Institute of Musculoskeletal Science, Department of Medicine, The University of Melbourne-Western Health, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - K M Sanders
- Australian Institute of Musculoskeletal Science, Department of Medicine, The University of Melbourne-Western Health, Melbourne, VIC, Australia
- Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|