Gender differences in health-related quality of life in patients undergoing coronary angiography

Crystel M Gijsberts, Pierfrancesco Agostoni, Imo E Hoefer, Folkert W Asselbergs, Gerard Pasterkamp, Hendrik Nathoe, Yolande E Appelman, Dominique P V de Kleijn, Hester M den Ruijter, Crystel M Gijsberts, Pierfrancesco Agostoni, Imo E Hoefer, Folkert W Asselbergs, Gerard Pasterkamp, Hendrik Nathoe, Yolande E Appelman, Dominique P V de Kleijn, Hester M den Ruijter

Abstract

Background: Health-related quality of life (HRQOL) reflects the general well-being of individuals. In patients with coronary artery disease (CAD), HRQOL is compromised. Female patients with CAD have been reported to have lower HRQOL. In this study, we investigate gender differences in HRQOL and in associations of patient characteristics with HRQOL in patients with coronary angiography (CAG).

Methods: We cross-sectionally analysed patients from the Utrecht Coronary Biobank undergoing CAG. All patients filled in an HRQOL questionnaire (RAND-36 and EuroQoL) on inclusion. RAND-36 and EuroQoL HRQOL measures were compared between the genders across indications for CAG, CAD severity and treatment of CAD. RAND-36 HRQOL measures were compared with the general Dutch population. Additionally, we assessed interactions of gender with patient characteristics in their association with HRQOL (EuroQoL).

Results: We included 1421 patients (1020 men and 401 women) with a mean age of 65 in our analysis. Women reported lower HRQOL measures than men (mean EuroQoL self-rated health grade 6.84±1.49 in men, 6.46±1.40 in women, p<0.001). The reduction in RAND-36 HRQOL as compared with the general Dutch population was larger in women than in men. From regression analysis, we found that diabetes, a history of cardiovascular disease and symptoms of shortness of breath determined HRQOL (EuroQoL) more strongly in men than in women.

Conclusions: Women reported lower HRQOL than men throughout all indications for CAG and regardless of CAD severity or treatment. As compared with the general population, the reduction in HRQOL was more extreme in women than in men. Evident gender differences were found in determinants of HRQOL in patients undergoing CAG, which deserve attention in future research.

Trial registration: NCT02304744 (clinicaltrials.gov).

Keywords: CORONARY ARTERY DISEASE; QUALITY OF CARE AND OUTCOMES.

Figures

Figure 1
Figure 1
Flow chart of patient recruitment and selection process.

References

    1. Harrison PL, Pope JE, Coberley CR et al. . Evaluation of the relationship between individual well-being and future health care utilization and cost. Popul Health Manag 2012;15:325–30. 10.1089/pop.2011.0089
    1. Marquis P, Caron M, Emery MP et al. . The role of health-related quality of life data in the drug approval processes in the US and Europe: a review of guidance documents and authorizations of medicinal products from 2006 to 2010. Pharmaceut Med 2011;25:147–60.
    1. Hlatky MA, Chung SC, Escobedo J et al. . The effect of obesity on quality of life in patients with diabetes and coronary artery disease. Am Heart J 2010;159:292–300. 10.1016/j.ahj.2009.11.004
    1. Oreopoulos A, Padwal R, McAlister FA et al. . Association between obesity and health-related quality of life in patients with coronary artery disease. Int J Obes (Lond) 2010;34:1434–41. 10.1038/ijo.2010.73
    1. Uchmanowicz I, Loboz-Grudzien K, Jankowska-Polanska B et al. . Influence of diabetes on health-related quality of life results in patients with acute coronary syndrome treated with coronary angioplasty. Acta Diabetol 2013;50:217–25. 10.1007/s00592-011-0280-2
    1. Stafford L, Berk M, Jackson HJ. Tobacco smoking predicts depression and poorer quality of life in heart disease. BMC Cardiovasc Disord 2013;13:35 10.1186/1471-2261-13-35
    1. Müller-Nordhorn J, Muckelbauer R, Englert H et al. . Longitudinal association between body mass index and health-related quality of life. PLoS ONE 2014;9:e93071 10.1371/journal.pone.0093071
    1. Al Hayek AA, Robert AA, Al Saeed A et al. . Factors associated with health-related quality of life among Saudi patients with type 2 diabetes mellitus: a cross-sectional survey. Diabetes Metab J 2014;38:220–9. 10.4093/dmj.2014.38.3.220
    1. Coste J, Quinquis L, D'Almeida S et al. . Smoking and health-related quality of life in the general population. Independent relationships and large differences according to patterns and quantity of smoking and to gender. PLoS ONE 2014;9:e91562 10.1371/journal.pone.0091562
    1. Mendis S, Puska P, Norrving B. Global Atlas on cardiovascular disease prevention and control. Geneva: WHO, 2011.
    1. Jacobs AK. Coronary intervention in 2009: are women no different than men? Circ Cardiovasc Interv 2009;2:69–78. 10.1161/CIRCINTERVENTIONS.108.847954
    1. Hemingway H, Langenberg C, Damant J et al. . Prevalence of angina in women versus men: a systematic review and meta-analysis of international variations across 31 countries. Circulation 2008;117:1526–36. 10.1161/CIRCULATIONAHA.107.720953
    1. Bruins Slot MH, Rutten FH, van der Heijden GJ et al. . Gender differences in pre-hospital time delay and symptom presentation in patients suspected of acute coronary syndrome in primary care. Fam Pract 2012;29:332–7. 10.1093/fampra/cmr089
    1. Kaul P, Armstrong PW, Sookram S et al. . Temporal trends in patient and treatment delay among men and women presenting with ST-elevation myocardial infarction. Am Heart J 2011;161:91–7. 10.1016/j.ahj.2010.09.016
    1. Norris CM, Spertus JA, Jensen L et al. . Sex and gender discrepancies in health-related quality of life outcomes among patients with established coronary artery disease. Circ Cardiovasc Qual Outcomes 2008;1:123–30. 10.1161/CIRCOUTCOMES.108.793448
    1. Bakhai A, Ferrières J, James S et al. . Treatment, outcomes, costs, and quality of life of women and men with acute coronary syndromes who have undergone percutaneous coronary intervention: results from the antiplatelet therapy observational registry. Postgrad Med 2013;125:100–7. 10.3810/pgm.2013.03.2644
    1. Kendel F, Dunkel A, Müller-Tasch T et al. . Gender differences in health-related quality of life after coronary bypass surgery: results from a 1-year follow-up in propensity-matched men and women. Psychosom Med 2011;73:280–5. 10.1097/PSY.0b013e3182114d35
    1. VanderZee KI, Sanderman R, Heyink JW et al. . Psychometric qualities of the RAND 36-Item Health Survey 1.0: a multidimensional measure of general health status. Int J Behav Med 1996;3: 104–22. 10.1207/s15327558ijbm0302_2
    1. EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990;16:220–33.
    1. Rose GA, Blackburn H. Cardiovascular survey methods. Geneva, Switzerland: World Health Organization (Sales agent for UK., H. M. Stationery Office), 1968.
    1. Van der Zee KI, Sanderman R. Het meten van de algemene gezondheidstoestand met de RAND-36: een handleiding. Rijksuniversiteit, Groningen, 1993:28 ISBN: 90-72156-60-9
    1. Groningen RU. SYNTAX file RAND-36 V1. tools/syntax_file_rand-36_v1_withoutaggregatescores.pdf.
    1. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria: 2013. ISBN 3-900051-07-0, URL
    1. Martin LM, Holmes SD, Henry LL et al. . Health-related quality of life after coronary artery bypass grafting surgery and the role of gender. Cardiovasc Revasc Med 2012;13:321–7. 10.1016/j.carrev.2012.09.002
    1. Hess R, Thurston RC, Hays RD et al. . The impact of menopause on health-related quality of life: results from the STRIDE longitudinal study. Qual Life Res 2012;21:535–44. 10.1007/s11136-011-9959-7
    1. Degroote S, Vogelaers DP, Vermeir P et al. . Socio-economic, behavioural, (neuro)psychological and clinical determinants of HRQoL in people living with HIV in Belgium: a pilot study. J Int AIDS Soc 2013;16:18643 10.7448/IAS.16.1.18643
    1. Murthy VL, Naya M, Taqueti VR et al. . Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation 2014;129:2518–27. 10.1161/CIRCULATIONAHA.113.008507
    1. Pries AR, Habazettl H, Ambrosio G et al. . A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings. Cardiovasc Res 2008;80:165–74. 10.1093/cvr/cvn136
    1. Shaw LJ, Bugiardini R, Merz CNB. Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol 2009;54:1561–75. 10.1016/j.jacc.2009.04.098
    1. Bugiardini R, Bairey Merz CN. Angina with ‘normal’ coronary arteries: a changing philosophy. JAMA 2005;293:477–84. 10.1001/jama.293.4.477
    1. Gulati M, Cooper-DeHoff RM, McClure C et al. . Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women's Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med 2009;169:843–50. 10.1001/archinternmed.2009.50
    1. Banks K, Lo M, Khera A. Angina in women without obstructive coronary artery disease. Curr Cardiol Rev 2010;6:71–81. 10.2174/157340310790231608
    1. Cox DJ. Blood glucose awareness training: what is it, where is it, and where is it going? Diabetes Spectr 2006;19:43–9. 10.2337/diaspect.19.1.43
    1. Montalescot G, Sechtem U, Achenbach S et al. . 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949–3003. 10.1093/eurheartj/eht310.P4876
    1. Shaw LJ, Bairey Merz CN, Pepine CJ et al. . Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) study: part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol 2006;47:S4–20. 10.1016/j.jacc.2005.01.072
    1. Lanza GA, Parrinello R, Figliozzi S. Management of microvascular angina pectoris. Am J Cardiovasc Drugs 2014;14:31–40. 10.1007/s40256-013-0052-1

Source: PubMed

3
Iratkozz fel