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Psychosocial predictors of change in quality of life in patients after coronary interventions

      Abstract

      Objective

      Health-related quality of life (HRQOL) after coronary interventions (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty) usually improves in patients, but not in all patients. Some patients actually show a significant decline in HRQOL. Our aim was to explore the potential of psychologic well-being (anxiety, depression), vital exhaustion, Type D personality, and socioeconomic position as predictors of HRQOL in patients with coronary disease.

      Methods

      A total of 106 patients scheduled for coronary angiography were interviewed before (baseline) and 12 to 24 months after coronary angiography. Socioeconomic status was evaluated by education. The General Health Questionnaire 28 was used for measuring psychologic well-being (anxiety, depression), the Maastricht interview was used for measuring vital exhaustion, and the Type D questionnaire was used for measuring personality. HRQOL was assessed using the Short Form-36 (physical and mental components) questionnaire. Functional status was assessed with a combination of New York Heart Association and Canadian Cardiovascular Society classifications. Linear regressions were used to analyze data.

      Results

      A change in physical HRQOL was predicted by baseline psychologic well-being (β = −.39; 95% confidence interval [CI], −1.00 to −.16) and baseline HRQOL (β = −.61; 95% CI, −.83 to −.34). A change in mental HRQOL was predicted by (baseline) psychologic well-being (β = −.37; 95% CI, −.99 to −.09), vital exhaustion (β = −.21; 95% CI, −.69 to −.03), and baseline HRQOL (β = −.76; 95% CI, −1.03 to −.44). Ejection fraction did not significantly predict HRQOL.

      Conclusion

      Psychosocial factors (psychologic well-being, vital exhaustion) seem to be more important predictors of change in HRQOL compared with some objective medical indicators (ejection fraction) among patients with coronary disease.

      Keywords

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      References

        • Bobak M.
        • Marmot M.
        Coronary heart disease in Central and Eastern Europe and former Soviet Union.
        in: Marmot M.G. Elliott P. Coronary heart disease epidemiology: from aetiology to public health. Oxford University Press, Oxford, England2005: 83-110
        • Beard J.R.
        • Earnest A.
        • Morgan G.
        • Chan H.
        • Summerhayes R.
        • Dunn T.M.
        • et al.
        Socioeconomic disadvantage and acute coronary events: a spatiotemporal analysis.
        Epidemiology. 2008; 19: 485-492
        • Studencan M.
        Nová univerzálna definícia infarktu myokardu v klinickej praxi (a new universal definition of myocardial infarction).
        Kardiológia pre prax. 2008; 6: 51-54
        • Shephard R.J.
        • Franklin B.
        Changes in the quality of life: a major goal of cardiac rehabilitation.
        J Cardiopulm Rehabil. 2001; 21: 189-200
        • Höfer S.
        • Doering S.
        • Rumpold G.
        • Oldridg N.
        • Benzer W.
        Determinants of health-related quality of life in patients with coronary artery disease.
        Eur J Cardiovasc Prev Rehabil. 2006; 13: 398-406
        • Spilker B.
        Introduction to the field of quality of life trials.
        in: Spilker B. Quality of life assessments in clinical trials. Raven Press, New York1990: 3-10
        • Ware J.E.
        • Kosinski M.
        • Keller S.D.
        SF-36 Physical and mental summary scales: a user's manual.
        The Health Institute, Boston1994
        • Rumsfeld J.S.
        • Magid D.J.
        • O'Brien M.
        • McCarthy M.
        • MaWhinney S.
        • Shroyer A.L.
        • et al.
        Changes in health-related quality of life following coronary artery bypass graft surgery.
        Ann Thorac Surg. 2001; 72: 2026-2032
        • Spertus J.A.
        • Jones P.
        • McDonell M.
        • Fan V.
        • Fihn S.D.
        Health status predicts long-term outcome in outpatients with coronary disease.
        Circulation. 2002; 106: 43-49
        • Ho P.M.
        • Masoudi F.A.
        • Peterson P.N.
        • Shroyer A.L.
        • McCarthy Jr., M.
        • Grover F.L.
        • et al.
        Health-related quality of life predicts mortality in older but not younger patients following cardiac surgery.
        Am J Geriatr Cardiol. 2005; 14: 176-182
        • Lenzen M.J.
        • Scholte op Reimer W.J.M.
        • Pedersen S.S.
        • Boersma E.
        • Maier W.
        • Widimsky P.
        • et al.
        The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: a report from the Euro Heart Survey on Coronary Revascularisation.
        Heart. 2007; 93: 339-344
        • Mejhert M.
        • Kahan T.
        • Persson H.
        • Edner M.
        Predicting readmissions and cardiovascular events in heart failure patients.
        Int J Cardiol. 2006; 109: 108-113
        • Murberg T.A.
        • Bru E.
        • Svebak S.
        • Tveteras R.
        • Aarsland T.
        Depressed mood and subjective health symptoms as predictors of mortality in patients with congestive heart failure: a two-years follow-up study.
        Int J Psychiatry Med. 1999; 29: 311-326
        • Hunt J.O.
        • Hendrata M.V.
        • Myles P.S.
        Quality of life 12 months after coronary artery bypass graft surgery.
        Heart Lung. 2000; 29: 401-411
        • Failde I.I.
        • Soto M.M.
        Changes in health related quality of life 3 months after an acute coronary syndrome.
        BMC Public Health. 2006; 6: 18
        • Hawkes A.L.
        • Mortensen O.S.
        Up to one third of individual cardiac patients have a decline in quality of life post-intervention.
        Scand Cardiovasc J. 2006; 40: 214-218
        • Rumsfeld J.S.
        • Ho P.M.
        • Magid D.J.
        • McCarthy M.J.
        • Shroyer A.L.
        • MaWhinney S.
        • et al.
        Predictors of health-related quality of life after coronary artery bypass surgery.
        Ann Thorac Surg. 2004; 77: 1508-1513
        • Bradshaw P.J.
        • Jamrozik K.D.
        • Gilfillan I.S.
        • Thompson P.L.
        Asymptomatic long-term survivors of coronary artery bypass surgery enjoy a quality of life equal to the general population.
        Am Heart J. 2006; 151: 537-544
        • Herlitz J.
        • Wiklund I.
        • Caidahl K.
        • Karlson B.W.
        • Sjoland H.
        • Hartford M.
        • et al.
        Determinants of an impaired quality of life five years after coronary artery bypass surgery.
        Heart. 1999; 81: 342-346
        • Saur C.D.
        • Granger B.B.
        • Muhlbaier L.H.
        • Forman L.M.
        • McKenzie R.J.
        • Taylor M.C.
        • et al.
        Depressive symptoms and outcome of coronary artery bypass grafting.
        Am J Respir Crit Care Med. 2001; 10: 4-10
        • Jarvinen O.
        • Julkunen J.
        • Huhtala H.
        • Tarkka M.R.
        • Saarinen T.
        Changes in health-related quality of life and functional capacity following coronary artery bypass graft surgery.
        Eur J Cardiothorac Surg. 2003; 24: 750-756
        • Hata M.
        • Yagi Y.
        • Sezai A.
        • Niino T.
        • Yoda M.
        • Wakui S.
        • et al.
        Risk analysis for depression and patient prognosis after open heart surgery.
        Circ J. 2006; 70: 389-392
        • Brummett B.H.
        • Boyle S.H.
        • Siegler I.C.
        • Williams R.B.
        • Mark D.B.
        • Barefoot J.C.
        Ratings of positive and depressive emotion as predictors of mortality in coronary patients.
        Int J Cardiol. 2005; 100: 213-216
        • Frasure-Smith N.
        • Lesperance F.
        Reflections on depression as a cardiac risk factor.
        Psychosom Med. 2005; 67: S19-S25
        • Kemp D.E.
        • Malhotra S.
        • Franco K.N.
        • Tesar G.
        • Bronson D.L.
        Heart disease and depression: don't ignore the relationship.
        Cleve Clin J Med. 2003; 70: 745-761
        • Pfiffner D.
        • Hoffmann A.
        Psychosocial predictors of death for low-risk patients after a first myocardial infarction: a 7-year follow-up study.
        J Cardiopulm Rehabil. 2004; 24: 87-93
        • Schuitemaker G.E.
        • Dinant G.J.
        • Van Der Pol G.A.
        • Appels A.
        Assessment of vital exhaustion and identification of subjects at increased risk of myocardial infarction in general practice.
        Psychosomatics. 2004; 45: 414-418
        • Pedersen S.S.
        • Theuns D.A.M.J.
        • Muskens-Heemskerk A.
        • Erdman R.A.M.
        • Jordaens L.
        Type-D personality but not implantable cardioverter-defibrillator indication is associated with impaired health-related quality of life 3 months post-implantation.
        Europace. 2007; 9: 675-680
        • Goldberg D.P.
        • Hilier V.F.
        A scaled version of the General Health Questionnaire.
        Psychol Med. 1979; 9: 139-145
        • Goldberg D.P.
        • Williams P.
        A user's guide to the general health questionnaire.
        NFER NELSON Publishing Company Ltd, Windsor1988
        • Nagyova I.
        • Krol B.
        • Szilasiova A.
        • Stewart R.
        • Dijk van J.
        • Heuvel van den W.
        General health questionnaire-28: psychometric evaluation of the Slovak version.
        Stud Psychol. 2000; 42: 351-356
        • Failde I.
        • Ramos I.
        Validity and reliability of the SF-36 Health Survey Questionnaire in patients with coronary artery disease.
        J Clin Epidemiol. 2000; 53: 359-365
        • Meesters C.
        • Appels A.
        An interview to measure vital exhaustion I. Development and comparison with the Maastricht questionnaire.
        Psychol Health. 1996; 11: 557-571
        • Meesters C.
        • Appels A.
        An interview to measure vital exhaustion II. Reliability and validity of the interview and correlations of vital exhaustion with personality characteristics.
        Psychol Health. 1996; 11: 557-571
        • Denollet J.
        DS14. Standard assessment of negative affectivity, social inhibition, and type D personality.
        Psychosom Med. 2005; 67: 89-97
        • McGowan J.H.
        • Cleland J.G.F.
        Reliability of reporting left ventricular systolic function by echocardiography: a systematic review of 3 methods.
        Am Heart J. 2003; 146: 388-397
        • Wyrwich K.W.
        • Wolinsky F.D.
        Identifying meaningful intra-individual change standards in health related quality of life measures.
        J Eval Clin Pract. 2000; 6: 39-49
        • Ruo B.
        • Rumsfeld J.S.
        • Hlatky M.A.
        • Liu H.
        • Browner W.S.
        • Whooley M.A.
        Depressive symptoms and health related quality of life.
        J Am Med Assoc. 2003; 290: 215-221
        • Prescott E.
        • Holst C.
        • Gronbaek M.
        • Schnohr P.
        • Jensen G.
        • Barefoot J.
        Vital exhaustion as a risk factor for ischaemic heart disease and all-cause mortality in a community sample: a prospective study of 4084 men and 5479 women in the Copenhagen City Heart Study.
        Int J Epidemiol. 2003; 32: 990-997
        • Mendes de Leon C.F.
        • Kop W.J.
        • de Swart H.V.
        • Bar F.W.
        • Appels A.
        Psychosocial characteristics and recurrent events after percutaneous transluminal coronary angioplasty.
        Am J Cardiol. 1996; 77: 252-255
        • Appels A.
        • Kop W.
        • Schouten E.
        The nature of the depressive symptomatology preceding myocardial infarction.
        Behav Med. 2000; 26: 86-90
        • Karlamangla A.S.
        • Singer B.H.
        • Williams D.R.
        • Schwartz J.E.
        • Matthews K.A.
        • Kiefe C.I.
        Impact of socioeconomic status on longitudinal accumulation of cardiovascular risk in young adults: the CARDIA Study.
        Soc Sci Med. 2005; 60: 999-1015
        • Yarnell J.
        • Yu S.
        • McCrum E.
        • et al.
        Education, socioeconomic and lifestyle factors, and risk of coronary heart disease.
        J Epidemiol. 2005; 34: 268-275
        • Everson S.A.
        • Siobhan C.M.
        • Lynch J.W.
        • Kaplan G.A.
        Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes.
        J Psychosom Res. 2002; 53: 891-895