Abstract
BackgroundPatient-reported outcomes are increasingly seen as complementary to biomedical measures. However, their prognostic importance has yet to be established, particularly in female long-term myocardial infarction (MI) survivors. We aimed to determine whether 10-year survival in older women after MI relates to patient-reported outcomes, and to compare their survival with that of the general female population.MethodsWe included all women aged 60-80 years suffering MI during 1992-1997, and treated at one university hospital in Norway. In 1998, 145 (60% of those alive) completed a questionnaire package including socio-demographics, the Sense of Coherence Scale (SOC-29), the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) and an item on positive effects of illness. Clinical information was based on self-reports and hospital medical records data. We obtained complete data on vital status.ResultsThe all-cause mortality rate during the 1998-2008 follow-up of all patients was 41%. In adjusted analysis, the conventional predictors s-creatinine (HR 1.26 per 10% increase) and left ventricular ejection fraction below 30% (HR 27.38), as well as patient-reported outcomes like living alone (HR 6.24), dissatisfaction with self-rated health (HR 6.26), impaired psychological quality of life (HR 0.60 per 10 points difference), and experience of positive effects of illness (HR 6.30), predicted all-cause death. Major adverse cardiac and cerebral events were also significantly associated with both conventional predictors and patient-reported outcomes. Sense of coherence did not predict adverse events. Finally, 10-year survival was not significantly different from that of the general female population.ConclusionPatient-reported outcomes have long-term prognostic importance, and should be taken into account when planning aftercare of low-risk older female MI patients.
Highlights
Patient-reported outcomes are increasingly seen as complementary to biomedical measures
Informed consent was obtained from the subjects [19], and the study was approved by the Regional Committee for Medical Research Ethics, Western Norway, and the Norwegian Social Science Data Services
Mean serum creatinine was 92.5 μmol/L, 38% of the myocardial infarction (MI) survivors had a reduced ejection fraction (EF), and 12% were diagnosed with diabetes
Summary
Patient-reported outcomes are increasingly seen as complementary to biomedical measures. Their prognostic importance has yet to be established, in female long-term myocardial infarction (MI) survivors. We aimed to determine whether 10-year survival in older women after MI relates to patient-reported outcomes, and to compare their survival with that of the general female population. Research on long-term survival after acute myocardial infarction (MI) in older women is scarce. The population-based MONICA-studies [1] had an age limit of 64 years. Few studies have investigated patient-reported outcomes in female long-term MI survivors. There is a growing recognition of the importance of a patient perspective on health after medical treatment of cardiovascular disease [2,3]. Patient-reported outcomes can provide an additional measure complementary to objective biomedical measures.
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