Quality of life of patients with chronic stable angina before and four years after coronary revascularisation compared with a normal population

Abstract

Objective: To assess the impact of coronary revascularisation on the health related quality of life (HRQOL) of patients with chronic stable angina compared with data from "community" norms four years following revascularisation.

Design: Prospective survey and review of medical records.

Setting: Seven of the eight public Swedish heart centres that performed coronary artery interventions.

Subjects: 827 patients aged 55-79 years with chronic stable angina who underwent coronary artery revascularisation in 1994 or 1995 and completed the four year HRQOL survey.

Main outcome measures: Five components of the Swedish quality of life survey.

Results: Compared with age and sex adjusted population norms, patients at baseline had significantly lower mean scores on all five functioning and wellbeing scales (p < 0.001). Four years after revascularisation, the mean levels of functioning and wellbeing were similar to those in the normative population (p > 0.05) except for quality of sleep (p < 0.001). The improvements were the same across age groups and for men and women. However, 36% of men and 55% of women were not completely free from angina by four years (p < 0.001). Men without angina after four years had better HRQOL than their community norms (p < 0.001) on all dimensions except quality of sleep (p > 0.05). Women without angina had less pain (p < 0.01) and better general health perception (p < 0.05) but similar physical functioning, quality of sleep, and emotional wellbeing compared with their community counterparts. Both men and women who had suffered at least one anginal attack during the preceding four weeks had significantly worse HRQOL by four years than their community norms (p < 0.01).

Conclusions: By four years following revascularisation, three fifths of patients with chronic stable angina were free of angina and their HRQOL was the same as or better than that of the general Swedish population. However, fewer than half of all women and two thirds of men who underwent revascularisation were angina-free after four years. Among patients with new or persistent angina, the HRQOL was worse than that in community norms.

Figure 1

Mean (95% confidence interval (CI)) Swedish quality of life survey (SWED-QUAL) scores at baseline and by four years for patients with chronic stable angina who had undergone coronary revascularisation compared with age and sex adjusted Swedish norms (minimum score is 0; maximum score is 100).

Figure 2

Mean (95% CI) SWED-QUAL scores for patients with chronic stable angina who had undergone coronary revascularisation and reported no angina at the four year follow up compared with age and sex adjusted Swedish norms (minimum score is 0; maximum score is 100).

Figure 3

Mean (95% CI) SWED-QUAL scores for patients with chronic stable angina who had undergone coronary revascularisation and reported angina at the four year follow up compared with age and sex adjusted Swedish norms (minimum score is 0; maximum score is 100).

Figure 4

Mean (95% CI) SWED-QUAL scores for patients with chronic stable angina who had undergone coronary revascularisation and reported no angina at the four year follow up compared with age adjusted Swedish norms, by sex (minimum score is 0; maximum score is 100).

Figure 5

Mean (95% CI) SWED-QUAL scores for patients with chronic stable angina who had undergone coronary revascularisation and reported angina at the four year follow up compared with age adjusted Swedish norms, by sex (minimum score is 0; maximum score is 100).