Frøjd Lars Aastebøl, Munkhaugen John, Papageorgiou Costas, Sverre Elise, Moum Torbjørn, Dammen Toril
Department of Medicine, Drammen Hospital, Drammen, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Front Psychol. 2023 Jun 9;14:1119093. doi: 10.3389/fpsyg.2023.1119093. eCollection 2023.
Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and is associated with poor outcomes. Therefore, it is of clinical importance to identify the key determinants of HRQoL among these patients. There is, however, limited knowledge of how a comprehensive set of psychosocial factors influence HRQoL. We aimed to determine the relative associations of clinical and psychosocial factors with mental and physical components of HRQoL in a sample of CHD outpatients.
This cross-sectional study included 1,042 patients 2-36 (mean 16) months after a CHD event recruited from two general Norwegian hospitals with a combined catchment area making up 7% of the Norwegian population, representative with regards to demographic and clinical factors. We collected data on HRQoL, demographics, comorbidities, coronary risk factors, and psychosocial factors. HRQoL was assessed using the Short Form 12 (SF12), which comprises a Mental Component Scale (MCS), and the Physical Component Scale (PCS). Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS.
Mean age was 61 [standard deviation (SD) 10] years, 20% were females, 18% had type D personality, 20% significant depression symptoms, 14% significant symptoms of anxiety whereas 45% reported insomnia. The presence of type D personality (β: -0.19), significant symptoms of depression (β: -0.15), and the presence of insomnia (β: -0.13) were negatively associated with MCS, but not PCS in multi-adjusted analyses. The presence of chronic kidney disease (β: -0.11) was associated with reduced MCS, whereas the presence of chronic obstructive pulmonary disease (β: -0.08) and low physical activity (β: -0.14) were negatively associated with PCS. Younger age was associated with lower MCS, whereas older age was associated with lower PCS.
We conclude that Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest determinants of the mental component of HRQoL. Assessing and managing these psychological factors among CHD outpatients may improve their mental HRQoL.
健康相关生活质量（HRQoL）是冠心病（CHD）患者的一个重要治疗目标，且与不良预后相关。因此，识别这些患者中HRQoL的关键决定因素具有临床重要性。然而，对于一整套社会心理因素如何影响HRQoL的了解有限。我们旨在确定临床和社会心理因素与冠心病门诊患者样本中HRQoL的心理和身体组成部分之间的相对关联。
这项横断面研究纳入了1042例在冠心病事件发生后2至36（平均16）个月的患者，这些患者来自挪威两家综合医院，其合并的服务区域占挪威人口的7%，在人口统计学和临床因素方面具有代表性。我们收集了关于HRQoL、人口统计学、合并症、冠心病危险因素和社会心理因素的数据。使用简短健康调查问卷12项版（SF12）评估HRQoL，该问卷包括心理成分量表（MCS）和身体成分量表（PCS）。采用粗线性回归分析和多因素调整线性回归分析来研究协变量与MCS和PCS之间的关联。
平均年龄为61[标准差（SD）10]岁，20%为女性，18%具有D型人格，20%有显著的抑郁症状，14%有显著的焦虑症状，而45%报告有失眠。在多因素调整分析中，D型人格的存在（β：-0.19）、显著的抑郁症状（β：-0.15）和失眠的存在（β：-0.13）与MCS呈负相关，但与PCS无关。慢性肾脏病的存在（β：-0.11）与MCS降低有关，而慢性阻塞性肺疾病的存在（β：-0.08）和低体力活动（β：-0.14）与PCS呈负相关。年龄较小与较低的MCS相关，而年龄较大与较低 的PCS相关。
我们得出结论，D型人格、抑郁症状、失眠和慢性肾脏病是HRQoL心理组成部分的最强决定因素。在冠心病门诊患者中评估和管理这些心理因素可能会改善他们的心理HRQoL。
