Coronary heart disease patients live longer, but not always happier, lives

Better treatments have improved survival in people with coronary heart disease, but the quality of those extra years may be less than ideal, according to research reported in Circulation: Journal of the American Heart Association.

Compared with adults without coronary heart disease (CHD), adults with CHD scored up to 9 percent lower on four scales measuring “quality of life.” Patients with coronary heart disease were more likely to say they had poorer quality of life, or describe themselves as sick, said lead author Jipan Xie, M.D., Ph.D., former health scientist in the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention in Atlanta, Ga.

Quality of life, which includes physical functioning, psychological functioning, social functioning, overall life satisfaction, and perceptions of health status, can be used to measure effectiveness of treatment and predict the long-term mortality after a cardiac event.

Those most likely to report poorer quality of life in this study were:
• age 18 to 49;
• women; and
• black or Hispanic.

The age-related difference, Xie said, probably reflects a difference in age-related expectations.
“Younger people may feel more pressure — especially younger men — in the workplace and may be more threatened by limitations imposed by their disease,” she said.

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.

“The implications of these findings underscore the need for interventions aimed at improved health-related quality of life for people with coronary heart disease — a population that has been growing rapidly,” she said.

Study highlights
• People with coronary heart disease report a worse “quality of life” than people free of heart disease.
• Heart patients who were younger than 50, female, black or Hispanic were all more likely to have lower quality of life scores.
• Quality of life is an important indicator of the socioeconomic impact of disease, the effectiveness of treatment and long-term mortality.

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 challenge of survivorship, in which large numbers of people are living with CHD. For example, she suggested educational efforts aimed at employers to help fashion work environments that would better accommodate employees with heart disease.

About 16 million people in the United States have coronary heart disease, according to the American Heart Association.