Abstract 3779: Impact of Non-Fatal Cardiovascular Events on Change in Health-Related Quality of Life in Patients Who Survive Myocardial Infarction
Background: There is limited understanding of the long-term changes in health-related quality of life (HRQL) in myocardial infarction (MI) survivors, which has both therapeutic and trial design implications. We utilized the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial experience to test the hypothesis that non-fatal events that occur after an acute MI worsen HRQL.
Methods: VALIANT enrolled 14,703 patients with MI complicated by Killip class ≥ 2 and/or reduced ejection fraction between 0.5 and 10 days post-MI. A subset of 2556 (17.4%) patients completed the Euro-Qol and HRQL was measured using the visual analog scale (VAS) (scores ranging from 0 to 100 with 100 representing best imaginable health state) with baseline established at either hospital discharge or 14 days post-randomization, and repeat assessment at 6,12, 20, and 24 months. The trajectory of VAS scores following enrollment in the trial was modeled using a linear mixed effects regression model. The deviation from this trajectory following a non-fatal cardiovascular (CV) event (heart failure (HF) hospitalization, MI, stroke, or resuscitated sudden death) was assessed to evaluate incremental impact of the event on the VAS relative to the expected VAS if the patient had not experienced the event. Patients who died prior to the next VAS assessment were excluded.
Results: Over a 2 year follow-up, 586 patients experienced a non-fatal CV event of which 128 (21.8%) died prior to the next VAS assessment resulting in 458 patients eligible for the analysis. These patients experienced a trajectory-adjusted 6.8 point decrease (p<0.0001) in VAS scores following the non-fatal CV event (Table⇓). HF hospitalization was associated with a 6.9 point decrease in VAS scores (p<0.0001).
Conclusion: MI survivors who were hospitalized for HF within 2 years following the event had a significantly worse HRQL. Future studies should consider the impact of non-fatal events on longitudinal changes in HRQL.