Henriksson Catrin, Larsson Margareta, Herlitz Johan, Karlsson Jan-Erik, Wernroth Lisa, Lindahl Bertil
Department of Medical Sciences , Uppsala Clinical Research Center, Uppsala University , Uppsala , Sweden.
Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.
Open Heart. 2014 Dec 13;1(1):e000051. doi: 10.1136/openhrt-2014-000051. eCollection 2014.
Despite increased awareness of the importance of early treatment in acute myocardial infarction (AMI), the delay from symptom onset to hospital arrival is still too long and rehospitalisations are frequent. Little is known about how health-related quality of life (HRQL) affects delay time and the frequency of readmissions.
We used quality registers to investigate whether patients' HRQL has any impact on delay time with a new AMI, and on the rate of readmissions during the first year. Patients with AMI <75 years, with HRQL assessed with EQ-5D at 1-year follow-up, and who thereafter had a new AMI registered, were evaluated for the correlation between HRQL and delay time (n=454). The association between HRQL and readmissions was evaluated among those who had an additional AMI and a new 1-year follow-up registration (n=216).
Patients who reported poor total health status (EQ-VAS ≤50), compared to those who reported EQ-VAS 81-100, had tripled risk to delay ≥2 h from symptom onset to hospital arrival (adjusted OR 3.01, 95% CI 1.43 to 6.34). Patients scoring EQ-VAS ≤50 had also a higher risk of readmissions in the univariate analysis (OR 3.08, 95% CI 1.71 to 5.53). However, the correlation did not remain significant after adjustment (OR 1.99, 95% CI 0.90 to 4.38). EQ-index was not independently associated with delay time or readmissions.
Aspects of total health status post-AMI were independently associated with delay time to hospital arrival in case of a new AMI. However, the influence of total health status on the risk of readmissions was less clear.
尽管人们越来越意识到急性心肌梗死（AMI）早期治疗的重要性，但从症状发作到入院的延迟时间仍然过长，且再入院情况频繁发生。关于健康相关生活质量（HRQL）如何影响延迟时间和再入院频率，目前知之甚少。
我们使用质量登记册来调查患者的HRQL是否对新发AMI的延迟时间以及第一年的再入院率有任何影响。对年龄<75岁、在1年随访时用EQ-5D评估HRQL且此后登记有新发AMI的患者，评估HRQL与延迟时间之间的相关性（n = 454）。在那些有额外AMI且有新的1年随访登记的患者中评估HRQL与再入院之间的关联（n = 216）。
与报告EQ-VAS为81 - 100的患者相比，报告总体健康状况较差（EQ-VAS≤50）的患者从症状发作到入院延迟≥2小时的风险增加了两倍（调整后的OR为3.01，95%CI为1.43至6.34）。在单因素分析中EQ-VAS≤50的患者再入院风险也更高（OR为3.08，95%CI为1.71至5.53）。然而，调整后这种相关性不再显著（OR为1.99，95%CI为0.90至4.38）。EQ指数与延迟时间或再入院无独立关联。
AMI后总体健康状况的各个方面与新发AMI时到医院的延迟时间独立相关。然而，总体健康状况对再入院风险的影响尚不清楚。
