Acute coronary syndrome and predictors of quality of life.
BACKGROUND
Coronary disease in its various forms of presentation is associated with a reduction in the patients' own perception of their quality of life (QoL). QoL is an important measure of effectiveness of treatment; however, the predictors of QoL after admission for acute coronary syndrome (ACS) are not completely clear.


OBJECTIVE
To identify the clinical, demographic and psychosocial characteristics of patients admitted for ACS that were predictive of QoL in clinical follow-up.


METHODS
Physical and mental QoL were prospectively evaluated in 278 patients admitted for ACS, using Short Form-36 v2 physical (PCS) and mental (MCS) component summary scales. Based on the median PCS (55) and MCS (56) scores, the population was divided into two groups. Depressive symptoms were assessed using the Beck Depression Inventory.


RESULTS
The patients with a better QoL perception were male, young, smokers and had more than 12 years' education. A greater proportion of patients with PCS and MCS below the median score presented prior cardiovascular events and depressive symptoms. A worse physical QoL perception was more common in unmarried, hypertensive and diabetic patients. There was no association between clinical evolution or in-hospital complications and baseline QoL scores. Baseline PCS and MCS were 55 +/- 24 and 55 +/- 27 and at 16 months, 63 +/- 25 and 66 +/- 29. Clinical follow-up was achieved in 181 patients. A worse mental QoL perception at follow-up was related to female gender, baseline MCS < 56 and depressive symptoms. A PCS below median score at follow-up was more frequent in women and in patients with prior cardiovascular events, hypertension, diabetes, dyslipidemia and a lower level of education. Patients with better physical QoL at follow-up were smokers, presented higher baseline PCS and MCS, and had fewer depressive symptoms. Percutaneous myocardial revascularization was associated with a better physical QoL. In a logistic regression model the independent predictors of PCS were: gender, baseline PCS, level of education and prior cardiovascular events. Gender and depressive symptoms were independent predictors of MCS.


CONCLUSIONS
In the study population, baseline clinical and psychosocial characteristics were the most important predictors of QoL after ACS. Depression was associated with worse mental QoL. In-hospital evolution and treatment did not appear to strongly affect patients' follow-up perceptions of QoL.
Dias
Carla Costa
CC
Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal. carlacostadias@netcabo.pt
Mateus
Pedro
P
Santos
Lino
L
Mateus
Carlos
C
Sampaio
Francisco
F
Adão
Luís
L
Bettencourt
Nuno
N
Ribeiro
José
J
Teixeira
Madalena
M
Fonseca
Conceição
C
Simões
Lino
L
Coelho
Rui
R
Ferreira
Pedro L
PL
Ribeiro
Vasco G
VG
D000367:Age Factors; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D003327:Coronary Disease / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D004522:Educational Status; D004562:Electrocardiography; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013577:Syndrome