Abstract
BackgroundThe role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance. The aim of this study was to know the gender differences in the evolution of HRQL at 3 and 6 months after a coronary event, and to identify the key clinical, demographic and psychological characteristics of each gender associated with these changes.MethodsA follow-up study was carried out, and 175 patients (112 men and 63 women) with acute myocardial infarction (AMI) or unstable angina were studied. The SF-36v1 health questionnaire was used to assess HRQL, and the GHQ-28 (General Health Questionnaire) to measure mental health during follow-up. To study the variables related to changes in HRQL, generalized estimating equation (GEE) models were performed.ResultsFollow-up data were available for 55 men and 25 women at 3 months, and for 35 men and 12 women at 6 months. Observations included: a) Revascularization was performed later in women. b) The frequency of rehospitalization between months 3 and 6 of follow-up was higher in women c) Women had lower baseline scores in the SF-36. d) Men had progressed favourably in most of the physical dimensions of the SF-36 at 6 months, while at the same time women's scores had only improved for Physical Component Summary, Role Physical and Social Functioning; e) the variables determining the decrease in HRQL in men were: worse mental health and angina frequency; and in women: worse mental health, history of the disease, revascularization, and angina frequency.ConclusionsThere are differences in the evolution of HRQL, between men and women after a coronary attack. Mental health is the determinant most frequently associated with HRQL in both genders. However, other clinical determinants of HRQL differed with gender, emphasizing the importance of individualizing the intervention and the content of rehabilitation programs. Likewise, the recognition and treatment of mental disorders in these patients could be crucial.
Highlights
The role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance
A follow-up study was carried out in the cardiology unit of a university hospital in the south of Spain (800 beds), where 186 consecutive patients admitted for a suspected acute episode of coronary heart disease were identified. 175 of the patients were diagnosed with acute myocardial infarction (AMI) or unstable angina on the basis of clinical, biochemical and electrocardiographic criteria, and on the basis of their hospital discharge report
One of the most significant differences by gender was detected in the GHQ-28 score, where 32.2% of the men scored ≥ 6 compared to 42.9% of the women (P < .001) (Table 1)
Summary
The role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance. Coronary disease affects men and women differently. The reasons why the disease affects men and women differently remain unclear. Different studies performed in the general population have shown that HRQL is worse in women than in men [1,11,12,13,14,15,16,17,18,19]. Several authors have shown that women with coronary disease report significantly poorer physical functioning and mental health than men [5,11,16,20,21]
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