Dondo Tatendashe B, Munyombwe Theresa, Hurdus Ben, Aktaa Suleman, Hall Marlous, Soloveva Anzhela, Nadarajah Ramesh, Haris Mohammad, West Robert M, Hall Alistair S, Gale Chris P
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK.
Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9JT, UK.
Eur Heart J Qual Care Clin Outcomes. 2024 Aug 30. doi: 10.1093/ehjqcco/qcae036.
Health-related quality of life (HRQoL) for patients following myocardial infarction (MI) is frequently impaired. We investigated the association of baseline and changes in HRQoL with mortality following MI.
Nationwide longitudinal study of 9474 patients admitted to 77 hospitals in England as part of the Evaluation of the Methods and Management of Acute Coronary Events study. Self-reported HRQoL was collected using EuroQol EQ-5D-3L during hospitalization and at 1, 6, and 12 months following discharge. The data was analysed using flexible parametric and multilevel survival models. Of 9474 individuals with MI, 2360 (25%) were women and 2135 (22.5%) died during the 9-year follow-up period. HRQoL improved over 12 months (baseline mean, mean increase: EQ-5D 0.76, 0.003 per month; EQ-VAS 69.0, 0.5 per month). At baseline, better HRQoL was inversely associated with mortality [Hazard ratio (HR) 0.55, 95% CI 0.47-0.63], and problems with self-care (HR 1.73, 1.56-1.92), mobility (1.65, 1.50-1.81), usual activities (1.34, 1.23-1.47), and pain/discomfort (1.34, 1.22-1.46) were associated with increased mortality. Deterioration in mobility, pain/discomfort, usual activities, and self-care over 12 months were associated with increased mortality (HR 1.43, 95% CI 1.31-1.58; 1.21, 1.11-1.32; 1.20, 1.10-1.32; 1.44, 1.30-1.59, respectively).
After MI, poor HRQoL at baseline, its dimensions, and deterioration over time are associated with an increased risk of mortality. Measuring HRQoL in routine clinical practice after MI could identify at-risk groups for interventions to improve prognosis.
心肌梗死（MI）患者的健康相关生活质量（HRQoL）常常受损。我们研究了MI后HRQoL的基线水平及变化与死亡率之间的关联。
作为急性冠状动脉事件的方法与管理评估研究的一部分，对英格兰77家医院收治的9474例患者进行了全国性纵向研究。在住院期间以及出院后1个月、6个月和12个月，使用欧洲五维度健康量表（EuroQol EQ-5D-3L）收集患者自我报告的HRQoL。采用灵活参数模型和多水平生存模型对数据进行分析。在9474例MI患者中，2360例（25%）为女性，2135例（22.5%）在9年随访期内死亡。HRQoL在12个月内有所改善（基线均值，平均增幅：EQ-5D为0.76，每月0.003；EQ视觉模拟量表（EQ-VAS）为69.0，每月0.5）。在基线时，较好的HRQoL与较低的死亡率呈负相关[风险比（HR）0.55，95%置信区间（CI）0.47 - 0.63]，而自我护理问题（HR 1.73，1.56 - 1.92）、活动能力（1.65，1.50 - 1.81）、日常活动（1.34，1.23 - 1.47）以及疼痛/不适（1.34，1.22 - 1.46）与死亡率增加相关。12个月内活动能力、疼痛/不适、日常活动和自我护理方面的恶化与死亡率增加相关（HR分别为1.43，95% CI 1.31 - 1.58；1.21，1.11 - 1.32；1.20，1.10 - 1.32；1.44，1.30 - 1.59）。
MI后，基线时较差的HRQoL、其各个维度以及随时间的恶化与死亡风险增加相关。在MI后的常规临床实践中测量HRQoL可以识别出有风险的群体，以便进行干预以改善预后。
