Sex differences in health-related quality of life trajectories following myocardial infarction: national longitudinal cohort study

Tatendashe Bernadette Dondo, Theresa Munyombwe, Marlous Hall, Ben Hurdus, Anzhela Soloveva, Gerard Oliver, Suleman Aktaa, Robert M West, Alistair S Hall, Chris P Gale, Tatendashe Bernadette Dondo, Theresa Munyombwe, Marlous Hall, Ben Hurdus, Anzhela Soloveva, Gerard Oliver, Suleman Aktaa, Robert M West, Alistair S Hall, Chris P Gale

Abstract

Objectives: To investigate sex-based differences in baseline values and longitudinal trajectories of health-related quality of life (HRQoL) in a large cohort of myocardial infarction (MI) survivors after adjusting for other important factors.

Design: Longitudinal cohort study.

Setting: Population-based longitudinal study the Evaluation of the Methods and Management of Acute Coronary Events study linked with national cardiovascular registry. Data were collected from 77 hospitals in England between 1 November 2011 and 24 June 2015.

Participants: 9551 patients with MI. Patients were eligible for the study if they were ≥18 years of age.

Primary and secondary outcome measures: HRQoL was measured by EuroQol five-dimension, visual analogue scale (EQ-5D, EQ VAS) survey at baseline, 1, 6 and 12 months after discharge. Multi-level linear and logistic regression models coupled with inverse probability weighted propensity scoring were used to evaluate sex differences in HRQoL following MI.

Results: Of the 9551 patients with MI and complete data on sex, 25.1% (2,397) were women. At baseline, women reported lower HRQoL (EQ VAS (mean (SD) 59.8 (20.4) vs 64.5 (20.9)) (median (IQR) 60.00 (50.00-75.00) vs 70.00 (50.00-80.00))) (EQ-5D (mean (SD) 0.66 (0.31) vs 0.74 (0.28)) (median (IQR) 0.73 (0.52-0.85) vs 0.81 (0.62-1.00))) and were more likely to report problems in each HRQoL domain compared with men. In the covariate balanced and adjusted multi-level model sex differences in HRQoL persisted during follow-up, with lower EQ VAS and EQ-5D scores in women compared with men (adjusted EQ VAS model sex coefficient: -4.41, 95% CI -5.16 to -3.66 and adjusted EQ-5D model sex coefficient: -0.07, 95% CI -0.08 to -0.06).

Conclusions: Women have lower HRQoL compared with men at baseline and during 12 months follow-up after MI. Tailored interventions for women following an MI could improve their quality of life.

Trial registration number: ClinicalTrials.gov (NCT04598048, NCT01808027, NCT01819103.

Keywords: coronary heart disease; epidemiology; myocardial infarction.

Conflict of interest statement

Competing interests: CG reports personal fees from AstraZeneca, personal fees from Bayer, personal fees from Boehringer Inglehiem, personal fees from Amgen, personal fees from Daiichi Sankyo, personal fees from Vifor Pharma, grants from Abbott, grants from BMS, outside the submitted work. BH reports grants from National Institute for Health Research (NIHR/CS/009/004) and British Heart foundation (PG/19/54/34511), during the conduct of the study. AH reports personal fees (speaker honorarium) from NOVARTIS & SERVIER. AS acknowledges funding received from the European Society of Cardiology in form of an ESC Research Grant.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
HRQoL trajectories following myocardial infarction by sex and UK general population. EQ-5D, EuroQol five dimension; EQ VAS, EuroQol visual analogue scale; HRQoL, health-related quality of life.
Figure 2
Figure 2
Health-related quality of life domains trajectories following myocardial infarction by sex.

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