Association of cardiac rehabilitation and health-related quality of life following acute myocardial infarction

Ben Hurdus, Theresa Munyombwe, Tatendashe Bernadette Dondo, Suleman Aktaa, Gerrard Oliver, Marlous Hall, Patrick Doherty, Alistair S Hall, Chris P Gale, Ben Hurdus, Theresa Munyombwe, Tatendashe Bernadette Dondo, Suleman Aktaa, Gerrard Oliver, Marlous Hall, Patrick Doherty, Alistair S Hall, Chris P Gale

Abstract

Objective: To study the association of cardiac rehabilitation and physical activity with temporal changes in health-related quality of life (HRQoL) following acute myocardial infarction (AMI).

Methods: Evaluation of the Methods and Management of Acute Coronary Events-3 is a nationwide longitudinal prospective cohort study of 4570 patients admitted with an AMI between 1 November 2011 and 17 September 2013. HRQoL was estimated using EuroQol 5-Dimension-3 Level Questionnaire at hospitalisation, 30 days, and 6 and 12 months following hospital discharge. The association of cardiac rehabilitation and self-reported physical activity on temporal changes in HRQoL was quantified using inverse probability of treatment weighting propensity score and multilevel regression analyses.

Results: Cardiac rehabilitation attendees had higher HRQoL scores than non-attendees at 30 days (mean EuroQol 5-Visual Analogue Scale (EQ-VAS) scores: 71.0 (SD 16.8) vs 68.6 (SD 19.8)), 6 months (76.0 (SD 16.4) vs 70.2 (SD 19.0)) and 12 months (76.9 (SD 16.8) vs 70.4 (SD 20.4)). Attendees who were physically active ≥150 min/week had higher HRQoL scores compared with those who only attended cardiac rehabilitation at 30 days (mean EQ-VAS scores: 79.3 (SD 14.6) vs 70.2 (SD 17.0)), 6 months (82.2 (SD 13.9) vs 74.9 (SD 16.7)) and 12 months (84.1 (SD 12.1) vs 75.6 (SD 17.0)). Cardiac rehabilitation and self-reported physical activity of ≥150 min/week were each positively associated with temporal improvements in HRQoL (coefficient: 2.12 (95% CI 0.68 to 3.55) and 4.75 (95% CI 3.16 to 6.34), respectively).

Conclusions: Cardiac rehabilitation was independently associated with temporal improvements in HRQoL at up to 12 months following hospitalisation, with such changes further improved in patients who were physically active.

Trial registration: ClinicalTrials.gov NCT01808027.

Keywords: acute coronary syndromes; cardiac rehabilitation; cardiac risk factors and prevention; quality and outcomes of care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Proportion of patients with acute myocardial infarction who reported ≥1 problem across all of the EuroQol 5-Dimension domains at baseline, 30 days, and 6 and 12 months of follow-up. UK national average included.
Figure 2
Figure 2
Health-related quality of life trajectories of patients with acute myocardial infarction according to their attendance at cardiac rehabilitation and/or self-reported physical activity of ≥150 min/week.
Figure 3
Figure 3
Results of the imputed propensity score weighted multi-level modelling of the association of cardiac rehabilitation and change in EQ-VAS following AMI (regression coefficients, 95% confidence intervals). ACEi, ACE inhibitor; AMI, acute myocardial infarction; BMI, Body Mass Index; CABG, coronary artery bypass graft; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; EQ-5D VAS, EuroQol 5-dimension Visual Analogue Scale; IMD, Index of Multiple Deprivation; PCI, percutaneous coronary intervention; NSTEMI, non-ST-elevation myocardial infarction.

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