Abstract 3916: Predictors of 1-Year Quality of Life After Acute Myocardial Infarction
Background: Despite substantial improvements in AMI survival, little is known about the determinants of non-fatal post-MI outcomes. We assessed the factors associated with 1-year health-related quality of life (HRQL) in a large cohort of AMI patients.
Methods: We analyzed the 1,890 patients who survived 1 year after AMI in the prospective, 19-center PREMIER cohort study. HRQL was assessed at baseline and 1 year with the Seattle Angina Questionnaire (85% 1-year survey completion). The HRQL outcome was continuous (score range 0–100). Multivariable linear regression (with natural splines to allow for nonlinear associations for continuous predictor variables) was used to determine the demographic, clinical history, psychosocial, hospital course, and treatment factors associated with 1-year HRQL. The goal was to identify which variables, available at the time of MI discharge, are independently predictive of 1-year HRQL.
Results: The mean HRQL score for the study cohort at 1 year was 84.7 +/− 18.0. After adjustment for baseline HRQL, factors independently associated with worse 1-year HRQL were: younger age (non-linear association, but patients <60 years had 13-point lower scores than those ≥60 years; p<0.001); prior CABG surgery (−4.2 (−6.7,−1.7);p<0.001); female sex (−2.0 (−3.3,−0.7); p=0.001); STEMI (−1.6 (−2.7,−0.5; p=0.004); depressive symptoms during MI hospitalization (−1.9 (−2.8,−1.0) per +5 points on the PHQ; p=0.001); low BMI (−0.9 (−1.4,−0.4) per −5 kg/m2; p<0.001); low social support (−1.0 (−1.7,−0.3) per −5 points on the ESSI; p<0.001); and lower income category (p<0.05). There was a significant interaction between education and age, where lower education among younger patients was significantly associated with worse HRQL, but education was not predictive among older persons. The model R2 was 18.3%, consistent with HRQL predictive models for other conditions.
Conclusion: Clinicians should be aware that there are differences between the factors associated with HRQL after MI and established risk factors for post-MI survival (e.g. ejection fraction). Interventions to improve post-MI HRQL, targeting patients with the risk factors identified in this study, should be formally evaluated.