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The Association Between Health Related Quality of Life and Five Year Mortality in Patients with ST-Elevated Myocardial Infarction

Year 2018, Volume: 21 Issue: 1, 26 - 31, 01.04.2018

Abstract

Introduction: There is a
lack of studies focusing on the association between health related quality of
life (HRQoL) and mortality. In our study, we aimed to evaluate the association
between HRQoL and mortality of patients with ST-elevated myocardial infarction
(STEMI) treated by percutaneous coronary intervention (PCI).



Patients and Methods:
Ninety-two patients with STEMI undergoing primary PCI with committed 6-month
follow-up were included to the study. In the 6-month follow-up visit, EQ5D
questionnaire, which is valid internationally and is also valid for studies
performed in Turkey for acute coronary syndromes, was filled by patients after
obtaining their demographical and clinical findings. Data analyzes were
performed after 5-year follow-up. Mortality of the patients whose clinical
visits could not be performed evaluated by contacting with their relatives.



Results: Our study
is the first study which evaluates the association between HRQoL and long-term
survival in patients with STEMI. The mean age was 56.96 ± 12.61 and 81 (88%) of
the population were males. Mortality was observed in 12 patients after 5 years.
The mean Index score was 0.903 ± 0.145 and the mean Visual Analog Scale (VAS)
score was 80.58 ± 16.03. The means of the Index score and VAS score were lower
in patients with mortality (p= 0.008 and p= 0.011, respectively). Both Index
and VAS Scale scores were significantly associated with mortality (p= 0.002,
ki-kare: 9.918; p= 0.008, ki-kare= 7.112, respectively). It was revealed by
backward stepwise Cox regression analysis that the presence of an Index score ≤
0.9 is associated with mortality [p= 0.005; HR= 5.546 (1.668-18.443)].



Conclusion: According to our analysis,
lower HRQoL scores are associated with mortality. EQ5D index score is an
independent predictor of the long-term mortality in patients with STEMI treated
by PCI.

References

  • 1. Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569-619.
  • 2. Widimsky P, Wijns W, Fajadet J, de Belder M, Knot J, Aaberge L, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 2010;31:943-57.
  • 3. McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011;124:40-7.
  • 4. Jernberg T, Johanson P, Held C, Svennblad B, Lindback J, Wallentin L. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA 2011;305:1677-84.
  • 5. Fox KA, Steg PG, Eagle KA, Goodman SG, Anderson FA Jr, Granger CB, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA 2007;297:1892-900.
  • 6. Kahyaoglu Sut H, Unsar S. Is EQ-5D a valid quality of life instrument in patients with acute coronary syndrome? Anadolu Kardiyol Derg 2011;11:156-62.
  • 7. Busschbach JJV, McDonnell JM, Tangelder MJD, Eikelboom BCM, Buskens EM, Algra AM, et al. EuroQol values for economic modelling quality of life after infrainguinal bypass grafting surgery: a rectification. J Vasc Surg 1999;30.
  • 8. Greiner W, Weijnen T, Nieuwenhuizen M, Oppe S, Badia X, Busschbach J, et al. A single European currency for EQ-5D health states. Eur J Health Econ 2003;4.
  • 9. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001;33.
  • 10. Mert KU, Mert GO, Dural M, Unalır A. Akut ST elevasyonlu miyokard enfarktüsü sonrası yaşam kalitesi (EQ5D). MN Kardiyoloji 2016;23 182-91.
  • 11. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000;36:959-69.
  • 12. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992;305:160-4.
  • 13. Rumsfeld JS, MaWhinney S, McCarthy M Jr, Shroyer AL, VillaNueva CB, O’Brien M, et al. Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery. JAMA 1999;281:1298-303.
  • 14. Curtis LH, Phelps CE, McDermott MP, Rubin HR. The value of patient-reported health status in predicting short-term outcomes after coronary artery bypass graft surgery. Med Care 2002;40:1090-100.
  • 15. Rodriguez-Artalejo F, Guallar-Castillon P, Pascual CR, Otero CM, Montes AO, Garcia AN, et al. Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Arch Intern Med 2005;165:1274-9.
  • 16. Tsai SY, Chi LY, Lee CH, Chou P. Health-related quality of life as a predictor of mortality among community-dwelling older persons. Eur J Epidemiol 2007;22:19-26.
  • 17. Steinberg JS, Joshi S, Schron EB, Powell J, Hallstrom A, McBurnie M. Psychosocial status predicts mortality in patients with life-threatening ventricular arrhythmias. Heart Rhythm 2008;5:361-5.
  • 18. Brooks R. EuroQol: the current state of play. Health Policy 1996;37:53-72.
  • 19. Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 1998;316:736-41.
  • 20. Johnson JA, Coons SJ, Ergo A, Szava-Kovats G. Valuation of EuroQOL (EQ-5D) health states in an adult US sample. Pharmacoeconomics 1998;13:421-33.
  • 21. Mathews WC, May S. EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care. Health Qual Life Outcomes 2007;5:5.
  • 22. Cavrini G, Broccoli S, Puccini A, Zoli M. EQ-5D as a predictor of mortality and hospitalization in elderly people. Qual Life Res 2012;21:269-80.
  • 23. Pettersen KI, Kvan E, Rollag A, Stavem K, Reikvam A. Health-related quality of life after myocardial infarction is associated with level of left ventricular ejection fraction. BMC Cardiovasc Disord 2008;8:28.
  • 24. Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, et al. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol 1995;25.
  • 25. Hofer S, Lim L, Guyatt G, Oldridge N. The MacNew Heart Disease health-related quality of life instrument: A summary. Health Qual Life Outcomes 2004;2.
  • 26. Guyatt G. Measurement of health related quality of life in heart failure. J Am Coll Cardiol 1993;22.
  • 27. Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002;21.
  • 28. Furlong WJ, Feeny DH, Torrance GW, Barr RD. The Health Utilities Index (HUI) system for assessing health-related quality of life in clinical studies. Ann Med 2001;33.
  • 29. Greenland P, Reicher-Reiss H, Goldbourt U, Behar S. In-hospital and 1-year mortality in 1,524 women after myocardial infarction. Comparison with 4,315 men. Circulation 1991;83:484-91.
  • 30. Gottlieb S, Harpaz D, Shotan A, Boyko V, Leor J, Cohen M, et al. Sex differences in management and outcome after acute myocardial infarction in the 1990s: A prospective observational community-based study. Israeli Thrombolytic Survey Group. Circulation 2000;102:2484-90.
  • 31. Berger JS, Elliott L, Gallup D, Roe M, Granger CB, Armstrong PW, et al. Sex differences in mortality following acute coronary syndromes. JAMA 2009;302:874-82.
  • 32. Agarwal SK, Singla I, Hreybe H, Saba S. Clinical predictors of late death in survivors of acute myocardial infarction. Tex Heart Inst J 2009;36:24-30.
  • 33. Bosch X, Theroux P. Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes. Am Heart J 2005;150:215-20.
  • 34. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163:2345-53.
  • 35. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000;102:2031-7.
  • 36. De Luca G, Suryapranata H, van’t Hof AWJ, de Boer M-J, Hoorntje JCA, Dambrink J-HE, et al. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty. Implications for Early Discharge 2004;109:2737-43.
  • 37. Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol 2005;45:1397-405.
  • 38. Addala S, Grines CL, Dixon SR, Stone GW, Boura JA, Ochoa AB, et al. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score). Am J Cardiol 2004;93:629-32.
  • 39. Richards AM, Nicholls MG, Troughton RW, Lainchbury JG, Elliott J, Frampton C, et al. Antecedent hypertension and heart failure after myocardial infarction. J Am Coll Cardiol 2002;39:1182-8.
  • 40. Rembek M, Goch A, Goch J. The clinical course of acute ST-elevation myocardial infarction in patients with hypertension. Kardiol Pol 2010;68:157-63.
  • 41. Bozbay M, Uyarel H, Cicek G, Oz A, Keskin M, Murat A, et al. CHA2DS2-VASc Score Predicts In-Hospital and Long-Term Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Who Were Undergoing Primary Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2017;23:132-8.

ST Yükselmeli Miyokart İnfarktüsü Hastalarında Yaşam Kalitesi ile 5 Yıllık Mortalite Arasındaki İlişki

Year 2018, Volume: 21 Issue: 1, 26 - 31, 01.04.2018

Abstract

Amaç: Sağlık ile ilgili yaşam kalitesi ile mortalite ilişkisi
ile ilgili sınırlı sayıda çalışma mevcuttur. Çalışmamızda perkütan koroner
girişim (PKG) ile tedavi edilen ST yükselmeli miyokart infarktüsü (STYMİ)
hastalarının yaşam kalitelerinin mortalite ile ilişkisini değerlendirmeyi
amaçladık. 



Hastalar ve Yöntem: Çalışmaya akut STYMİ tanısı alıp
primer PKG uygulanan ve 6. ay takipleri yapılan 92 hasta dahil edildi. Altıncı
ayda yapılan klinik vizitte demografik ve klinik verileri toplandıktan sonra
uluslararası geçerliliği olan ve Türkiye’de de akut koroner sendromlarda
geçerlilik çalışması yapılmış olan EQ5D yaşam kalite ölçeği hastalar tarafından
dolduruldu. Hastaların 5 yıl takiplerinin tamamlanmasını takiben veriler analiz
edildi. Klinik vizit yapılamayan hastalar ya da bu hastaların yakınları
mortaliteyi değerlendirmek için telefonla arandı. 



Bulgular: Bizim çalışmamız, STYMİ hastalarında yaşam kalitesi ile
uzun dönem sağkalımın ilişkisini inceleyen ilk çalışmadır. Beş yıl takibi
edilen 92 hastanın yaş ortalaması 56.96 ± 12.61 ve 81 (%88)’i erkek idi. Beş
yıl sonunda 12 hastada mortalite görüldü. İndeks skor ortalaması 0.903 ± 0.145
ve vizüel analog ölçek (VAS) skor ortalaması 80.58 ± 16.03’dü. İndeks skor ve
VAS skor ortalamaları mortalite olan hastalarda daha düşük bulundu (sırasıyla,
p= 0.008, p= 0.011). Hem indeks skor hem de VAS skor anlamlı olacak şekilde
mortalite ile ilişkiliydi (sırasıyla, p= 0.002, ki-kare= 9.918; p= 0.008,
ki-kare= 7.112). Geriye doğru kademeli Cox regresyon analizi kullanılarak indeks
skor ≤ 0.9 olmasının mortalite ile ilişkili olduğu ortaya çıkarıldı [p= 0.005;
HR= 5.546 (1.668-18.443)].



Sonuç: Bizim analizlerimize göre,
düşük sağlık ile ilgili yaşam kalitesi skorları mortalite ile ilişkilidir. EQ5D
indeks skoru PKG ile tedavi edilen STYMİ hastalarında uzun dönem mortalitenin
bağımsız bir ön gördürücüsüdür. 

References

  • 1. Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569-619.
  • 2. Widimsky P, Wijns W, Fajadet J, de Belder M, Knot J, Aaberge L, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 2010;31:943-57.
  • 3. McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011;124:40-7.
  • 4. Jernberg T, Johanson P, Held C, Svennblad B, Lindback J, Wallentin L. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA 2011;305:1677-84.
  • 5. Fox KA, Steg PG, Eagle KA, Goodman SG, Anderson FA Jr, Granger CB, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA 2007;297:1892-900.
  • 6. Kahyaoglu Sut H, Unsar S. Is EQ-5D a valid quality of life instrument in patients with acute coronary syndrome? Anadolu Kardiyol Derg 2011;11:156-62.
  • 7. Busschbach JJV, McDonnell JM, Tangelder MJD, Eikelboom BCM, Buskens EM, Algra AM, et al. EuroQol values for economic modelling quality of life after infrainguinal bypass grafting surgery: a rectification. J Vasc Surg 1999;30.
  • 8. Greiner W, Weijnen T, Nieuwenhuizen M, Oppe S, Badia X, Busschbach J, et al. A single European currency for EQ-5D health states. Eur J Health Econ 2003;4.
  • 9. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001;33.
  • 10. Mert KU, Mert GO, Dural M, Unalır A. Akut ST elevasyonlu miyokard enfarktüsü sonrası yaşam kalitesi (EQ5D). MN Kardiyoloji 2016;23 182-91.
  • 11. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000;36:959-69.
  • 12. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992;305:160-4.
  • 13. Rumsfeld JS, MaWhinney S, McCarthy M Jr, Shroyer AL, VillaNueva CB, O’Brien M, et al. Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery. JAMA 1999;281:1298-303.
  • 14. Curtis LH, Phelps CE, McDermott MP, Rubin HR. The value of patient-reported health status in predicting short-term outcomes after coronary artery bypass graft surgery. Med Care 2002;40:1090-100.
  • 15. Rodriguez-Artalejo F, Guallar-Castillon P, Pascual CR, Otero CM, Montes AO, Garcia AN, et al. Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Arch Intern Med 2005;165:1274-9.
  • 16. Tsai SY, Chi LY, Lee CH, Chou P. Health-related quality of life as a predictor of mortality among community-dwelling older persons. Eur J Epidemiol 2007;22:19-26.
  • 17. Steinberg JS, Joshi S, Schron EB, Powell J, Hallstrom A, McBurnie M. Psychosocial status predicts mortality in patients with life-threatening ventricular arrhythmias. Heart Rhythm 2008;5:361-5.
  • 18. Brooks R. EuroQol: the current state of play. Health Policy 1996;37:53-72.
  • 19. Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 1998;316:736-41.
  • 20. Johnson JA, Coons SJ, Ergo A, Szava-Kovats G. Valuation of EuroQOL (EQ-5D) health states in an adult US sample. Pharmacoeconomics 1998;13:421-33.
  • 21. Mathews WC, May S. EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care. Health Qual Life Outcomes 2007;5:5.
  • 22. Cavrini G, Broccoli S, Puccini A, Zoli M. EQ-5D as a predictor of mortality and hospitalization in elderly people. Qual Life Res 2012;21:269-80.
  • 23. Pettersen KI, Kvan E, Rollag A, Stavem K, Reikvam A. Health-related quality of life after myocardial infarction is associated with level of left ventricular ejection fraction. BMC Cardiovasc Disord 2008;8:28.
  • 24. Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, et al. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol 1995;25.
  • 25. Hofer S, Lim L, Guyatt G, Oldridge N. The MacNew Heart Disease health-related quality of life instrument: A summary. Health Qual Life Outcomes 2004;2.
  • 26. Guyatt G. Measurement of health related quality of life in heart failure. J Am Coll Cardiol 1993;22.
  • 27. Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002;21.
  • 28. Furlong WJ, Feeny DH, Torrance GW, Barr RD. The Health Utilities Index (HUI) system for assessing health-related quality of life in clinical studies. Ann Med 2001;33.
  • 29. Greenland P, Reicher-Reiss H, Goldbourt U, Behar S. In-hospital and 1-year mortality in 1,524 women after myocardial infarction. Comparison with 4,315 men. Circulation 1991;83:484-91.
  • 30. Gottlieb S, Harpaz D, Shotan A, Boyko V, Leor J, Cohen M, et al. Sex differences in management and outcome after acute myocardial infarction in the 1990s: A prospective observational community-based study. Israeli Thrombolytic Survey Group. Circulation 2000;102:2484-90.
  • 31. Berger JS, Elliott L, Gallup D, Roe M, Granger CB, Armstrong PW, et al. Sex differences in mortality following acute coronary syndromes. JAMA 2009;302:874-82.
  • 32. Agarwal SK, Singla I, Hreybe H, Saba S. Clinical predictors of late death in survivors of acute myocardial infarction. Tex Heart Inst J 2009;36:24-30.
  • 33. Bosch X, Theroux P. Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes. Am Heart J 2005;150:215-20.
  • 34. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163:2345-53.
  • 35. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000;102:2031-7.
  • 36. De Luca G, Suryapranata H, van’t Hof AWJ, de Boer M-J, Hoorntje JCA, Dambrink J-HE, et al. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty. Implications for Early Discharge 2004;109:2737-43.
  • 37. Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol 2005;45:1397-405.
  • 38. Addala S, Grines CL, Dixon SR, Stone GW, Boura JA, Ochoa AB, et al. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score). Am J Cardiol 2004;93:629-32.
  • 39. Richards AM, Nicholls MG, Troughton RW, Lainchbury JG, Elliott J, Frampton C, et al. Antecedent hypertension and heart failure after myocardial infarction. J Am Coll Cardiol 2002;39:1182-8.
  • 40. Rembek M, Goch A, Goch J. The clinical course of acute ST-elevation myocardial infarction in patients with hypertension. Kardiol Pol 2010;68:157-63.
  • 41. Bozbay M, Uyarel H, Cicek G, Oz A, Keskin M, Murat A, et al. CHA2DS2-VASc Score Predicts In-Hospital and Long-Term Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Who Were Undergoing Primary Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2017;23:132-8.
There are 41 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Kadir Uğur Mert

Gurbet Özge Mert This is me

Muhammet Dural This is me

Publication Date April 1, 2018
Published in Issue Year 2018 Volume: 21 Issue: 1

Cite

Vancouver Mert KU, Mert GÖ, Dural M. ST Yükselmeli Miyokart İnfarktüsü Hastalarında Yaşam Kalitesi ile 5 Yıllık Mortalite Arasındaki İlişki. Koşuyolu Heart Journal. 2018;21(1):26-31.