Review Article |
Corresponding author: Irma Melyani Puspitasari ( irma.melyani@unpad.ac.id ) Academic editor: Rumiana Simeonova
© 2022 Febio Gutama, Melisa Intan Barliana, Irma Melyani Puspitasari.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Gutama F, Barliana MI, Puspitasari IM (2022) Factors associated with health-related quality of life in patients with coronary heart disease. Pharmacia 69(3): 771-777. https://doi.org/10.3897/pharmacia.69.e87279
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Coronary heart disease (CHD) contributes to decreased health-related quality of life (HRQOL). This review article investigates the factors that can affect the HRQOL in CHD patients. A literature search from PubMed and EBSCO databases was performed until March 2021 with predetermined keywords. The review of 15 included articles showed that many factors that can affect the HRQOL by using EQ-5D instrument in CHD patients, such as education, gender, comorbidity, percutaneous coronary intervention (PCI)/coronary artery bypass graft (CABG) intervention, patient-physician interaction, obesity, physical activity, numbers of medication, smoking, self-efficacy, social/family life, alcohol drinking, income, employment, and behavioral risk factor profile. The top three factors associated with HRQOL in CHD patients were education, gender, and comorbidity. Therefore, we should pay more attention to CHD patients with lower education levels, females, and comorbidity.
factors, health-related quality of life, coronary heart disease, EQ-5D
Coronary heart disease (CHD), also called ischemic heart disease or coronary artery disease, is the biggest killer globally, responsible for 16% of total deaths. Since 2000, the most significant increase in fatalities has been for this disease, rising by more than 2 million to 8.9 million deaths in 2019 (
CHD contributes to decreased health-related quality of life (HRQOL) (
In cardiovascular disease patients, recent study showed that poor HRQOL was influenced by older age, low household income, unemployment, limited activity, poor perceived health, and depression (
The literature search was performed using the PubMed dan EBSCO (Academic Search Complete and CINAHL Plus with Full Text) databases until March 2021. Search strategies included the use of the following terms: (“coronary artery disease” or “coronary heart disease” or “ischemic heart disease”) AND (“health-related quality of life” or “quality of life”) AND (factor or predictor) AND (EQ5D or EQ-5D) NOT Review. After that, articles were selected and filtered by inclusion criteria: English-language articles, papers published in the last ten years (2010–2020), and full text. Meanwhile, the exclusion criteria: are not original research and unrelated topic/outcome.
Fig.
Table
Authors | Site of Research | Number of Patients | Instrument |
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Global | 8968 | EQ-5D-3L |
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Palestine | 275 | EQ-5D-5L |
De Smedt et al. 2020 | Europe | 7567 | EQ-5D-5L |
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Hongkong | 1957 | EQ-5D-3L |
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Global | 1905 | EQ-5D-3L |
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Slovenia | 423 | EQ-5D-3L |
Zając et al. 2016 | Poland | 78 | EQ-5D |
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China | 1928 | EQ-5D-3L |
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Korea | 708 | EQ-5D-3L |
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Europe | 3775 | EQ-5D-3L |
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Europe | 8996 | EQ-5D |
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Germany | 290 | EQ-5D-3L |
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Europe | 3505 | EQ-5D-3L |
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Canada | 5362 | EQ-5D |
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Canada | 525 | EQ-5D-3L |
Table
Authors | Factors associated with HRQOL in patients | Outcome | Conclusion |
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PCI and CABG intervention | EQ-5D index score increased after patient got the intervention Improvement in EQ-5D index score in PCI group (baseline: 0.789)1 month: 0.09712 months: 0.08036 months: 0.097Improvement in EQ-5D index score in CABG group (baseline: 0.791)1 month: 0.01612 months: 0.08936 months: 0.085 | HRQOL improves after the intervention |
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Self-efficacy | Higher levels of self-efficacy (OR 1.10) associated with higher EQ-5D index score*Self-efficacy measured by SCSES (Sullivan’s Cardiac Self-Efficacy Scale) | Higher levels of efficacy predicted good HRQOL |
Patient-physician interaction | Good patient-physician interaction associated (OR 1.11) with higher EQ-5D index score*Patient-physician interaction measured by PEPPI-5 (5-item Perceived Efficacy in Patient-Physician) | Good patient-physician interaction predicted good HRQOL | |
Numbers of medication | EQ-5D index score decreased when patient had more higher numbers of medicationNumber of medications in OR1-3: Ref4-6: 0.54 ≥ 7: 0.23 | Higher numbers of medication predicted poor HRQOL | |
De Smedt et al. 2020 | Age | Older patients performed worse compared to younger patients on EQ-5D dimensions, except on the anxiety/depression dimension | Older age predicted poor HRQOL |
Gender | Females had worse outcomes compared to males on all EQ-5D dimensions | Female predicted poor HRQOL | |
Education | Lower educated patients reported more problems on EQ-5D dimensions compared to higher educated patients | Lower education predicted poor HRQOL | |
Behavioral risk factor profile (obesity, smoking, physical activity) | Patients with behavioral risk factors were more likely to have severe or extreme problems on EQ-5D dimensions | Behavioral risk factor profile predicted poor HRQOL | |
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Gender | Females had lower EQ-VAS score than males.The difference in EQ-VAS score on female patients was -8.32 compared to general population. Meanwhile, males score was -5.24 | Female predicted poor HRQOL |
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Age | Older patients had lower EQ-VAS score (coefficient β = -0.183) | Older age predicted poor HRQOL |
Gender | Females had lower EQ-VAS score (coefficient β = -2.878) | Female predicted poor HRQOL | |
Education | EQ-VAS score decreased when patient had lower education levelEducation level in coefficient βPrimary education: -0.2046Secondary education: RefHigh education: 0.2635 | Lower education level predicted poor HRQOL | |
Physical activity | Patients with lower physical activity (< 20 min, 3×/week) had lower EQ-VAS score (coefficient β = -4.384) | Lower physical activity predicted poor HRQOL | |
Smoking | Smoking had lower EQ-VAS score (coefficient β = -2.062) | Smoking predicted poor HRQOL | |
Body weight (Central Obesity) | Central obesity had lower EQ-VAS score (coefficient β = -1.887) | Central obesity predicted poor HRQOL | |
Comorbidity (Diabetes) | EQ-VAS score decreased when patients had diabetes (coefficient β = -2.911) | Diabetes predicted poor HRQOL | |
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Gender | Females had lower EQ-VAS score (coefficient = -6.45) | Female predicted poor HRQOL |
Education | Higher education had higher EQ-VAS score (coefficient = 3.33) | Higher education predicted good HRQOL | |
Employed | Unemployed patients had lower EQ-VAS score (coefficient = -3.73) | Not having employment predicted poor HRQOL | |
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Age | Older patients had lower EQ-5D index score (coefficient = -0.004) | Older age predicted poor HRQOL |
Gender | Females had lower EQ-5D index score (coefficient = -0.039) | Female predicted poor HRQOL | |
Education | Lower education level had lower EQ-5D index score (coefficient = -0.016) | Lower education level predicted poor HRQOL | |
Comorbidity (Stroke, Noncardiovascular disease) | Patients with stroke had lower EQ-5D index score (coefficient β = -0.080) and lower EQ-VAS score (coefficient = -5.113)Patient with noncardiovascular disease had lower EQ-5D index score (coefficient = -0.051) | Stroke and noncardiovascular disease predicted poor HRQOL | |
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Comorbidity (Diabetes) | Patients with diabetes had lower EQ-5D index score (0.82) than those without diabetes (0.86) | Diabetes predicted poor HRQOL |
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Body weight (Obesity) | Patients with obesity had lower EQ-5D index scoreEQ-5D index score between groups Normal: 0.890Overweight: 0.887Mild obesity: 0.871Moderate obesity: 0.869Severe obesity: 0.852 | Obesity predicted poor HRQOL |
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Patient-physician relationship | Good medication adherence had higher EQ-5D index score (coefficient = 0.0195)More positive evaluations of physician’s clinical behavior had higher EQ-5D index score (coefficient = 0.0282) Good medication adherence is influenced by interaction between patient and physician.Good evaluation is indicating a good patient-physician relationship | Good patient-physician interaction associated with higher HRQOL |
Gender | Female had lower EQ-5D score (coefficient = -0.0543) | Female predicted poor HRQOL | |
Education | Lower education (≤ 9 years in school) had lower EQ-5D score (coefficient = -0.0381) | Lower education level predicted poor HRQOL | |
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Comorbidity (heart failure, peripheral artery disease) | Patients with heart failure disease had lower EQ-5D index score level (OR = 0.45) and lower EQ-VAS score (coefficient = -6.27)Patients with peripheral artery disease had lower EQ-5D index score level (OR = 0.32) | Heart failure and peripheral artery disease predicted poor HRQOL |
Family physician visit frequency | Higher physician visit frequency had lower EQ-5D index score level (OR = 0.62) and lower EQ-VAS score (coefficient = -2.98) | Higher physician visit frequency predicted poor HRQOL | |
Education | Higher years of education had higher EQ-5D index score level (OR = 1.85) | Higher years of education predicted good HRQOL | |
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Age | Older patients had lower EQ-5D index score (coefficient = -0.017) | Older age predicted poor HRQOL |
Comorbidity (diabetes, stroke) | Patients with diabetes had lower EQ-VAS (coefficient = -3.709)Patients with stroke had lower EQ-VAS (coefficient = -3.082) | Diabetes and stroke predicted poor HRQOL | |
Body weight | Patients with obesity had more problems on mobility dimension (OR = 1.632) and pain/discomfort dimension (OR = 1.633). | Obesity predicted poor HRQOL | |
House hold income | Patients with higher household income had higher EQ-5D index score (coefficient = 0.012) | Higher household income predicted good HRQOL | |
Social/family life (Family population, Marital status) | Patients with higher family population had higher EQ-5D index score (coefficient = 0.013) and higher EQ-VAS score (coefficient = 2.150)Married patients had higher EQ-VAS index score (coefficient = 2.597) | Big family and being married predicted good HRQOL | |
Smoking | Smoking had more problems on mobility dimension (OR = 1.983), self-care (OR = 2.592), usual activities (OR = 2.613) and pain/discomfort dimension (OR = 1.971) | Smoking predicted poor HRQOL | |
Alcohol drinking | Alcohol drinking had higher EQ-5D index score (coefficient = 0.012) and higher EQ-VAS score (coefficient = 1.581) | Alcohol drinking predicted good HRQOL | |
Physical activity | Higher physical activity had higher EQ-5D index score (coefficient = 0.021) and higher EQ-VAS score (coefficient = 3.104) | Higher physical activity predicted good HRQOL | |
Education | High education had less problems on self-care (OR = 0.575) | High education predicted good HRQOL | |
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Revascularization (CABG/ PCI intervention) | Patients with revascularization had EQ-5D index score improvement (from 0.741 into 0.882) after 1-year measurement | Revascularization predicted good HRQOL |
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PCI intervention | Patients with PCI intervention had EQ-VAS score improvement after 36 months measurementEQ VAS score between group1. Age group < 65 yearsBaseline: 50.16 months: 71.212 months: 71.236 months: 72.92. Age group 65–74 yearsBaseline: 51.66 months: 70.912 months: 71.136 months: 72.82. Age group > 74 yearsBaseline: 52.66 months: 70.512 months: 71.236 months: 72 | PCI intervention predicted good HRQOL |
Zając et al. 2016 | PCI intervention | PCI in patients after previous CABG improved HRQOL in 1-year measurementPCI SVG groupEQ-5D index score increased from 0.66 into 0.70EQ-VAS score increased from 64.7 into 69.3PCI NA groupEQ-5D index score increased from 0.65 into 0.72EQ-VAS score increased from 64.4 into 70.5Control groupEQ-5D index score increased from 0.66 into 0.67EQ-VAS score increased from 64.1 into 64.9 | PCI intervention predicted good HRQOL |
After we collected the outcomes from all included articles, we identified factors associated with HRQOL in patients with CHD described below:
Seven of 15 included articles identified higher education as a factor that improved HRQOL in CHD patients. EQ-5D index score was higher in higher education patients.
Based on six articles, females had worse HRQOL in CHD patients. Compared to the males, female patients generally had more problems in all EQ-5D dimensions. Female patients also had lower EQ-5D index scores and EQ-VAS. EQ-5D index score could be lower than 0.0543 in female patients, according to
Five articles showed comorbidity associated with worse HRQOL in CHD patients. Three of them studied diabetes. According to
Four articles found that older age was associated with poor HRQOL in CHD patients. Older patients, in general, gave worse results on all EQ-5D dimensions than younger patients, except for the anxiety/depression dimension.
Four articles stated that percutaneous coronary intervention (PCI)/coronary artery bypass graft (CABG) intervention could improve HRQOL in CHD patients.
In 3 articles, obesity was positively associated with poor HRQOL in CHD patients. Orepoulos et al. (2010) observed that obese patients had lower EQ-5D index scores than regular patients. De Smedth et al. (2013) showed that patients with central obesity could decrease their EQ-VAS score by 1.887 compared to patients without central obesity.
Three articles showed that interaction between CHD patients and their physicians could affect patients’ HRQOL.
Two articles showed that physical activity was positively associated with good HRQOL. According to
Two articles showed that smoking was positively associated with poor HRQOL.
De Smedt et al. (2020) showed that patients’ poor behavioral risk factor profile (obesity, smoking, physical activity) was likely to have severe/extreme problems on EQ-5D dimensions.
Based on 15 included articles, the top three factors associated with HRQOL in CHD patients were education, gender, and comorbidity. Therefore, we should pay more attention to CHD patients with lower education levels, females, and comorbidity. Additionally, other factors are also no less important (such as age, PCI/CABG Intervention, patient-physician interaction, obesity, physical activity, numbers of medication, smoking, self-efficacy, social/family life, alcohol drinking, income, employment, and behavioral risk factor profile that need to be considered in strategy and effort to improve the HRQOL patients.