Unstable angina (UA) patients have lower mortality and reinfarction risks than ST-elevation (STEMI) or non-ST elevation myocardial infarction (NSTEMI) patients and, accordingly, receive less aggressive treatment. Little is known, however, about the health status outcomes (angina, physical function, and quality of life) of UA versus MI patients among survivors of an ACS hospitalization.
In a cohort of 1,192 consecutively enrolled ACS survivors from two Kansas City hospitals, we evaluated the associations between ACS presentation (UA, NSTEMI, and STEMI) and one-year health status (angina, physical functioning and quality of life), one-year cardiac rehospitalization rates, and two-year mortality outcomes, using multivariable regression modeling.
After multivariable adjustment for demographic, hospital, co-morbidity, baseline health status, and treatment characteristics, UA patients had a greater prevalence of angina at 1 year than STEMI patients (adjusted relative risk [RR] = 1.42; 95% CI [1.06, 1.90]) and similar rates as NSTEMI patients (adjusted RR = 1.1; 95% CI [0.85, 1.42]). In addition, UA patients fared no better than MI patients in Short Form-12 physical component scores (UA vs. STEMI score difference -0.05 points; 95% CI [-2.41, 2.3]; UA vs. NSTEMI score difference -1.91 points; 95% CI [-4.01, 0.18]) or Seattle Angina Questionnaire quality of life scores (UA vs. STEMI score difference -1.39 points; 95% CI [-5.63, 2.85]; UA vs. NSTEMI score difference -0.24 points 95% CI [-4.01, 3.54]). Finally, UA patients had similar rehospitalization rates as MI patients (UA vs. STEMI adjusted hazard ratio [HR] = 1.31; 95% CI [0.86, 1.99]; UA vs. NSTEMI adjusted HR = 1.03; 95% CI [0.73, 1.47]), despite better 2-year survival (UA vs. STEMI adjusted HR = 0.51; 95% confidence interval (CI) [0.28, 0.95]; UA vs. NSTEMI adjusted HR = 0.40; 95% CI [0.24, 0.65]).
Although UA patients have better survival rates, they have similar or worse one-year health status outcomes and cardiac rehospitalization rates as compared with MI patients. Clinicians should be aware of the adverse health status outcome risks for UA patients and consider close monitoring for the opportunity to improve their health status and minimize the need for subsequent rehospitalization.
Acute coronary syndrome (ACS) clinical presentations, including ST-elevation myocardial infarction [STEMI], non-ST-elevation myocardial infarction [NSTEMI], and unstable angina [UA], are associated with different mortality and recurrent myocardial infarction (MI) rates 1-4. Accordingly, optimal ACS management, as outlined in the American College of Cardiology/American Heart Association guidelines, stratifies and treats patients differently according to their presentation so that those with the greatest mortality risk receive the most aggressive therapy 1,5-8. However, mortality and rehospitalization are not the only clinically important outcomes. Patient health status outcomes, including their symptom burden, functional status, and health-related quality of life, are critical outcomes from the patient's perspective 9-12. Accordingly, patient health status has recently been advocated as a marker of healthcare quality 13-15.
Despite its clinical importance, little is known about the association between ACS presentation and health status outcomes, especially among UA patients. Given that many cardiac patients are initially identified during an ACS presentation, characterizing this association from the perspective of this presentation is essential to better prognosticate and treat patients with symptomatic coronary disease. Accordingly, we evaluated one-year health status outcomes in a consecutive cohort of ACS patients as a function of their clinical presentation. Identifying patients at risk for poorer health status could identify the need for improved methods of risk stratification so as to improve care and outcomes in ACS patients./>/>/>
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