Coronary heart disease patients live longer, but not always happier, lives

July 14, 2008

Better treatments have improved survival in people with coronary heart disease, but the quality of those extra years may be less than ideal, according to research reported in Circulation: Journal of the American Heart Association.

Compared with adults without coronary heart disease (CHD), adults with CHD scored up to 9 percent lower on four scales measuring "quality of life." Patients with coronary heart disease were more likely to say they had poorer quality of life, or describe themselves as sick, said lead author Jipan Xie, M.D., Ph.D., former health scientist in the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention in Atlanta, Ga.

Quality of life, which includes physical functioning, psychological functioning, social functioning, overall life satisfaction, and perceptions of health status, can be used to measure effectiveness of treatment and predict the long-term mortality after a cardiac event.

Those most likely to report poorer quality of life in this study were:

-- age 18 to 49;
-- women; and
-- black or Hispanic.

The age-related difference, Xie said, probably reflects a difference in age-related expectations.

"Younger people may feel more pressure — especially younger men — in the workplace and may be more threatened by limitations imposed by their disease," she said.

Older people, especially those who were older than 65, were less likely to say heart disease limited their life or had an adverse effect on their quality of life.

"The implications of these findings underscore the need for interventions aimed at improved health-related quality of life for people with coronary heart disease — a population that has been growing rapidly," she said.

With limited resources, such interventions should be targeted at those populations revealed to be most vulnerable – younger adults, women, blacks and Hispanics, she said.

Xie said the success of interventions to reduce CHD risk and death has set the stage for the challenge of survivorship, in which large numbers of people are living with CHD. For example, she suggested educational efforts aimed at employers to help fashion work environments that would better accommodate employees with heart disease.

About 16 million people in the United States have coronary heart disease, according to the American Heart Association.

The analysis, which used data from the 2000 and 2002 Medical Expenditure Panel Surveys, identified 2,091 people with a history of coronary heart disease from a sample of 37,386 individuals. Researchers say it is the first comparison of quality of life scores between CHD patients and non-CHD patients on a national scale.

On average, CHD patients had 2.4 percent lower mental health scores; 4.6 percent lower health utility scores – which measured mobility, self-care, usual activity, pain and anxiety; 9 percent lower self-ratings of health; and 9.2 percent lower physical health scores.

Researchers noted that men and women with heart disease rated lower on the mental health measure than did participants free of CHD. Yet, while self-rated health scores indicated that men were more affected by CHD than women, physical health scores indicated women with heart disease had more functional impairment than men. Xie said contradictory findings are fairly common in these types of analyses, but the findings suggest a disconnect between self-perception and functional ability.

Researchers said the study is limited because the disease status was self-reported and patients had various stages of CHD and treatments. In addition, there was not enough information to explain the differences in patient-reported health status among demographic subgroups.

Source: American Heart Association