Quality of life six months after myocardial infarction treated with thrombolytic therapy

OBJECTIVE: To assess and compare quality of life of patients six months after an acute myocardial infarction treated with one of two thrombolytic agents, streptokinase (SK) or recombinant tissue plasminogen activator (tPA). DESIGN: A cohort study of consecutive patients randomly allocated to thrombolytic therapy and treated in hospitals participating in the Australian arm of the International tPA/SK Mortality Trial (AUS-TASK). PATIENTS AND SETTING: 776 patients with acute myocardial infarction were asked to complete questionnaires at their follow-up clinic visit six months after the infarct. MAIN OUTCOME MEASURES: Two measures were used: (i) the York Health Measurement Questionnaire, which measures activities and distress and provides basic descriptors of quality of life; and (ii) a time trade-off question about the number of years a person would be willing to give up in exchange for returning to full health. RESULTS: The quality of life of the 714 respondents (92%) was generally high, with a mean index of 0.98. The five main areas causing distress were: lack of energy; breathlessness; anxiety; difficulty sleeping; and pain. In the time trade-off question, the mean number of years respondents were willing to forgo, out of 15 years, was 0.87 years; while 76% did not think it worthwhile to forgo any time. The 8% of patients who declined to answer the questionnaire were in significantly poorer health (New York Heart Association classification, P = 0.01; and Karnofsky index, P < 0.001). There were no significant differences in quality of life or time trade-off answers between patients allocated to streptokinase or tPA (P = 0.96 and 0.73, respectively). CONCLUSIONS: Quality of life six months after myocardial infarction is generally high, and most patients are able to return to normal activities. However, it is significantly impaired in a small group of patients, mainly those with a subsequent stroke or re-infarction. There was no significant difference in quality of life between those treated with tPA and those with streptokinase.