Lebensqualität von ambulanten kardiologischen Patienten einer Universitätsklinik

Abstract

Summary In an ageing population, quality of life (QOL) plays an important role in disease management. QOL in patients with cardiovascular diseases treated in an outpatient setting are rarely described in a single research project, mainly because of the methodological complexity and missing instruments, eg patients questionnaires in German. The aim of the following study was to determine QOL by means of standardised, validated and self-administered questionnaires at the Cardiovascular Center Zurich outpatient clinic between January and June 2003. We used the Short Form 36 (SF-36) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to assess determinants of QOL in 250 consecutive patients with coronary heart disease (44%), congenital heart disease (19%), valvular heart disease (17%), hypertensive heart disease (6%), and dilatative cardiomyopathy (5%). Questionnaires’ return rate was 91%. Of those, 17 (7.5%) were not readable, thus data of 210 questionnaires (84%) were analysed. Mean age was 55 years (± 16.4, range 18 to 85 years) and average inter-correlation among the items measured by Cronbach’s alpha was 0.8414 (physical role ) to 0.8890 (social function) with the SF-36 and 0.6010 (physical dimension) to 0.8182 (emotional dimension) with the MLHFQ. Determinants of decreasing QOL were increasing BMI (SF-36: p = 0.0010; MLHFQ: p = 0.0239), number of medications (SF-36 and MLHFQ: p <0.001), number of cardiovascular risk factors (SF-36: p = 0.0004; MLHFQ: p = 0.0173), increased age (SF-36: p = 0.0061; MLHFQ: p = 0.0404) and lower left ventricular ejection fraction (SF-36: p = 0.0065; MLHFQ: p = 0.0002), respectively. All cardiovascular diseases could be discriminated against dilatative cardiomyopathy, however questionnaires’ items were not able to express the specific distinguishing qualities of all other diagnoses. In comparison with a standard disease-free population, social function was dramatically reduced in all cardiovascular diseases (48.3% ± 10.4 vs 88.8% ± 18.4; p <0.0001). SF-36 and MLHFQ are reliable instruments in their German translation for determining QOL in cardiovascular patients in an outpatient setting. Patients with dilatative cardiomyopathy have the poorest QOL, however discrimination between diseases by means of these two instruments is not feasible. Items for describing social role in cardiovascular diseases ought to be reevaluated. Physicians should pay more attention to the social function of patients with cardiovascular diseases.