Analysis of determinants and one-year prognostic contribution of quality of life and psychological status indicators in patients with myocardial infarction

Abstract

The aim of this study was to search for significant associations between quality of life and psychological status indicators and the 1-year prognosis of patients with myocardial infarction (MI) and other determinants. Material and methods . The study included 150 patients with non-fatal MI. Psychological status and quality of life indicators, behavioral and socioeconomic factors were assessed. Medical records were collected at discharge. The incidence of a composite cardiovascular outcome was recorded after one year. Using statistical analysis, a search was conducted for significant associative relationships between various variables in the study (methods of logistic linear and binary regression). Results. Subclinical and clinical manifestations of anxiety (frequency 4.7 %) were significantly associated with the lack of higher education odds ratio (OR) – 11.3 (95 % confidence interval (CI) 1.2; 109.6), coronary artery bypass grafting (CABG) after MI – OR 22.9 (95 % CI 1.6; 337.5), low EQ-5D utility index – OR 1.9 (95 % CI 1.6; 2.4); while depression (frequency 6.7 %) was associated with acute stress before MI – OR 5.6 (95 % CI 1.3; 23.2), and the development of a one-year composite cardiovascular outcome – OR 4.5 (95 % CI 1.2; 17.6). According to the quality of life assessment after MI, moderate and severe problems with mobility were identified in 6.7 % of patients, daily activities in 2.0 %, pain in 10.7 %, anxiety/depression in 6.7 %, and there were no problems with self-care. The patients’ health status according to the EQ-VAS scale was 75 (65; 85) points, and the calculated EQ-5D utility index was 1 (1; 1). Low health status score (frequency 41.3 %) was significantly associated with alcohol consumption – OR 2.3 (95 % CI 1.0; 4.9), acute stress before MI – OR 2.3 (95 % CI 1.1; 4.9), low level of physical activity – OR 2.8 (95 % CI 1.0; 7.8)), non-prescription of mineralocorticoid receptor antagonists – OR 2.8 (95 % CI 1.3; 5.9), development of the one-year composite cardiovascular outcome – OR 3.2 (95 % CI 1.2; 8.1); a low EQ-5D score (frequency 16.7 %) was associated with CABG after MI – OR 21.3 (95 % CI 2.2; 211.2) and the development of a one-year composite cardiovascular outcome – OR 3.4 (95 % CI 1.2; 9.1). In patients with MI, quantitative changes in the levels of psychological status indicators (depression, anxiety) and key quality of life parameters (health status according to the EQ-VAS scale and the summary weighted utility index EQ-5D) were not only interrelated with each other at the time of MI, but were also determined by factors preceding MI (social – income, family status, behavioral – acute stress); clinical features associated with MI (patient age at the time of the event, non-use of statins before MI, history of multifocal atherosclerosis, completeness of coronary revascularization in MI or CABG), and also reflected in the 1-year prognosis (development of a composite cardiovascular outcome). Conclusions . In patients with MI, significant associations were confirmed between quality of life and psychological status indicators and one-year prognosis, as well as social, behavioral, and clinical determinants.