Background
Methods
Data and participants
Setting
Health-related quality of life
Exposure
Other variables
Statistical analysis
Missing data
Patient involvement
Results
Patient characteristics
Variable | Total cohort n=9566 | Multimorbidity class 1 (severe) 591 (6.5%) | Multimorbidity class 2 (moderate) 4301 (47.6%) | Multimorbidity class 3 (mild) 4147 (45.9%) | P value† |
---|---|---|---|---|---|
Age, mean (SD) | 64.1 (11.9) | 74.8 (9.3) | 68.8 (10.3) | 57.7 (10.5) | <0.001* |
Women, n (%) | 2384 (24.9) | 177 (30.0) | 1274 (29.7) | 803 (19.4) | <0.001* |
IMD, mean (SD) | 23.0 (15.7) | 24.0 (16.2) | 22.3 (15.2) | 23.7 (16.1) | 0.04 |
BMI, mean(SD) | 28.7 (6.0) | 29.8 (5.4) | 28.9 (5.5) | 28.2 (6.5) | <0.001* |
Ethnicity (Caucasian), n (%) | 8136 (85.1) | 507 (94.8) | 3639 (94.2) | 3530 (93.3) | 0.41 |
Ex/current smoking status, n (%) | 6248 (65.3) | 368 (64.6) | 2709 (64.2) | 5979 (67.2) | <0.001* |
NSTEMI, n (%) | 5658 (59.2) | 508 (86.0) | 2870 (66.7) | 2046 (49.3) | <0.001* |
STEMI, n (%) | 3908 (40.8) | 83 (14.0) | 1431 (33.3) | 2101 (50.7) | |
Co-morbidities | |||||
Diabetes, n (%) | 1714 (17.9) | 375 (64.7) | 1143 (27.1) | 107 (2.6) | <0.001* |
Peripheral vascular disease, n (%) | 317 (3.3) | 121 (20.5) | 168 (3.9) | 24 (0.6) | <0.001* |
Cerebrovascular disease, n (%) | 428 (4.5) | 122 (20.6) | 297 (6.9) | 0 | <0.001* |
Asthma or COPD, n (%) | 1166 (12.2) | 147 (24.9) | 651 (15.1) | 358 (8.6) | <0.001* |
Chronic renal failure, n (%) | 289 (3.0) | 235 (39.8) | 45 (1.1) | 8 (0.2) | <0.001* |
Heart failure, n (%) | 212 (2.2) | 203 (34.4) | 0 | 6 (0.1) | <0.001* |
Hypertension, n (%) | 4078 (42.6) | 408 (69.0) | 3295 (76.6) | 337 (8.1) | <0.001* |
Previous MI, n (%) | 1522 (15.9) | 384 (65.0) | 1006 (23.4) | 114 (2.8) | <0.001* |
Angina, n (%) | 1792 (18.7) | 374 (63.3) | 1322 (30.7) | 80 (1.9) | <0.001* |
Previous PCI, n (%) | 899 (9.4) | 169 (28.7) | 617 (14.4) | 98 (2.4) | <0.001* |
CABG surgery, n (%) | 643 (6.7) | 152 (25.8) | 452 (10.5) | 29 (0.7) | <0.001* |
Discharge medications | |||||
Aspirin, n (%) | 8147 (85.2) | 464 (79.2) | 3626 (84.7) | 3636 (87.9) | <0.001* |
ACE inhibitors, n (%) | 7609 (79.5) | 418 (71.3) | 3389 (79.2) | 3436 (83.1) | <0.001* |
Beta-blockers, n (%) | 7592 (79.7) | 430 (73.4) | 3340 (78. 0) | 3439 (83.1) | <0.001* |
Statin, n (%) | 8140 (85.1) | 477 (81.4) | 3619 (84.6) | 3636 (87.9) | <0.001* |
Rehabilitation | |||||
Cardiac rehabilitation, n (%) | 8509 (88.9) | 502 (85.1) | 3854 (90.3) | 3877 (94.5) | <0.001* |
Long-term health conditions in MI patients
Multimorbidity clusters in MI patients
Factors associated with multimorbidity class membership
Multimorbidity and perceptions of health state
Variable | Multimorbidity class 1 (severe) 591 (6.5%) | Multimorbidity class 2 (moderate) 4301 (47.6%) | Multimorbidity class 3 (mild) 4147 (45.9%) | P value |
---|---|---|---|---|
EQ-5D, mean (SD) | ||||
Baseline | 0.62 (0.31) | 0.71 (0.29) | 0.75 (0.28) | <0.001* |
1 month | 0.61 (0.30) | 0.73 (0.26) | 0.78 (0.24) | <0.001* |
6 months | 0.60 (0.30) | 0.75 (0.26) | 0.82 (0.24) | <0.001* |
12 months | 0.59 (0.30) | 0.76 (0.27) | 0.83 (0.24) | <0.001* |
Utilities: EQ-VAS, mean (SD) | ||||
Baseline | 59.39 (20.83) | 63.08 (20.30) | 64.57 (21.01) | <0.001* |
1 month | 58.95 (19.36) | 68.20 (18.27) | 71.73 (17.73 | <0.001* |
6 months | 59.92 (20.79) | 71.38 (18.54) | 76.39 (17.22) | <0.001* |
12 months | 61.73 (19.43) | 72.05 (18.60) | 77.69 (17.31) | 0.001* |
EQ-5D dimensions baseline | ||||
Mobility | 398 (67.34) | 1833 (42.62) | 1048 (25.27) | <0.001* |
Self-care | 163 (27.58) | 690 (16.04) | 399 (9.62) | <0.001* |
Activities | 370 (62.61) | 2115 (49.17) | 1837 (44.30) | <0.001* |
Pain | 288 (48.73) | 1662 (38.64) | 1178 (28.41) | <0.001* |
Anxiety and depression | 221 (37.39) | 1473 (34.25) | 1381 (33.30) | 0.081 |
EQ-5D 30 days | ||||
Mobility | 264 (71.35) | 1364 (43.86) | 683 (24.03) | <0.001* |
Self-care | 120 (32.61) | 481 (15.49) | 215 (7.58) | <0.001* |
Activities | 275 (74.53) | 1862 (60.06) | 1498 (53.05) | <0.001* |
Pain | 228 (61.79) | 1484 (47.81) | 1077 (38.08) | <0.001* |
Anxiety and depression | 160 (43.72) | 1152 (37.13) | 1066 (37.54) | 0.05 |
EQ-5D 6 months | ||||
Mobility | 209 (70.13) | 1149 (43.31) | 538 (23.08) | <0.001* |
Self-care | 97 (33.33) | 387 (14.63) | 173 (7.42) | <0.001* |
Activities | 216 (71.76) | 1220 (46.02) | 766 (32.90) | <0.001* |
Pain | 208 (69.57) | 1280 (48.25) | 808 (34.71) | <0.001* |
Anxiety and depression | 129 (43.14) | 821 (30.99) | 730 (31.32) | <0.001* |
EQ-5D 12 months | ||||
Mobility | 207 (76.10 | 1080 (44.68) | 477 (22.60) | <0.001* |
Self-care | 97 (35.27) | 389 (16.11) | 166 (7.88) | <0.001* |
Activities | 203 (74.09) | 1091 (45.19) | 571 (27.05) | <0.001* |
Pain | 195 (70.91) | 1126 (46.94) | 673 (32.08) | <0.001* |
Anxiety and depression | 99 (36.00) | 696 (28.88) | 568 (26.92) | 0.006* |
Multimorbidity and HRQoL measured by EQ-5D
Adjusted results from multilevel modelling of longitudinal EQ-VAS, EQ-5D scores, and multimorbidity classes
Variable | Regression coefficient (95% CI) | P value |
---|---|---|
Intercept | 48.39 (40.06 to 56.72) | |
Month, baseline (ref) | ||
1 month | 4.62 (4.04 to 5.19) | <0.001* |
6 months | 3.43 (2.11 to 4.75) | <0.001* |
12 months | −1.10 (−3.55 to 1.35) | 0.38 |
Multimorbidity classes Mild (ref) | ||
Moderate | −0.98 (−1.93 to −0.04) | 0.04 |
Severe | −5.12 (−7.04 to −3.19) | <0.001* |
Diagnosis(STEMI) ref | ||
Diagnosis (NSTEMI) | −0.26 (−1.19 to 0.65) | 0.57 |
Age | 0.12 (0.08 to 0.15) | <0.001* |
Women | −4.17 (−5.02 to −3.32) | <0.001* |
Ethnicity White | 0.81 (−1.61 to 3.24 | 0.51 |
Ex/current smoking status | −1.07 (−1.84 to -0.30) | 0.01 |
Previous MI | −1.37 (−2.64 to −0.10) | 0.03 |
Previous Angina | −2.15 (−3.27 to −1.04) | <0.001* |
Treatments | ||
Previous PCI | −1.53 (−2.96 to 0.11) | 0.035 |
Previous CABG surgery | −3.03 (−4.64 to −1.42) | <0.001* |