Wohlfahrt Peter, Jenča Dominik, Stehlik Josef, Melenovský Vojtěch, Mrázková Jolana, Staněk Vladimír, Kettner Jiří, Šramko Marek, Želízko Michael, Adámková Věra, Piťha Jan, Kautzner Josef
Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Videnska 800, 140 59, Prague, Czech Republic.
Clin Res Cardiol. 2023 Jan;112(1):39-48. doi: 10.1007/s00392-022-02008-z. Epub 2022 Mar 18.
Recent advances in therapy led to a significant decrease in mortality and morbidity after myocardial infarction (MI). However, little is known about quality of life (QoL) after MI. We examined heart failure (HF)-related quality-of-life (QoL) impairment, its trajectories, and determinants after MI.
Data from a single-center prospectively designed registry of consecutive patients hospitalized for MI at a large tertiary cardiology center were utilized. At 1 month and 1 year after hospital discharge, patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ).
In total, 850 patients (aged 65 ± 12 years, 27% female) hospitalized between June 2017 and October 2020 completed KCCQ at 1 month after discharge. Of these, 38.7% showed HF-related QoL impairment (KCCQ ≤ 75). In addition to characteristics of MI (MI size, diuretics need, heart rate), comorbidities as renal dysfunction and anemia were associated with QoL impairment. Of the 673 eligible, 500 patients (74.3%) completed KCCQ at 1 year after MI. On average, QoL improved by 5.9 ± 16.8 points during the first year after MI (p < 0.001); but, in 18% of patients QoL worsened. Diabetes control and hemoglobin level at the time of hospitalization were associated with QoL worsening.
Two out of 5 patients after MI present with HF-related QoL impairment. In addition to guideline-directed MI management, careful attention to key non-cardiac comorbidities as chronic kidney disease, anemia and diabetes may lead to further augmentation of the benefit of modern therapies in terms of QoL.
近期治疗进展使心肌梗死（MI）后的死亡率和发病率显著降低。然而，对于MI后的生活质量（QoL）知之甚少。我们研究了MI后与心力衰竭（HF）相关的生活质量（QoL）损害、其轨迹及决定因素。
利用来自一家大型三级心脏病中心对因MI住院的连续患者进行的单中心前瞻性设计登记的数据。出院后1个月和1年时，患者完成堪萨斯城心肌病问卷（KCCQ）。
2017年6月至2020年10月期间住院的850例患者（年龄65±12岁，27%为女性）在出院后1个月完成了KCCQ。其中，38.7%表现出与HF相关的QoL损害（KCCQ≤75）。除了MI的特征（MI大小、利尿剂需求、心率）外，肾功能不全和贫血等合并症与QoL损害相关。在673例符合条件的患者中，500例（74.3%）在MI后1年完成了KCCQ。MI后的第一年，QoL平均改善了5.9±16.8分（p<0.001）；但18%的患者QoL恶化。住院时的血糖控制和血红蛋白水平与QoL恶化相关。
五分之二的MI后患者存在与HF相关的QoL损害。除了遵循指南进行MI管理外，仔细关注慢性肾病、贫血和糖尿病等关键非心脏合并症，可能会在QoL方面进一步增强现代疗法的益处。
