Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
BMJ Open. 2022 Jul 13;12(7):e062302. doi: 10.1136/bmjopen-2022-062302.
To describe the magnitude and predictors of symptom burden (SB) and quality of life (QoL) 3 months after hospital admission for acute chest pain.
Prospective observational study.
Single centre, outpatient follow-up.
1506 patients.
Scores reported for general health (RAND-12), angina-related health (Seattle Angina Questionnaire 7 (SAQ-7)) and dyspnoea (Rose Dyspnea Scale) 3 months after hospital admission for chest pain.
A total of 1506 patients received questionnaires assessing general health (RAND-12), angina-related health (SAQ-7) and dyspnoea (Rose Dyspnea Scale) 3 months after discharge. Univariable and multivariable regression models identified predictors of SB and QoL scores. A mediator analysis identified factors mediating the effect of an unstable angina pectoris (UAP) diagnosis.
774 (52%) responded. Discharge diagnoses were non-ST elevation myocardial infarction (NSTEMI) (14.2%), UAP (17.1%), non-coronary cardiac disease (6.6%), non-cardiac disease (6.3%) and non-cardiac chest pain (NCCP) (55.6%). NSTEMI had the most favourable, and UAP patients the least favourable SAQ-7 scores (median SAQ7-summary; 88 vs 75, p<0.001). NCCP patients reported persisting chest pain in 50% and dyspnoea in 33% of cases. After adjusting for confounders, revascularisation predicted better QoL scores, while UAP, current smoking and hypertension predicted worse outcome. NSTEMI and UAP patients who were revascularised reported higher scores (p<0.05) in SAQ-7-QL, SAQ7-PL, SAQ7-summary (NSTEMI) and all SAQ-7 domains (UAP). Revascularisation altered the unstandardised beta value (>±10%) of an UAP diagnosis for all SAQ-7 and RAND-12 outcomes.
Patients with NSTEMI reported the most favourable outcome 3 months after hospitalisation for chest pain. Patients with other diseases, in particular UAP patients, reported lower scores. Revascularised NSTEMI and UAP patients reported higher QoL scores compared with patients receiving conservative treatment. Revascularisation mediated all outcomes in UAP patients.
NCT02620202.
描述急性胸痛住院 3 个月后症状负担（SB）和生活质量（QoL）的程度和预测因素。
前瞻性观察性研究。
单中心门诊随访。
1506 名患者。
胸痛住院 3 个月后，报告了一般健康状况（RAND-12）、与心绞痛相关的健康状况（西雅图心绞痛问卷 7（SAQ-7））和呼吸困难（Rose 呼吸困难量表）的评分。
共 1506 名患者接受了评估一般健康状况（RAND-12）、与心绞痛相关的健康状况（SAQ-7）和呼吸困难（Rose 呼吸困难量表）的问卷。单变量和多变量回归模型确定了 SB 和 QoL 评分的预测因素。中介分析确定了不稳定型心绞痛（UAP）诊断影响的中介因素。
774 名（52%）患者做出了回应。出院诊断为非 ST 段抬高心肌梗死（NSTEMI）（14.2%）、UAP（17.1%）、非冠状动脉心脏疾病（6.6%）、非心脏疾病（6.3%）和非心脏性胸痛（NCCP）（55.6%）。NSTEMI 患者的 SAQ-7 评分最高（中位 SAQ7-摘要为 88），而 UAP 患者的评分最低（75，p<0.001）。NCCP 患者报告胸痛持续存在的比例为 50%，呼吸困难的比例为 33%。在调整混杂因素后，血运重建预测 QoL 评分更高，而 UAP、当前吸烟和高血压预测结局更差。接受血运重建的 NSTEMI 和 UAP 患者报告的 SAQ-7-QL、SAQ7-PL、SAQ7-摘要（NSTEMI）和所有 SAQ-7 域（UAP）的评分更高（p<0.05）。血运重建改变了 UAP 诊断对所有 SAQ-7 和 RAND-12 结果的未标准化β值（>±10%）。
NSTEMI 患者在因胸痛住院 3 个月后报告了最有利的结果。患有其他疾病的患者，尤其是 UAP 患者，报告的评分较低。与接受保守治疗的患者相比，接受血运重建的 NSTEMI 和 UAP 患者报告的 QoL 评分更高。血运重建介导了 UAP 患者的所有结局。
NCT02620202。
