Chronic stable angina is associated with lower health-related quality of life: evidence from Chinese patients.

Jing Wu,Hongliang Cong,Yang Lu,He Sun,Junyi Zheng,Yuerong Han,Judy Xu,Yoshihiro Fukumoto

doi:10.1371/journal.pone.0097294

Abstract

ObjectivesTo compare health-related quality of life (HRQoL) between patients with stable angina and the general population in China and to examine factors associated with HRQoL among patients with stable angina.MethodsA cross-sectional HRQoL survey of stable angina patients recruited from 4 hospitals (n = 411) and the general population recruited from 3 Physical Examination Centers (n = 549) was conducted from July to December, 2011 in two large cities, Tianjin and Chengdu. HRQoL was assessed using the EQ-5D, EQ-VAS, and SF-6D instruments. The health status specific to patients with stable angina was assessed using the Seattle Angina Questionnaire (SAQ). Information on socio-demographic, clinical, and lifestyle factors were also collected. Nested regressions were performed to explore how these factors were associated with HRQoL in patients with stable angina.ResultsCompared with the general population (44.2±10 years, 49.9% females), stable angina patients (68.1±12 years, 50.4% females) had significantly lower HRQoL scores in EQ-5D utility index (0.75±0.19 vs. 0.90±0.20, p<0.05), SF-6D utility index (0.68±0.12 vs. 0.85±0.11, p<0.05), and EQ-VAS (71.2±12.3 vs. 83.9±10.9, p<0.05). The differences remained (−0.05 for EQ-5D, −9.27 for EQ-VAS and −0.13 for SF-6D) after controlling for socio-economic characteristics. SAQ scores showed that stable angina patients experienced impaired disease-specific health status, especially in angina stability (40.5±34.6). Nested regressions indicated stable angina-specific health status explained most of the variation in HRQoL, among which disease perception, physical limitation, and angina stability were the strongest predictors. More physical exercise and better sleep were positively related with HRQoL.ConclusionsCompared to the general population, stable angina patients were associated with lower HRQoL and lower health utility scores, which were largely impacted by clinical symptoms. Further studies are needed to characterize the influence of geographic and cultural factors on the variations of health-related utility in stable angina patients.

Highlights

Stable angina, the cardinal symptom of coronary artery disease (CAD), is prevalent with an annual incidence of about 0.5% in western populations $ 40 years old [1]
Compared to the general population $ 40 years old, stable angina patients were associated with older age, lower education level, lower household income, and higher rates of acute diseases
A higher percentage of stable angina patients had a family history of CAD and suffered from sleep disorders compared to the general population

Summary

Introduction

The cardinal symptom of coronary artery disease (CAD), is prevalent with an annual incidence of about 0.5% in western populations $ 40 years old [1]. Stable angina is a major debilitating health condition with common chronic symptoms of intermittent, reversible chest pain or discomfort. It has a major negative impact on health-related quality of life (HRQoL), including poor general health status, pain, impaired role functioning, activity restriction, inability to selfmanage, and psychological distress [9,10,11]. Few studies measured improvements in quality of life on anti-angina therapy [13,14]

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