Quality of life four years after acute myocardial infarction: short form 36 scores compared with a normal population

Objectives-To assess the impact of myocardial infarction on quality of life in four year survivors compared to data from "community norms", and to det ermine factors associated with a poor qualify of life. Design-Cohort study based on the Nottingham heart attack register. Setting-Two district general hospitals serving a defined urban/rural popula tion. Subjects-All patients admitted with acute myocardial infarction during 1992 and alive at a median of four years. Main outcome measures-Short form 36 (SF 36) domain and overall scores. Results-Of 900 patients with an acute myocardial infarction in 1992, there were 476 patients alive and capable of responding to a questionnaire in 199 7. The response rate was 424 (89.1%). Compared to age and sex adjusted norm ative data, patients aged under 65 years exhibited impairment in all eight domains, the largest differences being in physical functioning (mean differ ence 20 points), role physical (mean difference 23 points), and general hea lth (mean difference 19 points). In patients over 65 years mean domain scor es were similar to community norms. Multiple regression analysis revealed t hat impaired quality of life was closely associated with inability to retur n to work through ill health, a need for coronary revascularisation, the us e of anxiolytics, hypnotics or inhalers, the need for two or more angina dr ugs, a frequency of chest pain one or more times per week, and a Rose dyspn oea score of greater than or equal to 2. Conclusions-The SF 36 provides valuable additional information for the prac tising clinician. Compared to community norms the greatest impact on qualit y of life is seen in patients of working age. Impaired quality of Life was reported by patients unfit for work, those with angina and dyspnoea, patien ts with coexistent lung disease, and those with anxiety and sleep disturban ces. Improving quality of life after myocardial infarction remains a challe nge for physicians.