The use of HeartQoL in patients with coronary heart disease: Association with risk factors and European reference values. The EUROASPIRE IV study of the European Society of Cardiology

Abstract

Background

HeartQoL is a recently developed core health-related quality of life instrument for patients with coronary heart disease. The current study aims to investigate its association with patients’ coronary risk profile and to provide reference values for patients with coronary heart disease across Europe.

Design

Analyses are based on the EUROASPIRE IV (EUROpean Action on Secondary and Primary prevention through Intervention to Reduce Events) cross-sectional survey.

Methods

Patients with a diagnosis of coronary heart disease were examined and interviewed six months to three years after their coronary event. The HeartQoL questionnaire was completed by 7261 coronary heart disease patients. Reference values were calculated and the association with the coronary risk profile was assessed.

Results

Significantly worse outcomes were observed in higher-risk patient groups. Both metabolic and behavioural risk factors were associated with worse HeartQoL outcomes. Further, the HeartQoL scores decreased as the number of risk factors increased. The mean global reference values in males were 2.27 ± 0.65 (<60 years), 2.30 ± 0.61 (between 60 and 69 years) and 2.19 ± 0.64 (≥70 years). Likewise, in females, the respective global HeartQoL reference values were 2.02 ± 0.67, 2.01 ± 0.66 and 1.83 ± 0.70. The ceiling effect in males was 11.4%, 10.4% and 7.4% for the three age classes respectively, whereas in females the ceiling effect was 5.2%, 3.5% and 1.9%, respectively.

Conclusion

HeartQoL scores were associated with patients’ coronary risk profile. The reference values may help other researchers to interpret HeartQoL scores. Further research should focus on the minimal important difference needed to evaluate the effect of therapies and lifestyle changes.

Keywords

Get full access to this article

View all access options for this article.

References

Anker

Agewall

Borggrefe

. The importance of patient-reported outcomes: A call for their comprehensive integration in cardiovascular clinical trials. Eur Heart J 2014; 35: 2001–2009.

Department of Health. A mandate from the Government to the NHS Commissioning Board: April 2013 to March 2015. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/256497/13-15_mandate.pdf (2013, accessed 28 Januray 2016).

European Medicines Agency. Reflection paper on the regulatory guidance for the use of health related quality of life (HRQL) measures in the evaluation of medicinal products. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003637.pdf (2005, accessed 28 Januray 2016).

Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century, Washington, DC: The National Academies Press, 2001.

Swenson

Clinch

. Assessment of quality of life in patients with cardiac disease: The role of psychosomatic medicine. J Psychosom Res 2000; 48: 405–415.

Rabin

de Charro

. EQ-5D: A measure of health status from the EuroQol Group. Ann Med 2001; 33: 337–343.

Ware

Jr . SF-36 health survey update. Spine 2000; 25: 3130–3139.

Oldridge

Höfer

McGee

. The HeartQoL: Part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol 2014; 21: 98–106.

Oldridge

Höfer

McGee

. The HeartQoL: Part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol 2014; 21: 90–97.

10.

Rector

Cohn

. Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J 1992; 124: 1017–1025.

11.

Spertus

Winder

Dewhurst

. Development and evaluation of the Seattle Angina Questionnaire: A new functional status measure for coronary artery disease. J Am Coll Cardiol 1995; 25: 333–341.

12.

Agewall

Henareh

. Low self-estimated quality of life after myocardial infarction and future cardiovascular risk. Int J Cardiol 2012; 157: 128–129.

13.

De Smedt

Clays

Annemans

. The association between self-reported lifestyle changes and health-related quality of life in coronary patients: The EUROASPIRE III survey. Eur J Prev Cardiol 2013; 21: 796–805.

14.

De Smedt

Clays

Annemans

. Health related quality of life in coronary patients and its association with their cardiovascular risk profile: Results from the EUROASPIRE III survey. Int J Cardiol 2013; 168: 898–903.

15.

Kotseva K, on behalf of the EUROASPIRE investigators. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from twenty four European countries. Eur J Prev Cardiol. Epub ahead of print 16 February 2015. DOI10.1177/2047487315569401.

16.

IPAQ core group. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) – short and long forms, http://www.ipaq.ki.se/ipaq.htm.

17.

De Smedt D, Clays E, Höfer S, et al. Validity and reliability of the HeartQoL questionnaire in a large sample of stable coronary patients: The EUROASPIRE IV Study. Eur J Prev Cardiol. Epub ahead of print 10 September 2015. DOI: 10.1177/2047487315604837.

18.

Perk

De Backer

Gohlke

. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012; 33: 1635–1701.

19.

Graham

Atar

Borch-Johnsen

. European guidelines on cardiovascular disease prevention in clinical practice: Full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14(Suppl. 2): S1–S113.

20.

Norman

Sloan

Wyrwich

. The truly remarkable universality of half a standard deviation: Confirmation through another look. Expert Rev Pharmacoecon Outcomes Res 2004; 4: 581–585.

21.

Pragodpol

Ryan

. Critical review of factors predicting health-related quality of life in newly diagnosed coronary artery disease patients. J Cardiovasc Nurs 2012; 28: 277–284.

22.

Xie

Zheng

. Patient-reported health status in coronary heart disease in the United States: Age, sex, racial, and ethnic differences. Circulation 2008; 118: 491–497.

23.

Martinelli

Mizutani

Mutti

. Quality of life and its association with cardiovascular risk factors in a community health care program population. Clinics (Sao Paulo) 2008; 63: 783–788.

24.

Norris

Murray

Triplett

. Gender roles in persistent sex differences in health-related quality-of-life outcomes of patients with coronary artery disease. Gender Med 2010; 7: 330–339.

25.

Phillips-Bute

Mathew

Blumenthal

. Female gender is associated with impaired quality of life 1 year after coronary artery bypass surgery. Psychosom Med 2003; 65: 944–951.

26.

Bergman

Aestedt

Fridlund

. The impact of comprehensibility and sense of coherence in the recovery of patients with myocardial infarction: A long-term follow-up study. Eur J Cardiovasc Nurs 2012; 11: 276–283.

27.

Emery

Frid

Engebretson

. Gender differences in quality of life among cardiac patients. Psychosom Med 2004; 66: 190–197.

28.

Norris

Spertus

Jensen

. Sex and gender discrepancies in health-related quality of life outcomes among patients with established coronary artery disease. Circ Cardiovasc Qual Outcomes 2008; 1: 123–130.

29.

The EuroQol Group’s International Task Force on Self-Reported Health. Measuring self-reported population health: an international perspective based on EQ-5D. EuroQol Group. Availabel at: http://www.euroqol.org/fileadmin/user_upload/Documenten/PDF/Books/Measuring_Self-Reported_Population_Health_-_An_International_Perspective_based_on_EQ-5D.pdf (2004, accessed 28 January 2016).

30.

Burstrom

Fredlund

. Self rated health: Is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? J Epidemiol Community Health 2001; 55: 836–840.

31.

Metcalf

Scragg

Davis

. Relationship of different measures of socioeconomic status with cardiovascular disease risk factors and lifestyle in a New Zealand workforce survey. N Z Med J 2007; 120: U2392–U2392.

32.

Pappa

Kontodimopoulos

Papadopoulos

. Assessing the socio-economic and demographic impact on health-related quality of life: Evidence from Greece. Int J Public Health 2009; 54: 241–249.

33.

Winkleby

Jatulis

Frank

. Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health 1992; 82: 816–820.

34.

Oreopoulos

Padwal

McAlister

. Association between obesity and health-related quality of life in patients with coronary artery disease. Int J Obes (Lond) 2010; 34: 1434–1441.

35.

Peterson

Spertus

Magid

. The impact of diabetes on one-year health status outcomes following acute coronary syndromes. BMC Cardiovasc Disord 2006; 6: 41–41.

36.

Bize

Johnson

Plotnikoff

. Physical activity level and health-related quality of life in the general adult population: A systematic review. Prev Med 2007; 45: 401–415.

37.

Haddock

Poston

Taylor

. Smoking and health outcomes after percutaneous coronary intervention. Am Heart J 2003; 145: 652–657.

38.

Quist-Paulsen

Bakke

Gallefoss

. Does smoking cessation improve quality of life in patients with coronary heart disease? Scand Cardiovasc J 2006; 40: 11–16.

39.

Romain

Bernard

Attalin

. Health-related quality of life and stages of behavioural change for exercise in overweight/obese individuals. Diabetes Metab 2012; 38: 352–358.

40.

Schweikert

Hunger

Meisinger

. Quality of life several years after myocardial infarction: Comparing the MONICA/KORA registry to the general population. Eur Heart J 2009; 30: 436–443.

41.

Sevinc

Akyol

. Cardiac risk factors and quality of life in patients with coronary artery disease. J Clin Nurs 2010; 19: 1315–1325.

42.

Taira

Seto

. Impact of smoking on health-related quality of life after percutaneous coronary revascularization. Circulation 2000; 102: 1369–1374.