Skip Navigation

European Journal of Heart Failure 2001 3(5):561-568; doi:10.1016/S1388-9842(01)00171-4
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (4)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Ecochard, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ecochard, R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© 2001 European Society of Cardiology

Indicators of myocardial dysfunction and quality of life, one year after acute infarction

René Ecocharda,*, Cyrille Colina, Muriel Rabillouda, Guy de Gevigneyb, Danièle Caob, Corinne Ducreuxa, François Delahayeb and PRIMA group1

a Département d'Information Médicale Hospices Civils de Lyon, Lyon, France
b Service de Cardiologie, Hôpital Cardiologique Hospices Civils de Lyon, Lyon, France

* Corresponding author. Département d'Information Médicale des Hospices Civils de Lyon, Unité de Biostatistique, 162, avenue Lacassagne, 69424 Lyon Cedex 03, France. Tel.: +33-4-72-11-57-72; fax: +33-4-72-11-57-20. E-mail address: rene.ecochard{at}chu-lyon.fr (R. Ecochard)


   Abstract
Top
 Notes
 Abstract
1. Introduction
 2. Methods
 3. Results
 4. Discussion
 5. Conclusion
 References
 
Background: There remains controversy concerning the association between myocardial dysfunction diagnosed soon after acute myocardial infarction (AMI), and subsequent quality of life.

Aims: We searched for a correlation between criteria of myocardial dysfunction assessed within the first month after AMI, and quality of life perceived 1 year later.

Methods: Six hundred and seventy-one patients were followed up and quality of life was assessed using the Nottingham Health Profile. Spearman correlation was used for univariate analyses. A logistic regression identified independent predictors of impaired quality of life.

Results: Patients perceiving inferior quality of life were 61% for energy, 61% for sleep, 49% for physical mobility, 49% for pain, 63% for emotional reactions, and 28% for social isolation. Impaired quality of life was not associated with the initial Killip class. A low ejection fraction was associated with impaired physical mobility (OR = 1.21, 95% CI = 1.05–1.39). Presence of abnormally contracting myocardial segments was associated with impaired mobility (1.40, 1.09–1.80) and with increased pain (1.30, 1.02–1.66). The presence of diseased coronary vessels was associated with pain (1.25, 1.06–1.46).

Conclusion: Myocardial dysfunction was generally associated with impaired quality of life. This has to be considered when assessing improvement of quality of life after medical or surgical treatment of AMI.

Key Words: Heart failure • Myocardial dysfunction • Quality of life • Acute myocardial infarction • Coronary angiography • Nottingham Health Profile

Received October 1, 1999; Revised January 17, 2000; Accepted July 5, 2000


   1. Introduction
Top
 Notes
 Abstract
 1. Introduction
2. Methods
 3. Results
 4. Discussion
 5. Conclusion
 References
 
The prognosis after AMI in terms of mortality, has improved through the last three decades [1]. However, patients’ quality of life remains adversely affected [2]. Indeed, the quality of life following AMI was shown to be affected by emotional distress [3], angina pectoris [4], side effects induced by drug therapy [5], and by comorbidities [2]. Thus, traditional measurements of AMI outcome, such as survival rates or functional capacity and quality of life measurement, seem to complement each other to provide a more comprehensive assessment of the impact of the disease and/or its treatment [6,7].

Early symptomatic heart failure was shown to be associated with an impaired quality of life [8–10]. However, the relation between myocardial dysfunction and quality of life remains under discussion since Sjöland [11] did not observe an association between left-ventricular ejection fraction and quality of life, and Marwick [12] did not find a meaningful correlation between quality of life and the extent of viable myocardium measured by positron emission tomography.

Clinical assessment, coronary angiography and left ventriculography provide four criteria of myocardial dysfunction and extent of coronary disease: Killip class; number of diseased vessels; ejection fraction; and regional akinesia or dyskinesia. To examine the relationship between myocardial dysfunction and quality of life, we assessed the predictive value of these four criteria on health-related quality of life (HRQoL) 1 year after AMI.


   2. Methods
Top
 Notes
 Abstract
 1. Introduction
 2. Methods
3. Results
 4. Discussion
 5. Conclusion
 References
 
The patients originally participated in a prospective study of variations in patient management for acute myocardial infarction (the PRIMA Project) undertaken in the Isère, Loire, and Rhône Departments in the Rhône–Alpes region of France. Three physicians prospectively recorded the characteristics of all patients as well as the results of cardiac procedures. All patients were followed up and HRQoL was assessed 1 year after AMI. The investigation conformed with the principles outlined in the Declaration of Helsinki. All patients gave their written informed consent and the study was approved by the institutional review board and authorised by the Computing and Freedom National Committee.

2.1. Patients
All 48 hospital centres taking care of patients with AMI in the three Departments agreed to participate in the study. From September 1, 1993 to January 31, 1995, these hospitals admitted 2519 patients with AMI.

Patients were included in the present study if they were French citizens, resident and hospitalised for a diagnosed AMI in one of the three Departments, if they had been subject to a coronary angiography within 30 days after the acute phase of infarction (983/2519=39%), if they had survived at least 1 year after infarction (898/983=91.4%), and if they had completed the questionnaire (671/898=75%). Patients whose AMI occurred more than 28 days prior to hospitalisation, those with post-operative AMI, those less than 15 years old, and those lost to follow-up (10 patients or 1%) were excluded.

2.2. Patients’ characteristics
The following characteristics were recorded for all patients:

2.2.1. Baseline characteristics
Age and gender, cardiac history of prior myocardial infarction and/or of angina pectoris, and comorbidities: peripheral arterial disease; cerebrovascular accident or transient ischemic attack; severe and/or treated metabolic or endocrinologic disease; chronic renal failure; chronic pulmonary disease; severe and/or treated liver disease; systemic disease; cancer; neurologic disease; psychiatric disorder; oenolism; and drug abuse.

2.2.2. Infarction characteristics and evolution
Myocardial infarction location (anterior vs. non-anterior), the maximum level of creatine–phosphokinase adjusted for laboratory upper normal values, recurrent ischemia before coronary angiography, reinfarction within a month.

2.2.3. Treatments
Thrombolysis, surgical revascularisation (coronary artery bypass surgery, CABG or percutaneous transluminal coronary angioplasty, PTCA), use of cardiovascular drugs after the hospital phase (antiarrhythmics, anticoagulants, platelet aggregation inhibitors, long-acting nitrates, β-blockers, calcium-blockers, angiotensin-converting enzyme inhibitors, digitalis, diuretics), and rehabilitation.

2.2.4. Myocardial dysfunction and coronary stenosis
Four criteria were obtained by clinical assessment, coronary angiography and left ventriculography:

  1. Maximal Killip class [13] during the first 5 days after AMI: class I corresponds to no heart failure (73.8%), class II to mild heart failure — rales, S3, gallop and venous hypertension — (20.0%), class III to frank pulmonary oedema (5.6%), and class IV to cardiogenic shock (0.6%).
  2. Number of diseased vessels, as assessed by coronary angiography: stenosis of the left main coronary artery; left anterior descending coronary artery; left circumflex coronary artery; and right coronary. Disease was considered present when there was at least 70% stenosis of an artery. The proportions according to the number of diseased vessels — none to three — were 16.5, 42.6, 26.5 and 14.4%, respectively.
  3. Ejection fraction, as assessed by ventricular angiography. Four groups of patients were considered according to their ejection fraction using quartiles: ejection fraction >65%, 21.0%; ejection fraction of 56–65%, 27.6%; ejection fraction of 46–56%, 23.8%; and ejection fraction <46%, 27.6%.
  4. Number of angiographic abnormally contracting segments (0–3): abnormal wall motion (hypokinesis, akinesis, or dyskinesis) in the anterior-lateral; apical; and/or posterior area of the left ventricle. The proportions according to the number of abnormal segments — none to three — were 11.6, 54.2, 26.7 and 7.6%, respectively.

Table 1 shows baseline characteristics, characteristics of myocardial infarction and treatment of patients.


View this table:
[in this window]
[in a new window]

  		Table 1 Baseline characteristics of patients (n=671) who underwent coronary angiography, survived at least 1 year after AMI, and completed the NHP questionnaire

 
2.3. Measurement of the quality of life
HRQoL was assessed using the French version of the Nottingham Health Profile (NHP) validated by EuroQOL Group [14]. The questionnaire was mailed to all surviving patients 1 year after AMI. The NHP is a perceived health questionnaire for which validity and reliability in cardiology have been demonstrated [6,15]. It consists of 38 statements that convey limitations of activity or aspects of distress in the areas of energy, pain, emotional reactions, sleep, social isolation and physical mobility. Patients are required to indicate by a yes/no answer, which of the problems they are experiencing at the time they complete the questionnaire. Individual statements within each dimension do not contribute equally to the total score for that dimension. Thus, an affirmative answer to an individual statement receives the appropriate weighted score for that statement. The scores for the statements within each dimension are added to yield a total score between zero and 100. The higher the score the worse the perceived health status.

2.4. Statistical methods
We first calculated the mean age of patients and the percentages of patients presenting each characteristic. Profile plots [16] were used to display simultaneously the mean scores for the six areas, the patients being clustered by levels within each of the four criteria: four Killip classes; four quartiles of ejection fraction; four categories with 0, 1, 2 or 3 abnormally contracting segments; and four categories with 0, 1, 2 or 3 diseased vessels. The association between these criteria and the scores was assessed using Spearman's correlation. Profile plots using the median scores rather than the mean scores would have been more appropriate because of the non-normality of the distributions. However, for some dimensions, the proportion of score zero was so high that the medians were just ‘0’, so we preferred to deal with the mean scores.

For the above analysis, the scores were not dichotomised. However, for the following multivariate regression analysis, the scores were dichotomised to avoid the potential bias due to the non-normality of the distribution of NHP scores. The scores for each of the six areas were therefore, dichotomised by defining non-zero scores as impaired HRQoL/perception of discomfort. Baseline characteristics, characteristics of myocardial infarction, treatments and the four criteria of left ventricular dysfunction and extent of coronary disease were included in a stepwise logistic regression model to identify independent predictors of an impaired HRQoL. The stepwise regression selected the co-variates significantly associated with scores, and rejected the others; only significant factors were maintained in the final analysis.

We calculated the ORs and their 95% CIs. The effect of age is presented over 10 years to show the change in risk when the patient is 10 years older. The effect of lower ejection fraction is presented for an additional decrease of 10%. The effect of abnormally contracting segments is presented for one additional segment. All analyses were performed using the SAS 6.12 statistical analysis program (SAS Inc., Cary, NC, USA).


   3. Results
Top
 Notes
 Abstract
 1. Introduction
 2. Methods
 3. Results
4. Discussion
 5. Conclusion
 References
 
Compared to the rest of the 2519 patients, those included in this study were younger (P<0.001), more frequently men (P<0.001), with less history of AMI or angina pectoris (P<0.01), and less comorbidities (P<0.001). They also had less frequent anterior infarct location (P<0.01), but they were more frequently subject to thrombolysis (P<0.001) and underwent more frequent surgical revascularisation (P<0.001).

One year after AMI, dissatisfaction was perceived by 61% of our population in the dimension of energy, 61% in sleep, 49% in physical mobility, 49% in pain, 63% in emotional reactions, and 28% in social isolation.

3.1. Independent predictors of impaired HRQoL
Fig. 1 shows independent predictors for impaired HRQoL. The older the age, the more difficult was physical mobility. Women perceived more dissatisfaction than men in all dimensions, but emotional reactions. History of AMI was associated with impaired HRQoL in energy, physical mobility, pain, and social isolation while history of angina pectoris was not independently associated with impaired HRQoL. As expected, comorbidity was associated with physical mobility, emotional reaction, and social isolation dimensions. Energy level and pain scores were independently associated with rehabilitation.


Figure 1
View larger version (14K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 1 Correlation between patients’ characteristics evaluated within a month after acute myocardial infarction and each of the six dimensions of the Nottingham Health Profile for assessment of health-related quality of life, 1 year later. Odds ratios (dark squares with 0.5 and 2 as references) and corresponding 95% confidence intervals were plotted using a non-linear scale.

 
The scores were not independently associated with the infarction characteristics — infarction location, maximum level of creatine–phosphokinase, recurrent ischemia — except for reinfarction, which was strongly associated with low energy and poor sleep quality. There was no indication as to effects associated with usage of cardiovascular drugs. However, revascularisation had a clear positive impact on energy.

3.2. Heart condition assessment
Fig. 2 presents the mean scores as well as the results of univariate comparisons for Killip classes, ejection fraction, number of angiographic abnormally contracting segments, and number of diseased vessels. In order to avoid confusion, it is very important to note that differences between scores are significant whenever differences are large or whenever both differences and S.D.s are small. This is why close points seen on these graphs may nevertheless, mean significant differences. Conversely, distant points may not represent significant differences because of too large standard deviations.


Figure 2
View larger version (17K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 2 Mean Nottingham Health Profile scores (0–50) in each of the six health quality of life dimensions. Each line represents one of the four categories in each myocardial dysfunction criterion: four Killip classes; four quartiles of ejection fraction; four categories with 0, 1, 2 or 3 abnormally contracting segments; and four categories with 0, 1, 2 or 3 diseased vessels. Spearman correlation is indicated by * when P<0.05 and ** when P<0.01. Joining the scores helps to follow their change with increased abnormality of myocardial function; this does not mean that the score in each dimension is dependent on the score in another dimension.

 
Killip class III was the most frequently associated with increased discomfort in all HRQoL dimensions. However, the higher the Killip class, the higher the score (i.e. poorer HRQoL) for energy, physical mobility, pain, and social isolation. Low ejection fraction, presence of abnormally contracting segments and increased number of diseased vessels were all associated with perception of discomfort in most dimensions. They all mostly affected physical mobility.

After adjusting on all independent predictors, quality of life 1 year after AMI was not associated with the Killip class recorded during the first 5 days after the acute phase. In contrast, a low ejection fraction was associated with reduced physical mobility (OR=1.20, 95% CI=1.05–1.39), high number of abnormally contracting segments with reduced physical mobility and increased pain (OR=1.40, 95% CI=1.09–1.80 and 1.30, 1.02–1.66, respectively), and number of diseased vessels with increased pain (OR=1.25, 95% CI=1.06–1.46).


   4. Discussion
Top
 Notes
 Abstract
 1. Introduction
 2. Methods
 3. Results
 4. Discussion
5. Conclusion
 References
 
It has been said that myocardial infarction ‘affects both the body and the mind’ [10]. Emotionally, the patients seem to adjust well after a few months or years [10]. Physically, recovery is rather difficult to assess and looks quite uneven among patients. In healthy populations, women usually score more highly (perceive more discomfort) than men in all dimensions of the NHP; in addition, these scores tend to rise with age [17]. These trends were also observed for patients after AMI [2,4,10].

Nevertheless, our results on the predictors of discomfort 1 year after AMI, are in agreement with the investigations cited in Section 1, especially, Wicklund [5,10] and Brown [2]. Several authors have shown that 4 or 5 years after AMI patients were still strongly affected by angina pectoris [2,10,18], or by dyspnoea and anxiety [2,10]. In our population, patients with reinfarction were observed to be at high risk of discomfort perception, especially in energy and sleep dimensions.

The study population was limited to patients who underwent a coronary angiography within 30 days after the acute phase of infarction. Indeed, our aim was to verify whether criteria of myocardial dysfunction obtained by coronary angiography were independent predictors of impaired HRQoL/increased discomfort among these patients. Our conclusions are therefore, limited to similar patients, i.e. subject to such an investigation, and cannot be generalised to all patients with AMI.

Side effects induced by drug therapy were precisely studied by Wiklund et al. [5]. These authors observed adverse effects of diuretics on energy and physical mobility, but no such effects with the β-blocker metoprolol. They also observed impaired mobility among patients using antiarrhythmics. In our study, we found no adverse effects of drug therapy on HRQoL after adjusting for all other independent predictors, including criteria of myocardial dysfunction. This tends to suggest that impaired HRQoL observed with some drugs, such as diuretics, was due to heart failure, but not to the drug itself. Nevertheless, the NHP may also be insensitive to some peculiar effects of drug therapies Adverse effects of drugs should be confirmed by appropriate clinical trials. For example, a clinical trial by Ekeberg et al. [4] demonstrated absence of effect of angiotensin-converting enzyme inhibitors on HRQoL.

The effect of surgical revascularisation on HRQoL has been extensively studied [19–23]. CABG was shown to improve markedly HRQoL [24], and both CABG and PTCA were shown to produce similar benefits on quality of life and employment [19,22]. In our data, revascularisation had a clear positive impact on energy.

Two out of our three criteria for myocardial dysfunction were associated with inferior quality of life, 1 year after AMI; low ejection fraction was associated with impaired physical mobility and high number of abnormally contracting segments was associated with impaired physical mobility and pain. Additionally, the number of diseased vessels was associated with pain. Heart failure during the first days after AMI is known to be one of the main factors of long-term prognosis after hospitalisation for acute myocardial infarction [25,26]. Acute congestive heart failure during the first days after AMI is associated with further increased risk of death or impaired functional capacity. Nevertheless, in our data, Killip class during the first days following AMI was not an independent predictor of further HRQoL. After the acute phase, ventricular function may return to normal at least in some patients. Moreover, we can explain the absence of differences regarding HRQoL by the low proportion of patients with Killip class>II in our study. We observed that patients with heart failure were less likely to undergo coronary angiography. The same observation was made by other authors [27] despite the fact that large observational studies have proved the benefit from revascularisation in patients with severe heart failure [28]. This results in lack of power in the assessment of the association between Killip class and HRQoL.

Prognostic value of coronary angiography and left venticulography on long-term HRQoL is still a matter of debate. Sjöland et al. [24] approached all patients (n=2121) who underwent CABG without concomitant valvular surgery in referral centres of CABG. They assessed the relationship between pre-operative ejection fraction and NHP before and after surgery. The NHP scores did not differ significantly between patients with normal and depressed ejection fraction in any of the dimensions, neither before nor 2 years after the operation. The major complaint of their patients was angina pectoris. Approximately 60% of these patients had previous history of AMI and 65% of them had three-vessel disease. The authors explained the absence of differences regarding HRQoL by the low proportion of patients with less than 40% ejection fraction (9%) and thus, by a lack of power. In our data, ejection fraction was less than 40% in 12.6% of patients. All patients were observed during the first month after AMI, three-vessel disease was observed in only 14.4%, and only 18.2% had recurrent ischemia before coronary angiography. Thus, our population was more heterogeneous and though our analysis did not suffer from the lack of power suggested by Sjöland et al. to explain the absence of association between ejection fraction and HRQoL in their study.

Marwick et al. [12] prospectively studied 63 patients who underwent CABG. Patients were eligible for recruitment if they had at least a moderate left ventricular dysfunction; their main symptoms were related to left ventricular dysfunction rather than to angina pectoris. These authors did not observe a significant correlation between the extent of viable myocardium measured by pre-operative positron emission tomography and NHP scores 1 year later. Their small sample size could at least, partly explain their results.

In contrast to the maximal Killip class recorded within the first 5 days after AMI, coronary angiography and left ventriculography, performed during the first month after AMI appear to be independent predictors of better HRQoL. This can help physicians in the choice of the appropriate treatment after AMI. Moreover, it is wise to consider these predictors of HRQoL when studying improvement in quality of life during the years following surgical revascularisation or other treatments.

Despite several interesting results, this study remains subject to some technical and conjectural limitations. The expression ‘impaired HRQoL’ is probably not suitable for scores higher than zero because a part of the normal population scores so. This threshold was used only for our multivariate analysis, the univariate analysis being provided without transforming the original scores. We could have used another threshold (say >15 or the specific median of each score), but our choice was made to simplify the presentation and to increase the sensitivity of the analysis at the price of a lack of specificity. The high proportion of zeros in all dimensions (the so-called ‘floor effect’) reflects the lack of sensitivity of NHP to mild impairment of HRQoL. The QLMI (quality of life following myocardial infarction) questionnaire developed by Oldridge's team [29] is not yet translated into French, thus we were unable to use this more adequate tool.

Several authors did not dichotomise the scores before analysing NHP scores. Non-dichotomisation is appropriate if non-parametric tests are to be used so we did not dichotomise the scores for our univariate analysis, performed using Spearman's non-parametric correlation. However, for our multivariate regression analysis, we preferred to be protected against the potential bias due to the non-normality of the distribution of NHP scores. In their manual of validation of the French version of the NHP questionnaire, Denis Bucquet and Stéphanie Condon [17] proposed dichotomising as one of the ways to use NHP. This method has sometimes been applied to the English language version of NHP [23]. Nevertheless, we agree that dichotomising decreases the power of our comparisons.

As to the power of the study to find associations, we know that the power of comparisons made in an observational study with multivariate analysis changes between comparisons. In fact, statistically significant differences are reliable, but non-significant differences do not preclude the existence of effects. For instance, the absence of a relationship between surgical revascularisation and the other scores may be due to a lack of power of the test. Conversely, despite the clear trends shown in Fig. 2, several effects are, nevertheless, statistically not significant because the population size is too small to confirm these effects. For instance, correlations between ejection fraction and each NHP score were shown, but only the correlation between ejection fraction and physical mobility was statistically significant. This has to be taken into account to understand the apparent lack of association between revascularisation and pain or the fact that prior MI was associated with physical mobility, but not sleep, whereas reinfarction was associated with lower energy level and sleep problems.

Furthermore, we were unable to compare our levels of association with the levels found in other studies because of the diversity of the statistical methods.

Finally, it would have been wise to introduce a measure of anxiety and depression in our regression analysis. However, this would have swamped the physiological measures as predictors of HRQoL. Indeed, our results leave out consideration of the mechanism of action of myocardial dysfunction on HRQoL.


   5. Conclusion
Top
 Notes
 Abstract
 1. Introduction
 2. Methods
 3. Results
 4. Discussion
 5. Conclusion
References
 
In conclusion, the main result of this study indicates that low ejection fraction, high number of abnormally contracting segments, as well as high number of diseased vessels during the first month after AMI are independent predictors of discomfort perception, 1 year later. Coronary angiography and left ventriculography performed during the first month following AMI provide useful information on middle- and long-term perceived health status. This has to be taken into account when assessing the improvement in quality of life after medical or surgical treatment.


   Acknowledgements
 
This work was supported by grants from the French Ministry of Health (PHRC 1993 Lyon), from the Réseau National de Santé Publique, and from the Fédération Française de Cardiologie. The authors would like to thank the Prima centres supervisors and all the medical personnel who took part in this study. They also thank Jean Iwaz, for suggestions and criticisms of the manuscript.


   Notes
Top
 Notes
Abstract
 1. Introduction
 2. Methods
 3. Results
 4. Discussion
 5. Conclusion
 References
 
1 The following is a list of PRIMA centres. Isère:Bourgoin-Jallieu, la Côte Saint-André, Grenoble (Centre hospitalier universitaire, Clinique des Eaux Claires), la Mure, le Pont de Beauvoisin, Saint-Laurent du Pont, Saint-Marcellin, Saint-Martin d'Hères, Vienne, Voiron (Centre hospitalier général, Clinique de Chartreuse). Loire: Feurs, Firminy, Montbrison, Rive de Gier, Roanne, Saint-Chamond, Saint-Etienne (Clinique la Croix, Hôpital Bellevue, Hôpital de la Charit, Hôpital Nord, Hôpital de Saint-Jean-Bonnefond, Polyclinique Beaulieu), Saint-Galmier, Saint-Just et Saint-Rambert. Rhône: Condrieu, Givors, Lyon and surroundings (Centre hospitalier Lyon-Sud, Clinique Charcot, Clinique du Grand Large, Clinique des Minguettes, Clinique Mutualiste E. André, Clinique de la Roseraie, Clinique de la Sauvegarde, Clinique du Tonkin, Hôpital Cardiovasculaire et Pneumologique, Hôpital A. Charrial, Hôpital de la Croix-Rousse, Hôpital Desgenettes, Hôpital E. Herriot, Hôpital de l'Hôtel-Dieu, Hôpital de Sainte-Foy-lès-Lyon, Hôpital Saint Joseph, Infirmerie protestante, Polyclinique de Rillieux), Tarare, Villefranche-sur-Saône. Co-ordinating center: F. Delahaye, C. Colin, R. Ecochard, and G. de Gevigney. Back


   References
Top
 Notes
 Abstract
 1. Introduction
 2. Methods
 3. Results
 4. Discussion
 5. Conclusion
 References
 

  1. De Vreede J.J.M., Gorgels A.P.M., Verstraaten G.M.P., Vermeer F., Dassen W.R., Wellens H.J. Did prognosis after acute myocardial infarction change during the past 30 years? A meta-analysis. J Am Coll Cardiol (1991) 18:698–706.[Abstract]
  2. Brown N., Melville M., Gray D., et al. Quality of life 5 years after acute myocardial infarction: short form 36 scores compared with a normal population. Heart (1999) 81:352–358.[Abstract/Free Full Text]
  3. Stern M.J., Pascale L., McLoone J.B. Psychological adaptation following an acute myocardial infarction. J Chron Dis (1976) 29:513–526.[CrossRef][Web of Science][Medline]
  4. Ekeberg Ø., Klemsdal T.O., Kjeldsen S.E. Quality of life on enalapril after acute myocardial infarction. Eur Heart J (1994) 15:1135–1139.[Abstract/Free Full Text]
  5. Wiklund I., Herlitz J., Hjalmarson Å. Quality of life in Postmyocardial infarction patients in relation to drug therapy. Scand J Prim Health Care (1989) 7:13–28.[CrossRef][Medline]
  6. O'Brien B.J., Buxton M., Patterson D.L. Relationship between functional status and health-related quality of life after myocardial infarction. Med Care (1993) 31:950–953.[CrossRef][Web of Science][Medline]
  7. Permanyer-Miralda G., Alonso J., et al. Comparison of perceived health status and conventional functional evaluation in stable patients with coronary artery disease. J Clin Epidemiol (1991) 44:779–786.[CrossRef][Web of Science][Medline]
  8. Cowley A.J., Skene A.M. Treatment of severe heart failure: quantity or quality of life? A trial of enoximone. Br Heart J (1994) 72:226–230.[Abstract/Free Full Text]
  9. Dracup K., Walden J.A., Stevenson L.W., Brecht M.L. Quality of life in patients with advanced heart failure. J Heart Lung Transplant (1992) 11:273–279.[Web of Science][Medline]
  10. Wiklund I., Herlitz J., Hjalmarson Å. Quality of life five years after myocardial infarction. Eur Heart J (1989) 10:464–472.[Abstract/Free Full Text]
  11. Sjöland H., Caidahl K., Wilkund I., et al. Preoperative left-ventricular ejection fraction does not influence the improvement in quality of life after coronary artery bypass surgery. Thorac Cardiovasc Surg (1998) 46:198–206.[CrossRef][Web of Science][Medline]
  12. Marwick T.H., Zuchowski C., Lauer M.S., Secknus M.A., Williams J., Lytle B.W. Functional status and quality of life in patients with heart failure undergoing coronary bypass surgery after assessment of myocardial viability. J Am Coll Cardiol (1999) 33:750–758.[Abstract/Free Full Text]
  13. Killip T., Kimball J.T. Treatment of myocardial infarction in a coronary care unit. A 2-year experience with 250 patients. Am J Cardiol (1967) 20:457–464.[CrossRef][Web of Science][Medline]
  14. Bucquet D., Condon S., Ritchie K. The French version of the Nottingham Health Profile: a comparison of items weights with those of the source version. Soc Sci Med (1990) 30:829–835.[CrossRef][Web of Science][Medline]
  15. Visser M.C., Fletcher A.E., Parr G., Simpson A., Bulpitt C.J. A comparison of three quality of life instruments in subjects with angina pectoris: the Sickness Impact Profile, the Nottingham Health Profile, and the Quality of Well Being Scale. J Clin Epidemiol (1994) 47:157–163.[CrossRef][Web of Science][Medline]
  16. Fayers P.M., Machin D. Summarizing quality of life using graphical methods. In: Quality of life assessment in clinical trials (1998) Oxford: University Press.
  17. Bucquet D., Condon S. The European Group for Quality of Life. European guide to the Nottingham Health Profile (1992) Montpellier, France: Escubase.
  18. Skinner J.S., Albers C.J., Hall R.J.C., Adams P.C. Comparison of Nottingham health profile (NHP) scores with exercise duration and measures of ischemia during treadmill exercise testing in patients with coronary artery disease. Eur Heart J (1995) 16:1561–1565.[Abstract/Free Full Text]
  19. Pocock S.J., Henderson R.A., Seed P., Treasure T., Hampton J.R. Quality of life, employment status, and anginal symptoms after coronary angioplasty or bypass surgery. Circulation (1996) 94:135–142.[Abstract/Free Full Text]
  20. Herlitz J., Haglid M., Wiklund I., et al. Improvement in quality of life during 5 years after coronary artery bypass grafting. Coronary Artery Dis (1998) 9:519–526.[Web of Science][Medline]
  21. Caine N., Sharples L.D., Wallwork J. Prospective study of health-related quality of life before and after coronary artery bypass grafting: outcome at 5 years. Heart (1999) 81:347–351.[Abstract/Free Full Text]
  22. Währborg P. Quality of life after coronary angioplasty or bypass revascularization investigation (CABRI) trial. Eur Heart J (1999) 20:653–658. On behalf of the CABRI trialists.[Abstract/Free Full Text]
  23. Herlitz J., Wiklund I., Caidahl K., et al. Determinants of an impaired quality of life 5 years after coronary artery bypass surgery. Heart (1999) 81:342–346.[Abstract/Free Full Text]
  24. Sjöland H., Caidahl K., Wiklund I., et al. Impact of coronary artery bypass grafting on various aspects of quality of life. Eur J Cardiothorac Surg (1997) 12:612–619.[Abstract]
  25. Jacobs D.R. Jr., Kroenke C., Crow R., et al. PREDICT: A simple risk score for clinical severity and long-term prognosis after hospitalization for acute myocardial infarction or unstable angina: the Minnesota heart survey. Circulation (1999) 100:599–607.[Abstract/Free Full Text]
  26. Herlitz J., Karlson B.W., Lindqvist J., Sjolin M. Predictors of death and mode of death during long-term follow-up among patients with unconfirmed acute myocardial infarction. Clin Cardiol (1999) 22:179–183.[CrossRef][Web of Science][Medline]
  27. Pilote L., Miller D.P., Califf R.M., Rao J.S., Weaver W.D., Topol E.J. Determinants of the use of coronary angiography and revascularization after thrombolysis for acute myocardial infarction. N Engl J Med (1996) 335:1198–1205.[Abstract/Free Full Text]
  28. Califf R.M., Harrell F.E. Jr., Lee K.L., et al. The evolution of medical and surgical therapy for coronary artery disease: a 15-year perspective. JAMA (1989) 261:2077–2086.[Abstract/Free Full Text]
  29. Oldridge N., Guyatt G., Jones N., et al. Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction. Am J Cardiol (1991) 67:1084–1089.[CrossRef][Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur J Heart FailHome page
K. I. Pettersen, A. Reikvam, A. Rollag, and K. Stavem
Reliability and validity of the Kansas City Cardiomyopathy Questionnaire in patients with previous myocardial infarction
Eur J Heart Fail, March 2, 2005; 7(2): 235 - 242.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (4)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Ecochard, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ecochard, R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?