The influence of myocardial infarction and stroke on patient related quality of life

Aim: To investigate health-related quality of life in a large sample of patients with stroke and myocardial function.

Methods: Patient data were collected in the framework of the DETECT study (Wittchen et al., 2005), a prospective cross-sectional and longitudinal study to evaluate health care in Germany in patients with cardiovascular disease and risk factors. Patients examined and interviewed with standardised questionnaires including life orientation test, a depression screening, a risk index for the development of stroke and a 10-year score based on patient data to evaluate individual cardiovascular risk. HrQoL was evaluated with the EQ-5D. Certain laboratory parameters were obtained as well as blood pressure, heart frequency, weight and height. In this analysis, patients with either myocardial infarction or stroke or both were compared to patients having suffered neither. These subgroups consisted of 3109 patients, of which 1029 (33%) were female. Cardiovascular risk profiles were similar between those with myocardial infarction, stroke or both. Data was analysed using uni- and multivariate analysis to determine different influences of risk factors on HrQoL.

Results: There is a clinically significant difference between HrQoL outcomes in patients with stroke as compared to patients with myocardial infarction (p<0.05). EQ-5D was 0.66 for patients with myocardial infarction as compared to stroke (0.60). There was also a significant difference between patients having suffered both a myocardial infarct and stroke (0.53) and patients with stroke only. No difference was observed between patients with both and patients with stroke only. Multivariate analysis revealed several different determining factors including depression, sexual dysfunction, anxiety, age, body mass index, systolic blood pressure, nicotine abuse and carotid artery stenosis that influence HrQoL. However, the model was able only to explain14% of the observed variability.

Conclusions: As shown in previous publications, stroke has an important impact on HrQoL. From our data, we conclude that HrQoL of patients with myocardial infarct and stroke is mainly determined by the CNS insult. We could identify several risk factors that influence differences in outcome when comparing stroke and myocardial infarction. These data provide further evidence that early diagnosis and treatment of cardiovascular risk factors is essential to reduce subsequent stroke in German primary care.