Abstract
Background: Despite a high cardiovascular disease burden, data on patient-reported health status outcomes among individuals with cardiovascular disease in India are limited. Methods and Results: Between November 2014 and November 2016, we collected health-related quality of life data among 1261 participants in the ACS QUIK trial (Acute Coronary Syndrome Quality Improvement in Kerala). We used a translated, validated version of the Seattle Angina Questionnaire administered 30 days after discharge for acute myocardial infarction, wherein higher scores represent better health status. We compared results across sex, myocardial infarction type, and randomization status using regression models that account for clustering and temporal trends. Mean (SD) age was 60.8 (13.7) years, 62% were men, and 63% presented with ST-segment-elevation myocardial infarction. More than 2 out of 5 respondents (44%) experienced angina 30 days after hospitalization, but most (68% of respondents with angina; 27% of the total sample) experienced it less than once per week (Seattle Angina Questionnaire angina frequency score 60). Respondents rated high median (interquartile range [IQR]) scores for angina frequency (100.0 [80.0-100.0]) overall with similar unadjusted scores by sex, but between-hospitality variability was high. Median (IQR) physical limitation scale response was 58.3 (41.7-77.8), which is consistent with limitations in moderate- and high-intensity activities at 30-day follow-up. Older respondents had more angina frequency and physical limitations and lower treatment satisfaction and quality of life. Women had greater physical limitations (median [IQR], 52.8 [38.9-72.2] for women versus median [IQR], 61.1 [44.4-80.6] for men; P<0.01). Overall treatment satisfaction was high with median (IQR) score, 81.3 (75.0-93.8), but overall quality of life was lower with median (IQR) score, 66.7 (50.0-83.3). Allocation to the quality improvement intervention group had the strongest direct association with higher quality of life (difference, 4.2; P=0.03), but overall effects were modest. Conclusions: This study represents the largest report of quality of life among myocardial infarction survivors in India with variability across age, sex, and quality improvement intervention status. Wide variability demonstrated across hospitals warrants further study.
| Original language | English (US) |
|---|---|
| Article number | e004980 |
| Journal | Circulation: Cardiovascular Quality and Outcomes |
| Volume | 12 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2019 |
Funding
The ACS QUIK trial (Acute Coronary Syndrome Quality Improvement in Ke-rala) was sponsored by the National Heart, Lung, and Blood Institute (R00 HL107749), Centre for Chronic Disease Control, Cardiological Society of India-Kerala Chapter, Northwestern Global Health Initiative, and Northwestern University Clinical and Translational Science Institute (UL1TR001422). The translation, validation, and license of the Seattle Angina Questionnaire was sponsored by CV Outcomes, Inc. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; or decision to submit the article for publication. Dr Huffman receives support from the World Heart Federation to serve as its senior program advisor for the Emerging Leaders program, which is supported by unrestricted educational grants from Boehringer Ingelheim and Novartis with previous support from Bupa and AstraZeneca. He also receives funding from the American Heart Association, Verily, and AstraZeneca for work unrelated to this article. Dr. Huffman receives funding from the American Medical Association as an associate editor for JAMA Cardiology, which is unrelated to this work. The other authors report no conflicts.
Keywords
- India
- acute coronary syndrome
- health status
- myocardial infarction
- quality of life
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
