Abstract
BackgroundOutcomes following acute myocardial infarction (AMI) may result in death, increased morbidity, and change in quality of life (QOL). This study explores health-related QOL of first-time patients following AMI.MethodsThis cross-sectional study used a sample of patients with first-time AMI experienced between April 2011 and March 2015 at a tertiary health institution. Recruited patients belonged to different post-AMI periods: 2–10 weeks, 5–22 months, and > 22 months to 4 years post AMI. Inclusion criteria were not confused and communicating freely. Exclusion criteria were non-contactable, refusing to participate, and deceased. One-on-one interviews were conducted using the validated and pre-tested Quality of Life after Myocardial Infarction (QLMI) questionnaire. QOL of patients after AMI was evaluated at each period. Descriptive, Mann–Whitney U, Kruskal–Wallis, and regression analyses were conducted using SPSS version 24.ResultsA total of 534 participant interviews (overall response rate 65.4%) were conducted. Interviewees were predominantly male (67%), aged 51–65 years (45%), Indo-Trinidadian (81.2%), NSTEMI (64.4%), and hypertensive (72.4%). Overall QOL improved over time and in all domains: Emotional, Physical, and Social. Lower QOL was found among women, patients with NSTEMI, and diabetics in all domains; in patients with hypertension and renal disease in the Physical and Social domains only; and in patients with ischaemic heart disease (IHD) in the Physical domain only. Self-reported stress and lack of exercise were associated with lower QOL while drinking alcohol and eating out were related to better QOL. Hypercholesterolemia, smoking, and ethnicity showed no association with QOL. Declining QOL in the Physical domain with age was also found. The leading components of QOL were self-confidence and social exclusion (early post AMI), lack of self-confidence (intermediate post AMI), and tearfulness (late post AMI).ConclusionsQOL in AMI survivors improves over time. Female gender, NSTEMI, diabetes, hypertension, renal disease, stress, and lack of exercise were associated with lower QOL while hypercholesterolemia, smoking, and ethnicity showed no association with QOL. Cardiac rehabilitation and psychological support may enhance earlier increased QOL among survivors, particularly among vulnerable groups.
Highlights
Outcomes following acute myocardial infarction (AMI) may result in death, increased morbidity, and change in quality of life (QOL)
Bahall and Khan Health and Quality of Life Outcomes (2018) 16:32 care leads to a decrease in mortality [14] [15] and improvement in QOL and clinical outcomes [15], which can further increase life expectancy and decrease morbidity [16]
QOL was found to improve with time following AMI
Summary
Outcomes following acute myocardial infarction (AMI) may result in death, increased morbidity, and change in quality of life (QOL). Quality of life (QOL) is dependent on health provider factors such as access to medical care [2], cardiovascular risk factors [3], and severity of AMI [3], and on demographic and psychosocial factors such as age [4], sex [5], educational level [6], income [6], Bahall and Khan Health and Quality of Life Outcomes (2018) 16:32 care leads to a decrease in mortality [14] [15] and improvement in QOL and clinical outcomes [15], which can further increase life expectancy and decrease morbidity [16]. As stated by the World Health Organization (WHO), “quality of life is defined as individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns” [21] It incorporates many different aspects of a person’s life including: physical, psychological, level of independence, social relations, environmental, and spiritual/religion/personal beliefs [22]. Healthrelated QOL of life is defined as a “multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning”. [23]
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