Quality of life in patients with ischaemic heart disease: a prospective controlled study

OBJECTIVES: To assess quality of life in patients after acute myocardial infarction (AMI), coronary artery by-pass grafting surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) as compared with healthy controls. DESIGN: Self-administered questionnaires were completed 1 month and 1 year after the event. SETTING: Department of Cardiology, University Hospital, Malmö, Sweden; 1989-1992. SUBJECTS: 296 AMI, 99 CABG, 18 PTCA patients and 88 randomly selected healthy controls were included; 349 patients completed the entire programme. MAIN OUTCOME MEASURES: Quality of life in the dimensions of perceived general health, thoracic pain, breathlessness, feeling of arrhythmia, anxiety, depression, self-esteem, experience of social life and sex life. RESULTS: Patients differed from controls in both psychological and somatic aspects of QL after 1 month. Furthermore, 1 month after the event AMI patients experienced more anxiety (P = 0.001) than CABG patients, whilst CABG patients experienced a poorer sex life (P < 0.001) than AMI patients. One year after the event patients differed from controls primarily in somatic symptoms: no significant differences were found across patient groups. Patients who sought emergency out-patient care during the follow-up year for clinically diagnosed angina pectoris or cardiac incompensation had reported higher levels of thoracic pain (P < 0.001) and breathlessness (P < 0.001) at 1 month follow-up than patients who did not seek such care. CONCLUSIONS: Quality of life is considerably affected in patients following a cardiac event, especially during the initial recovery phase. Although substantial improvement in quality of life occurs over time, the persistence of residual distress at 1-year follow-up is a challenge for clinicians concerned with the full rehabilitation of the cardiac patient.