Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
Cardiology, Concord Hospital, Concord, New South Wales, Australia.
Open Heart. 2021 Feb;8(1). doi: 10.1136/openhrt-2020-001499.
To assess associations of health-related quality of life (HRQoL) with patient profile, resource use, cardiovascular (CV) events and mortality in stable patients post-myocardial infarction (MI).
The global, prospective, observational TIGRIS Study enrolled 9126 patients 1-3 years post-MI. HRQoL was assessed at enrolment and 6-month intervals using the patient-reported EuroQol-5 dimension (EQ-5D) questionnaire, with scores anchored at 0 (worst possible) and 1 (perfect health). Resource use, CV events and mortality were recorded during 2-years' follow-up. Regression models estimated the associations of index score at enrolment with patient characteristics, resource use, CV events and mortality over 2-years' follow-up.
Among 8978 patients who completed the EQ-5D questionnaire, 52% reported 'some' or 'severe' problems on one or more health dimensions. Factors associated with a lower index score were: female sex, older age, obesity, smoking, higher heart rate, less formal education, presence of comorbidity (eg, angina, stroke), emergency room visit in the previous 6 months and non-ST-elevation MI as the index event. Compared with an index score of 1 at enrolment, a lower index score was associated with higher risk of all-cause death, with an adjusted rate ratio of 3.09 (95% CI 2.20 to 4.31), and of a CV event, with a rate ratio of 2.31 (95% CI 1.76 to 3.03). Patients with lower index score at enrolment had almost two times as many hospitalisations over 2-years' follow-up.
Clinicians managing patients post-acute coronary syndrome should recognise that a poorer HRQoL is clearly linked to risk of hospitalisations, major CV events and death.
ClinicalTrials.gov Registry (NCT01866904) (https://clinicaltrials.gov).
评估心梗后稳定期患者的健康相关生活质量（HRQoL）与患者特征、资源利用、心血管（CV）事件和死亡率的相关性。
全球、前瞻性、观察性 TIGRIS 研究纳入了 9126 名心梗后 1-3 年的患者。在入组时和每 6 个月使用患者报告的欧洲五维健康量表（EQ-5D）问卷评估 HRQoL，得分在 0（最差）和 1（最佳健康）之间锚定。在 2 年的随访期间记录资源利用、CV 事件和死亡率。回归模型估计入组时的指数评分与患者特征、资源利用、CV 事件和 2 年随访期间的死亡率之间的相关性。
在完成 EQ-5D 问卷的 8978 名患者中，52%的患者在一个或多个健康维度上报告有“一些”或“严重”问题。与较低指数评分相关的因素包括：女性、年龄较大、肥胖、吸烟、心率较高、受教育程度较低、合并症（如心绞痛、中风）、入组前 6 个月内急诊就诊和非 ST 段抬高型心梗作为起始事件。与入组时的指数评分为 1 相比，较低的指数评分与全因死亡风险增加相关，调整后的风险比为 3.09（95%CI 2.20 至 4.31），与 CV 事件的风险比为 2.31（95%CI 1.76 至 3.03）。入组时指数评分较低的患者在 2 年随访期间的住院次数几乎增加了一倍。
管理急性冠脉综合征后患者的临床医生应认识到，较差的 HRQoL 与住院、主要 CV 事件和死亡的风险明显相关。
ClinicalTrials.gov 注册（NCT01866904）（https://clinicaltrials.gov）。
