Self-Reported Health and Outcomes in Patients With Stable Coronary Heart Disease

Ralph A H Stewart, Emil Hagström, Claes Held, Tom Kai Ming Wang, Paul W Armstrong, Philip E Aylward, Christopher P Cannon, Wolfgang Koenig, José Luis López-Sendón, Emile R Mohler 3rd, Nermin Hadziosmanovic, Susan Krug-Gourley, Marco Antonio Ramos Corrales, Saulat Siddique, Philippe Gabriel Steg, Harvey D White, Lars Wallentin, STABILITY Investigators, Ralph A H Stewart, Emil Hagström, Claes Held, Tom Kai Ming Wang, Paul W Armstrong, Philip E Aylward, Christopher P Cannon, Wolfgang Koenig, José Luis López-Sendón, Emile R Mohler 3rd, Nermin Hadziosmanovic, Susan Krug-Gourley, Marco Antonio Ramos Corrales, Saulat Siddique, Philippe Gabriel Steg, Harvey D White, Lars Wallentin, STABILITY Investigators

Abstract

Background: The major determinants and prognostic importance of self-reported health in patients with stable coronary heart disease are uncertain.

Methods and results: The STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial randomized 15 828 patients with stable coronary heart disease to treatment with darapladib or placebo. At baseline, 98% of participants completed a questionnaire that included the question, "Overall, how do you feel your general health is now?" Possible responses were excellent, very good, good, average, and poor. Adjudicated major adverse cardiac events, which included cardiovascular death, myocardial infarction, and stroke, were evaluated by Cox regression during 3.7 years of follow-up for participants who reported excellent or very good health (n=2304), good health (n=6863), and average or poor health (n=6361), before and after adjusting for 38 covariates. Self-reported health was most strongly associated with geographic region, depressive symptoms, and low physical activity (P<0.0001 for all). Poor/average compared with very good/excellent self-reported health was independently associated with major adverse cardiac events (hazard ratio [HR]: 2.30 [95% confidence interval (CI), 1.92-2.76]; adjusted HR: 1.83 [95% CI, 1.51-2.22]), cardiovascular mortality (HR: 4.36 [95% CI, 3.09-6.16]; adjusted HR: 2.15 [95% CI, 1.45-3.19]), and myocardial infarction (HR: 1.87 [95% CI, 1.46-2.39]; adjusted HR: 1.68 [95% CI, 1.25-2.27]; P<0.0002 for all).

Conclusions: Self-reported health is strongly associated with geographical region, mood, and physical activity. In a global coronary heart disease population, self-reported health was independently associated with major cardiovascular events and mortality beyond what is measurable by established risk indicators.

Clinical trial registration: URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00799903.

Keywords: coronary artery disease; general health; prognostic studies.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Relative strength of association with self‐reported health of each variable included in the full model, as measured by the Wald χ2 test minus the predictor degrees of freedom: (χ2−df)=χ2−predictor df. Higher values on the x‐axis indicate a stronger association with self‐reported health. hs indicates high sensitivity; MET, metabolic equivalent; NYHA, New York Heart Association.
Figure 2
Figure 2
Kaplan–Meier plot of major adverse cardiovascular events by self‐reported health at baseline.
Figure 3
Figure 3
Adverse events by self‐reported health at baseline adjusted (A) for treatment allocation only and (B) for all covariates. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented for each outcome for patients reporting good and average or poor health compared with the reference group that reported very good or excellent health. Heart failure refers to hospitalization for heart failure. CV indicates cardiovsacular; MACE, major adverse cardiac events; MI, myocardial infarction.

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