Quality of life trajectories in survivors of acute myocardial infarction: a national longitudinal study.
AIM
To define trajectories of perceived health-related quality of life (HRQoL) among survivors of acute myocardial infarction (AMI) and identify factors associated with trajectories.


METHODS
Data on HRQoL among 9566 survivors of AMI were collected from 77 National Health Service hospitals in England between 1 November 2011 and 24 June 2015. Longitudinal HRQoL was collected using the EuroQol five-dimension questionnaire measured at hospitalisation, 1, 6 and 12 months post-AMI. Trajectories of perceived HRQoL post-MI were determined using multilevel regression analysis and latent class growth analysis (LCGA).


RESULTS
One or more percieved health problems in mobility, self-care, usual activities, pain/discomfort and anxiety/depression was reported by 69.1% (6607/9566) at hospitalisation and 59.7% (3011/5047) at 12 months. Reduced HRQoL was associated with women (-4.07, 95% CI -4.88 to -3.25), diabetes (-2.87, 95% CI -3.87 to -1.88), previous AMI (-1.60, 95% CI -2.72 to -0.48), previous angina (-1.72, 95% CI -2.77 to -0.67), chronic renal failure (-2.96, 95% CI -5.08 to -0.84; -3.10, 95% CI -5.72 to -0.49), chronic obstructive pulmonary disease (-3.89, 95% CI -5.07 to -2.72) and cerebrovascular disease (-2.60, 95% CI -4.24 to -0.96). LCGA identified three subgroups of HRQoL which we labelled: improvers (68.1%), non-improvers (22.1%) and dis-improvers (9.8%). Non-improvers and dis-improvers were more likely to be women, non-ST-elevation myocardial infarction (NSTEMI) and have long-term health conditions, compared with improvers.


CONCLUSIONS
Quality of life improves for the majority of survivors of AMI but is significantly worse and more likely to decline for women, NSTEMI and those with long-term health conditions. Assessing HRQoL both in hospital and postdischarge may be important in determining which patients could benefit from tailored interventions.


TRIAL REGISTRATION
NCT01808027 and NCT01819103.
['Munyombwe|Theresa|T|0000-0002-1307-6691', 'Hall|Marlous|M|', 'Dondo|Tatendashe Bernadette|TB|0000-0002-8337-8425', 'Alabas|Oras A|OA|', 'Gerard|Oliver|O|', 'West|Robert M|RM|', 'Pujades-Rodriguez|Mar|M|', 'Hall|Alistair|A|', 'Gale|Chris P|CP|']
D000203:Activities of Daily Living D000368:Aged D001007:Anxiety D016208:Databases, Factual D003863:Depression D004739:England D005260:Female D006304:Health Status D006801:Humans D008137:Longitudinal Studies D008297:Male D008603:Mental Health D008875:Middle Aged D051346:Mobility Limitation D009203:Myocardial Infarction D010146:Pain D011788:Quality of Life D012307:Risk Factors D012648:Self Care D012737:Sex Factors D017741:Survivors D013997:Time Factors
myocardial infarction EQ-5D Growth modelling Health-related quality-of-life Outcomes research