Health-related quality of life outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction (HOOP-PCI study)

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[Background] Health-related quality of life (HRQOL) is an important measure of patient outcome following primary percutaneous coronary intervention (PPCI) for an ST-Elevation myocardial infarction (STEMI). The assessment of HRQOL quantifies patient perceptions of the impact of an acute, unanticipated cardiac event on their survival and normal function. Despite international recognition and recommendations supporting HRQOL as a vital measure of cardiovascular health status, HRQOL remains under-reported and not routinely implemented in PPCI care. Field triage patients who are fast-tracked to PPCI have less ischaemic time delays than routine Emergency Department (ED) admissions but their HRQOL and cardiac rehabilitation (CR) attendance patterns have not been investigated. [Aims] This study aims to examine HRQOL outcomes of STEMI patients and to identify the key factors that influence recovery and CR attendance at 4 weeks and 6 months after PPCI. [Method] Clinical and HRQOL data was collected and compared for age categories, divided at 60 and 70 years separately; the cut-off age of 70 years used for this thesis. The cut-off for older age at 60 years was used for the systematic review based on the global standard set by the World Health Organisation (World Health Organization, 2002). The age cut-off was changed to 70 years for the thesis study as it is more representative of older people in developed countries such as Australia. The timing of follow-up at 4 weeks and 6 months was chosen based on published evidence that improvements in HRQOL post-PPCI reached a plateau at 6 months, after which, no significant differences occurred. A prospective cohort study was conducted with repeated measures for all consecutive STEMI patients (n=246) comprised of 194 males and 52 females. All were treated by PPCI after ED or Field Triage admissions in two metropolitan hospitals, the Royal North Shore and North Shore Private Hospitals. Additional analyses included HRQOL in the subgroup of Field Triage patients and determination of CR participation at 4 weeks and 6 months. [Results] Age, length of hospitalisation, gender, partnership status and number of stents deployed were independent predictors of HRQOL after STEMI and PPCI. Participants aged ≥ 70 years achieved better cardiac-related HRQOL and mental health from angina relief despite physical limitations. Older age, longer hospitalization, hypertension and recurrent angina were associated with poorer HRQOL for field triage patients. Despite a high referral rate (96%, n=233), CR attendance was sub-optimal (36-54%, n=89-132). A total of 221 patients attended CR; men and patients who received post-discharge support were more likely to attend. [Recommendations] There is a need to integrate HRQOL measurement into PPCI care to ensure post-discharge support is directed at those who need it most. Older people and women were identified in this research as having lower HRQOL and attendance at CR. Important factors that negatively impact on HRQOL such as recurrent angina and longer hospitalization need to be considered in cardiovascular health-care delivery and risk management of acute STEMI cohorts. [Conclusion] The HRQOL for all ages improves from 4 weeks to 6 months after PPCI including field triage patients. Older age, longer hospitalization and female gender are common predictors of poorer HRQOL and lower CR attendance, constituting areas requiring future research focus.
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