title: The use of HeartQoL in patients with coronary heart disease: Association with risk factors and European reference values. The EUROASPIRE IV study of the European Society of Cardiology.
abstract: HeartQoL is a recently developed core health-related quality of life instrument for patients with coronary heart disease. The current study aims to investigate its association with patients' coronary risk profile and to provide reference values for patients with coronary heart disease across Europe.
  
  
  
  Analyses are based on the EUROASPIRE IV (EUROpean Action on Secondary and Primary prevention through Intervention to Reduce Events) cross-sectional survey.
  
  
  
  Patients with a diagnosis of coronary heart disease were examined and interviewed six months to three years after their coronary event. The HeartQoL questionnaire was completed by 7261 coronary heart disease patients. Reference values were calculated and the association with the coronary risk profile was assessed.
  
  
  
  Significantly worse outcomes were observed in higher-risk patient groups. Both metabolic and behavioural risk factors were associated with worse HeartQoL outcomes. Further, the HeartQoL scores decreased as the number of risk factors increased. The mean global reference values in males were 2.27 ± 0.65 (<60 years), 2.30 ± 0.61 (between 60 and 69 years) and 2.19 ± 0.64 (≥70 years). Likewise, in females, the respective global HeartQoL reference values were 2.02 ± 0.67, 2.01 ± 0.66 and 1.83 ± 0.70. The ceiling effect in males was 11.4%, 10.4% and 7.4% for the three age classes respectively, whereas in females the ceiling effect was 5.2%, 3.5% and 1.9%, respectively.
  
  
  
  HeartQoL scores were associated with patients' coronary risk profile. The reference values may help other researchers to interpret HeartQoL scores. Further research should focus on the minimal important difference needed to evaluate the effect of therapies and lifestyle changes.
authors: Department of Public Health, Ghent University, Belgium Delphine.desmedt@ugent.be.
authors: Delphine
authors: D
authors: De Smedt
authors: Department of Public Health, Ghent University, Belgium.
authors: Els
authors: E
authors: Clays
authors: Department of Medical Psychology, Innsbruck Medical University, Austria.
authors: Stefan
authors: S
authors: Höfer
authors: College of Health Sciences, University of Wisconsin-Milwaukee, USA.
authors: Neil
authors: N
authors: Oldridge
authors: Department of Public Health, Ghent University, Belgium Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK.
authors: Kornelia
authors: K
authors: Kotseva
authors: EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
authors: Aldo Pietro
authors: AP
authors: Maggioni
authors: National Research Centre for Preventive Medicine, Moscow, Russian Federation.
authors: Nana
authors: N
authors: Pogosova
authors: Shupik's National Medical Academy of Postgraduation Education, Kiev, Ukraine.
authors: Maryna
authors: M
authors: Dolzhenko
authors: Department of Public Health, Ghent University, Belgium.
authors: Dirk
authors: D
authors: De Bacquer
mesh_terms: D000368:Aged; D002309:Cardiology; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D011788:Quality of Life; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012955:Societies, Medical
keywords: Health-related quality of life; coronary heart disease; patient reported outcome