Gender differences in health-related quality of life and psychological distress among coronary patients: Does comorbidity matter? Results from the ESC EORP EUROASPIRE V registry

Highlights

• Substantial gender differences in patients' HRQoL.

• Women had worse HRQoL when having comorbidities.

• Being a women and having a comorbidity was associated with a decrease in HRQoL.

Abstract

Aims

This study aimed to provide an overview on contemporary gender differences in HRQoL/psychological distress and their relationship with comorbidity burden among European coronary heart disease (CHD) patients.

Methods

Analyses were based on the cross-sectional ESC EORP EUROASPIRE V survey. Consecutive patients (aged 18–80 years), hospitalized for a first or recurrent coronary event were included in this study. Data at hospital discharge and at follow-up (6 to 24 months after hospitalisation) were collected.

Results

Data were available for 8261 patients of which 25.8% women. Overall, women reported a worse EQ-5D-5L index score (0.73 vs. 0.81; P < 0.001), EQ-VAS (63.1 vs. 66.0; P = 0.001), global HeartQoL (1.94 vs. 2.26; P < 0.001), physical HeartQoL (1.96 vs. 2.30; P < 0.001), emotional HeartQoL (1.88 vs. 2.18; P < 0.001), HADS-A (6.69 vs. 4.99; P < 0.001), and HADS-D (5.73 vs. 4.62; P < 0.001) compared to men. Also, women were more likely to have comorbidities compared to men (1 comorbidity: 38.7% vs. 35.0%, 2 comorbidities: 9.7% vs. 7.5%; P < 0.001). There is indication that heart failure (EQ-VAS) and diabetes (global HeartQoL, emotional HeartQoL, physical HeartQoL, and HADS-D) interacted with gender and modulate the relationship with HRQoL, in disfavour of women.

Conclusion

Substantial gender-based health inequalities in terms of HRQoL and psychological distress were found, in disfavour of women. Women had worse HRQoL and psychological distress outcomes when having comorbidities. To a limited extent, comorbidity and women had a negative/synergistic effect on HRQoL. Special attention should be given to this population groups within daily clinical practice.

Introduction

During the last decades, there is growing interest into health-related quality of life (HRQoL) as a key health outcome indicator [1]. In general, HRQoL captures individuals' self-perceived impact of a medical condition, its symptoms and treatment on their physical, mental and social well-being [1], which is of particular importance in patients with chronic diseases [1,2]. Previous studies reported substantially impaired HRQoL outcomes in patients with coronary heart disease (CHD) compared to the general population, especially on the physical and emotional dimension [3,4]. Indeed, it is found that women have an increased risk of having psychological distress in terms of anxiety/depression compared to men [5]. In addition, studies showed that CHD patients suffering from comorbidities reported even worse HRQoL outcomes [2,6,7].

Moreover, several studies found gender differences in the HRQoL and psychological distress of CHD patients, mostly in disfavour of women [[8], [9], [10]]. Although gender differences in HRQoL are also present in the general population [11], these differences tends to be more pronounced in CHD patients [11,12]. Lower HRQoL outcomes in female CHD patients can be partially explained by the higher comorbidity burden in women due to their higher age [2,7]. Especially since women were more likely to report a lower HRQoL compared to men, it is important to examine the relationship between gender and comorbidity burden [2,6,7]. However, detailed evidence on gender differences and their association with comorbidities and HRQoL is lacking [7,13]. A better understanding of this association is needed to better manage the impact of HRQoL on CHD burden. The aim of this study is to provide an overview on contemporary gender differences in HRQoL in relation with comorbidity burden among European coronary patients. Analyses were based on data from the most recent ESC EORP EUROASPIRE V survey.