Atlanta, GA – Coronary heart disease has a significant impact on health-related quality of life, a new study shows . Furthermore, there are big variations in quality of life across different subgroups of people with CHD—for example, by age and by race, say Dr Jipan Xie (Centers for Disease Control and Prevention, Atlanta) and colleagues in their paper published online July 14, 2008 in Circulation.
"This is the first study on a national scale to quantify the health-related quality of life of patients with CHD compared with those who do not have it," Xie told heartwire. "We found that CHD patients consistently had worse quality of life and that there are interesting differences among certain demographic subgroups."
"The research is a reminder that attention must be paid to quality of life, which has been ignored previously," Xie added. "There are more and more people living with CHD as treatment is improving, so we must put interventions into place for all people living with CHD, not just physical rehab but all-around rehabilitation."
Young, women, and ethnic minorities disproportionately affected
The analysis by Xie et al used data from the 2000 and 2002 Medical Expenditure Panel Surveys, identifying 2091 people with a history of CHD from a sample of 37 386 individuals.
They observed impairment in the health status of patients with CHD in all measures, compared with those without CHD, but the most prominent differences were in physical-health score and self-reported health—those with CHD had 9% lower self-ratings of health and 9.2% lower physical-health scores. Those with CHD also had lower scores on mental-health scales—2.4% lower, on average, and 4.6% lower health-utility scores—a scale measuring mobility, self-care, usual activity, pain, and anxiety.
Patients with CHD were more likely to say they had poorer quality of life or describe themselves as sick, said Xie. Those most likely to report poorer quality of life in this study were younger patients (aged 18 to 49), women, and black or Hispanic patients.
The age-related difference probably reflects a difference in age-related expectations, Xie noted. "Younger people may feel more pressure—especially younger men—in the workplace and may be more threatened by limitations imposed by their disease."
Older people, especially those who were older than 65, were less likely to say heart disease limited their life or had an adverse effect on their quality of life.
Targeted interventions required
"The implications of these findings underscore the need for interventions aimed at improved health-related quality of life for people with CHD—a population that has been growing rapidly," she said. About 16 million people in the US have CHD, according to the American Heart Association.
With limited resources, such interventions should be targeted at those populations revealed to be most vulnerable—younger adults, women, blacks, and Hispanics, she said.
Xie said the success of interventions to reduce CHD risk and death has set the stage for the next challenge, in which large numbers of people are living with CHD. For example, she suggested educational efforts aimed at employers to help design work environments that would better accommodate employees with heart disease.