Perceived Disability and Lifestyle Modification Following Hospitalization for Non-ST Elevation Versus ST Elevation Acute Coronary Syndromes: The Patients' Point of View

Abstract

Medical personnel generally believe that non-ST elevation (NSTE) acute coronary syndromes (ACS) are less damaging than ST elevation myocardial infarction (STEMI), in keeping with the lower morbidity and mortality attributed to these subgroups in randomized clinical trials. We examined whether this concept translates into a difference from the patients' point of view regarding lifestyle modification and return to work following hospitalization for ACS. A structured anonymous self-completed questionnaire was mailed and returned by 160 consecutive patients (age 64+/-11 years; 125 (78%) men) 3-12 months after hospitalization for ACS. In 49 patients, the diagnosis was unstable angina pectoris (UAP), in 34 non-ST elevation myocardial infarction (NSTEMI) and in 73, ST elevation myocardial infarction (STEMI). The questionnaire addressed issues relating to demographic data, medical history, occupation, employment and income before the acute event, changes following hospitalization for ACS and questions relating to current perceived health status and return to work. Most (98/159, 62%) patients saw themselves as "heart patients" after hospitalization for ACS. Quality of life was perceived to have decreased in 70 (44%), self-image in 85 (53%), self-confidence in 78 (49%) and sexual function in 75 (48%), with no differences according to ACS type. Anxiety was reported by 85 (54%) patients and anxiety level (1.47+/-1.25 on the Brief Symptom Inventory scale) was high. Only 38 (49%) of 77 patients who were working prior to the acute event returned to full- or part-time gainful employment. By multivariate analysis, return to work was associated with 3 variables: younger age (p=0.015), shorter duration of hospitalization (p=0.036) and higher income bracket prior to the acute event (p=0.0001), with no relation to gender, in-hospitalization revascularization strategy, rehabilitation program or to underlying cardiac diagnosis (UAP, NSTEMI or STEMI). Hospitalization for ACS had a major negative impact on patient lifestyle and return to work, irrespective of the underlying cardiac diagnosis. The experience of hospitalization for an acute heart condition was uniformly traumatic with in many instances a prolonged adverse effect on patient function.