Associations between demographic, disease related, and treatment pathway related variables and health related quality of life in primary care patients with coronary heart disease

Abstract

BackgroundCoronory heart disease (CHD) is a common medical problem worldwide that demands shared care of general practitioners and cardiologists for concerned patients. In order to improve the cooperation between both medical specialists and to optimize evidence-based care, a treatment pathway for patients with CHD was developed and evaluated in a feasibility study according to the recommendation for the development and evaluation of complex interventions of the British Medical Research Council (MRC). In the context of this feasibility study the objective of the present research was to investigate the contributions of different disease related (e.g. prior myocardial infarction), pathway related (e.g. basic medication) and demographic variables on patients` perceived health related quality of life (HRQoL) as a relevant and widely used outcome measure in cardiac populations.MethodsData assessing demographic, disease and pathway related variables of CHD patients included in the study were collected in a quasi-experimental design with three study arms (pathway developers, users, control group) via case record forms and questionnaires at baseline and after 6 and 12 (intervention groups), and 9 months (control group), respectively after the initial implementation on GP level. Additionally, at the same measuring points the CHD patients participating in the study were interviewed by phone regarding their perceived HRQoL, measured with the EuroQol EQ-5D as an index-based health questionnaire. Due to the hierarchical structure of the data, we performed cross-sectional and longitudinal linear mixed models to investigate the impact of disease related, pathway related and demographic variables on patients` perceived HRQoL.ResultsOf 334 initially recruited patients with CHD, a total of 290 were included in our analysis. This was an average 13.2% dropout rate from baseline assessment to the 12-month follow-up. At all assessment points, patients` HRQoL was associated with a variety of sociodemographic variables (e.g. gender, employment, education) in each study group, but there was no association with pathway related variables. In both cross-sectional and longitudinal analyses highest HRQoL values in patients were reported in the physician group that had developed the pathway. In the longitudinal analyses there were no significant changes in the reported HRQoL values of the three groups over time.ConclusionsThe found associations between sociodemographic variables and the perceived HRQoL of patients with CHD are in line with other research. As there are no associations of HRQoL with pathway related variables like the basic medication, possible weaknesses in the study design or the choice of outcome have to be considered before planning and conducting an evaluation study according to the MRC recommendations. Additionally, as patients in the developer group reported the highest HRQoL values over time, a higher commitment of the GPs in the developer group can be assumed and should be considered in further research.

Comorbidities and characteristics of coronary heart disease patients: their impact on health-related quality of life

“…Different studies showed a negative impact of various conditions (e.g., HF, vascular comorbidities) and socio-demographic factors (including education) on the HRQoL of CHD patients [5, 10, 42], which is comparable to the results of our study. The EPA Cardio study, in which Slovenia also participated, did not explicitly examine the association between individual comorbid conditions and HRQoL but was focused exclusively on the number of different comorbid conditions that had a severe negative impact on HRQoL [38].…”

“…It is described as (in) compatibility between the actual and desired functional capacity, which is of particular importance in CHD patients [9]. HRQoL is defined by patients’ subjective perception of the effects of the disease (e.g., limited functionality, regular treatment and follow-up) on their everyday life [10, 11]. Besides typical measures, such as management of morbidity and mortality, HRQoL has become an increasingly important outcome measure in the care of elderly patients with chronic conditions.…”

“…Besides typical measures, such as management of morbidity and mortality, HRQoL has become an increasingly important outcome measure in the care of elderly patients with chronic conditions. It represents a paradigm shift from survival or cure as a primary endpoint of the patient’s well-being [8] and assessment of the effects of chronic illness on the patient’s everyday life, as well as the final objective of health care efforts in CHD patient population [10, 12, 13]. In addition, HRQoL is also important in predicting long-term prognosis, mortality, and coronary event recurrence [14–16].…”

Quality of Life among Patients with Acute Coronary Syndrome

“…This shows that the higher the educational level, the higher the QoL, corroborating the findings of previous studies (36,49,(58)(59)(60). Low educational level was associated with poor perception of the disease and its risk factors.…”

Sacubitril/Valsartan in Management of Heart Failure: A Review of Safety, Efficacy and Cost-Effectiveness

“…Health-related quality of life (HRQL) of patients from PARADIGM-HF trial showed promising HRQL in surviving patients with heart failure on SAC/VAL therapy [23]. At 8 months, SAC/VAL group noted improvements in both KCCQ clinical summary score (n= 6881, +0.64 versus -0.29; P=0.008) and KCCQ overall summary score (n=7623, +1.13 versus -0.14; P<0.001) in comparison to enalapril group and significantly less proportion of patients with deterioration (≥ 5 points decrease) of both KCCQ scores (27% versus 31%; P=0.01) [23].…”