Quality of life trajectories in survivors of acute myocardial infarction: a national longitudinal study

Aim: To define trajectories of perceived health-related quality of life (HRQoL) among survivors of acute myocardial infarction (AMI) and identify factors associated with trajectories.

Methods: Data on HRQoL among 9566 survivors of AMI were collected from 77 National Health Service hospitals in England between 1 November 2011 and 24 June 2015. Longitudinal HRQoL was collected using the EuroQol five-dimension questionnaire measured at hospitalisation, 1, 6 and 12 months post-AMI. Trajectories of perceived HRQoL post-MI were determined using multilevel regression analysis and latent class growth analysis (LCGA).

Results: One or more percieved health problems in mobility, self-care, usual activities, pain/discomfort and anxiety/depression was reported by 69.1% (6607/9566) at hospitalisation and 59.7% (3011/5047) at 12 months. Reduced HRQoL was associated with women (−4.07, 95% CI −4.88 to −3.25), diabetes (−2.87, 95% CI −3.87 to −1.88), previous AMI (−1.60, 95% CI −2.72 to −0.48), previous angina (−1.72, 95% CI −2.77 to −0.67), chronic renal failure (−2.96, 95% CI −5.08 to −0.84; −3.10, 95% CI −5.72 to −0.49), chronic obstructive pulmonary disease (−3.89, 95% CI −5.07 to −2.72) and cerebrovascular disease (−2.60, 95% CI −4.24 to −0.96). LCGA identified three subgroups of HRQoL which we labelled: improvers (68.1%), non-improvers (22.1%) and dis-improvers (9.8%). Non-improvers and dis-improvers were more likely to be women, non-ST-elevation myocardial infarction (NSTEMI) and have long-term health conditions, compared with improvers.

Conclusions: Quality of life improves for the majority of survivors of AMI but is significantly worse and more likely to decline for women, NSTEMI and those with long-term health conditions. Assessing HRQoL both in hospital and postdischarge may be important in determining which patients could benefit from tailored interventions.

Trial registration: NCT01808027 and NCT01819103