Gender differences in quality of life in coronary artery disease patients with comorbidities undergoing coronary revascularization.

Tom H Oreel,Jorrit Lemkes,Mirjam A G Sprangers,Alexander B A Vonk,Justine E Netjes,Hanneke W M Van Laarhoven,Michael Scherer-Rath,Pythia T Nieuwkerk,José P S Henriques,Iris D Hartog

doi:10.1371/journal.pone.0234543

Abstract

In comparison to male patients with coronary artery disease, female patients suffer from more comorbidities, experience symptoms of coronary artery disease differently and report poorer health-related quality of life (HRQoL) after coronary revascularization. However, there is limited data on the impact of comorbidity burden on the recovery in HRQoL in female and male patients. We investigated the impact of comorbidity burden on the change in HRQoL following coronary revascularization in female patients versus male patients. 230 patients (60 female) with coronary artery disease were assessed before, and two weeks, three months and six months after coronary revascularization. Disease-specific HRQoL was measured with the Short-Form Seattle Angina Questionnaire. Physical and mental health was measured with the Short-Form Health Survey. Comorbidity burden was assessed by the total number of identified comorbidity conditions and by the Charlson comorbidity score. Linear mixed models were used to estimate the effects of time, gender and comorbidity burden on HRQoL. Whereas HRQoL improved after coronary revascularization in all patients, female patients reported poorer physical health and disease-specific HRQoL and their physical health improved more slowly than male patients. A higher comorbidity burden was related with poorer physical health and disease-specific HRQoL in male patients, but not in female patients. A higher comorbidity burden was associated with slower improvement in HRQoL for both female and male patients. Female patients reported poorer HRQoL and their physical health improved more slowly after coronary revascularization, irrespective of comorbidity burden. Higher comorbidity burden was associated with poorer physical health and disease-specific HRQoL in male patients only. Our results indicate that female and male patients recover differently after coronary revascularization. These findings highlight the importance of comorbidity- and gender-specific approaches for evaluating coronary artery disease and coronary revascularization procedures.

Highlights

Coronary artery disease (CAD) is the leading cause of death and disability in the Western world [1]
This study aims to investigate the impact of comorbidity burden on changes in health-related quality of life (HRQoL) following coronary revascularization in female versus male CAD patients
All patients were recruited at the cardiology departments of the Amsterdam University Medical Centers: Academic Medical Center (AMC) and VU Medical Center (VUmc) locations

Summary

Introduction

Coronary artery disease (CAD) is the leading cause of death and disability in the Western world [1]. As CAD patients are becoming older, they are more likely to suffer from comorbidities which increases the overall disease burden and may negatively impact HRQoL [6,7,8,9]. Female CAD patients are generally older compared to their male counterparts, tend to have more comorbidities, and report a higher comorbidity burden [10,11,12,13]. Female patients experience symptoms of CAD differently than male patients [11, 14]. Since female and male patients may experience symptoms differently, a gender specific approach in coronary revascularization may be of great clinical importance. There is limited data about gender differences on the impact of comorbidity burden on HRQoL after coronary revascularization procedures

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Conclusion