Quality of life at six months after primary percutaneous coronary intervention performed at a predominantly rural population

Syed Fayaz Mujtaba, Jawaid Akbar Sial, Sajid Ali Shaikh, Muhammad Naeem, Imran Soomro, Musa Karim, Kiran Abbas, Moiz Ahmed, Kanza Abid Hussain


Background: HRQL is important in improving the quality of patient care. However, there is a paucity of data from low-income and middle-income countries (LMIC). Differences in socio-demographics and socio-cultural contexts may influence HRQOL. Therefore, this research was designed with the aim to explore the HRQOL in patients after Percutaneous Coronary Intervention (PCI).

Objective: The goal of the study was to evaluate the quality of life after six months of Percutaneous Coronary Intervention using HeartQol questionnaire at a tertiary care hospital in Pakistan.

Method: This was a Cross-sectional, descriptive study. Patients between the ages of 20-60 years who underwent primary Percutaneous Coronary Intervention at least 6 months ago were inducted in the study. Coronary angiography was performed mostly through radial as preferred route. Data was collected using a structured questionnaire covering demographic characteristics, predisposing risk factors, procedural details, and quality of life. Heart related Quality of life was assessed using HeartQol questionnaire. Collected data was analyzed using SPSS v.21.

Results: A total of 241 patients participated in the study. Mean age of the patients was 53.37±11.07 years.  On analysis of quality of life at six months, the median (IQR) HeartQol score was 31 (37-23) with majority of the patients, 84.22% (203) fall under the excellent score (>20).

Conclusion: It is of enormous prognostic importance that the quality of life of patient is assessed on a regular basis after PCI. Our study shows that the majority of patients had improved quality of life at six months of PCI. Majority of patients were not bothered by mild symptoms. Further investigation needs to be done to validate these results.


Keywords: Cardiovascular, HeartQol, Percutaneous Coronary Intervention

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Gierlaszyńska K, Pudlo R, Jaworska I, Byrczek-Godula K, Gąsior M. Tools for assessing quality of life in cardiology and cardiac surgery. Kardiochirurgia i torakochirurgia polska= Polish J cardio-thoracic surg. 2016 Mar;13(1):78.

Black N. Patient reported outcome measures could help transform healthcare. BMJ. 2013;346:f167.

Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014;71(4):522-54.

McNamara RL, Spatz ES, Kelley TA, Stowell CJ, Beltrame J, Heidenreich P, et al. Standardized outcome measurement for patients with coronary artery disease: consensus from the International Consortium for Health Outcomes Measurement (ICHOM). J Am Heart Assoc. 2015 May 19;4(5):e001767.

Oldridge N, Höfer S, McGee H, Conroy R, Doyle F, Saner H, et al. The HeartQoL: Part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol. 2014 Jan;21(1):90-7.

Oldridge N, Höfer S, McGee H, Conroy R, Doyle F, Saner H, et al. The HeartQoL: part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol. 2014 Jan;21(1):98-106.

De Smedt D, Clays E, Höfer S, Oldridge N, Kotseva K, Maggioni AP, et al. Validity and reliability of the HeartQoL questionnaire in a large sample of stable coronary patients: The EUROASPIRE IV Study of the European Society of Cardiology. Eur J Prev Cardiol. 2016 May;23(7):714-21.

Zangger G, Zwisler A-D, Kikkenborg Berg S, Kristensen MS, Grønset CN, Uddin J, et al. Psychometric properties of HeartQoL, a core heart disease-specific health-related quality of life questionnaire, in Danish implantable cardioverter defibrillator recipients. Eur J Prev Cardiol. 2018;25(2):142-9.

Kristensen MS, Zwisler A-D, Berg SK, Zangger G, Grønset CN, Risom SS, et al. Validating the HeartQoL questionnaire in patients with atrial fibrillation. Eur J Prev Cardiol. 2016;23(14):1496-503

Chamberlain DA, Fox KA, Henderson RA, Julian DG. Coronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial. The Lancet. 1997 Aug 16;350(9076):461-8.

Pitt B, Waters D, Brown WV, van Boven AJ, Schwartz L, Title LM. et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med. 1999;341(2):70-6.

Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003 Jan 4;361(9351):13-20.

Pinto DS, Kirtane AJ, Nallamothu BK, Murphy S, Cohen DJ, aham J, et al. Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation.2006;114(19):2019-25.

Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation. Eur Heart J. 2012;33(20):2569-619.

Stone GW, Grines CL, Rothbaum D, Browne KF, O’Keefe J, Overlie PA, Donohue BC, et al. Analysis of the relative costs and effectiveness of primary angioplasty versus tissue-type plasminogen activator: The Primary Angioplasty in Myocardial Infarction (PAMI) trial. The PAMI Trial Investigators. J Am Coll Cardiol. 1997;29(5):901-7.

Mortensen OS, Bjorner JB, Oldenburg B, Newman B, Groenvold M, Madsen JK, et al. Health-related quality of life one month after thrombolysis or primary PCI in patients with ST-elevation infarction. A DANAMI-2 sub-study. Scand. Cardiovasc. J. 2005 Sep;39(4):206-12.

Mortensen OS, Bjorner JB, Newman B, Oldenburg B, Groenvold M, Madsen JK, et al. Gender differences in health-related quality of life following ST-elevation myocardial infarction: women and men do not benefit from primary percutaneous coronary intervention to the same degree. Eur J Cardiovasc Prev Rehabil. 2007 Feb;14(1):37-43.

Pancholy SB, Shantha GPS, Patel T, Cheskin LJ. Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention: a meta-analysis. JAMA Intern Med. 2014 Nov;174(11):1822-30.

Laufer-Perl M, Shacham Y, Letourneau-Shesaf S, Priesler O, Keren G, Roth A, et al. Gender-related mortality and in-hospital complications following ST-segment elevation myocardial infarction: data from a primary percutaneous coronary intervention cohort. Clin Cardiol. 2015 Mar;38(3):145-9.

Holubkov R, Laskey WK, Haviland A, Slater JC, Bourassa MG, Vlachos HA, et al, NHLBI Dynamic Registry Investigators. Angina 1 year after percutaneous coronary intervention: A report from the NHLBI Dynamic Registry. Am Heart J 2002;144:826-33.

Mrdovic I, Savic L, Asanin M, Cvetinovic N, Brdar N, Djuricic N, et al. Sex-related analysis of short- and long-term clinical outcomes and bleeding among patients treated with primary percutaneous coronary intervention: an evaluation of the RISK-PCI data. Can J Cardiol. 2013 Sep;29(9):1097-103.

Yazdani-Bakhsh R, Javanbakht M, Sadeghi M, Mashayekhi A, Ghaderi H, Rabiei K. Comparison of health-related quality of life after percutaneous coronary intervention and coronary artery bypass surgery. ARYA Atheroscler. 2016 May;12(3):124-31.

Luttik ML, Jaarsma T, Veeger N, van Veldhuisen DJ. Marital status, quality of life, and clinical outcome in patients with heart failure. Heart Lung. 2006;35(1):3–8.

Lukkarinen H, Hentinen M. Assessment of quality of life with the Nottingham Health Profile among patients with coronary heart disease. J Adv Nurs. 1997;26(1):73-84.

Stein B, Weintraub WS, Gebhart SS, Cohen-Bernstein CL, Grosswald R, Liberman HA, et al. Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty. Circulation 1995Feb;91(4):979-89.

Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, et al. Development and evaluation of the Seattle Angina Questionnaire: A new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995;25(2):333-41.

Thompson DR, Jenkinson C, Roebuck A, Lewin RJ, Boyle RM, Chandola T. Development and validation of a short measure of health status for individuals with acute myocardial infarction: The myocardial infarction dimensional assessment scale (MIDAS). Qual Life Res. 2002;11(6):535-43.

Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997;35:1095-108.

Durmaz T, Ozdemir O, Ozdemir BA, Keles T, Bayram NA, Bozkurt E. Factors affecting the quality of life in patients with coronary heart disease. Turkish J Med Sci. 2009;39(3):343-51.

Rinfret S, Grines CL, Cosgrove RS, Ho KK, Cox DA, Brodie BR, et al. Quality of life after balloon angioplasty or stenting for acute myocardial infarction. One-year results from the Stent-PAMI trial. J Am Coll Cardiol. 2001;38(6):1614-21.