EQ-5D in coronary patients: what are they suffering from? Results from the ESC EORP European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE IV) Registry

  • Delphine De SmedtEmail author
  • Kornelia Kotseva
  • Guy De Backer
  • David Wood
  • Lisa Van Wilder
  • Dirk De Bacquer



Coronary patients often suffer from an impaired health, hence the aim of this study is to assess how coronary patients score on the different EQ-5D dimensions.


Analyses are based on the EUROASPIRE IV survey, conducted across 24 European countries. 7567 patients with stable coronary heart disease (mean age = 64.1 (SD = 9.6); males = 75.8%) completed the EQ-5D-5L instrument, 6 months to 3 years after their index hospitalization. Descriptive statistics and multilevel logistic regression was used to assess the differences between patient groups in reported problems on the EQ-5D dimensions. Furthermore, age-standardized country-specific outcomes were reported.


About one out of four patients reported to have no problems on all five dimensions (57.9% reported no problems on mobility, 88.4% reported no problems on self-care, 67.1% reported no problems on usual activities, 41.1% reported no problems on pain/discomfort, and 56.2% reported no problems on anxiety/depression). Elderly patients and females reported more problems. Patients with behavioral risk factors and patients with comorbidities were more likely to have severe or extreme problems. Comparison across countries showed major differences in reported problems.


Whether or not coronary patients have problems on one or more EQ-5D dimension, as well as the severity of the problems reported is largely associated with the patient profile. The least problems are seen on the self-care dimension and most problems are reported on the pain/discomfort dimension.


Coronary heart disease EQ-5D EUROASPIRE Health-related quality of life 



This work was supported by AstraZeneca, Bristol Myers Squibb/Emea Sarl, GlaxoSmithKline, F Hoffman–La Roche (Gold Sponsors), Merck, Sharp & Dohme and Amgen (Bronze Sponsors) (unrestricted research Grants to the European Society of Cardiology). The EUROASPIRE IV survey was carried out under the auspices of the European Society of Cardiology, EURObservational Research Programme. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript. The EUROASPIRE Study Group is grateful to the administrative staff, physicians, nurses and other personnel in the hospitals in which the survey was carried out and to all patients who participated in the surveys. EORP Oversight Committee, Executive Committee of the EURObservational Research Programme (EORP): Guy De Backer BE (Chair); Dirk De Bacquer, BE; Stephan Gielen, DE; Oliver Schnell, DE; Jouko Sundvall, FI; Jaakko Tuomilehto, FI; Philippe Amouyel, FR; Kornelia Kotseva, GB; David Wood, GB; Aldo P. Maggioni, IT; Lars Ryden, SE. Steering Committee: Mirza Dilic, BA; Belma Pojskic, BA; Dusko Vulic, BA; Dirk De Bacquer, BE; Johan De Sutter, BE; Nina Gotcheva, BG; Evagoras Nicolaides, CY; Jan Bruthans, CZ; Renata Cifkova, CZ; Peter Heuschmann, DE; Stefan Stoerk, DE; Almudena Castro Conde, ES; Seppo Lehto, FI; Philippe Amouyel, FR; Kornelia Kotseva, GB; David Wood, GB; Ioannis Goudevenos, GR; Davor Milicic, HR; Zeljko Reiner, HR; Bela Merkely, HU; David Moore, IE; Diego Vanuzzo, IT; Kairat Davletov, KZ; Aleksandras Laucevicius, LT; Andrejs Erglis, LV; Jaap Deckers, NL; Monika Hollander, NL; Andrzej Pajak, PL; Ana Abreu, PT; Carlos Tavares Aguiar, PT; Dan Gaita, RO; Silvia Mancas, RO; Nebojsa Lalic, RS; Dragan Lovic, RS; Rafael Oganov, RU; Nana Pogosova, RU; Viveca Gyberg, SE; Martin Stagmo, SE; Zlatko Fras, SI; Lale Tokgozoglu, TR; Maryna Dolzhenko, UA. The registry was managed and organized by the EORP department including Myriam Glemot as Project Officer, Marème Konte as Data Monitor. Overall activities were coordinated and supervised by Professor Aldo P. Maggioni (EORP Scientific Coordinator) and Thierry Ferreira (Head of EORP Department).


This work was supported by AstraZeneca, Bristol Myers Squibb/Emea Sarl, GlaxoSmithKline, F Hoffman–La Roche (Gold Sponsors), Merck, Sharp & Dohme and Amgen (Bronze Sponsors) (unrestricted research Grants to the European Society of Cardiology).

Compliance with ethical standards

Conflict of interest

None of the authors have a conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Local Research Ethics Committees approvals were obtained from each of the 74 participating centres.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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11136_2019_2334_MOESM4_ESM.docx (11 kb)
Supplementary material 3 (DOCX 12 kb)


  1. 1.
    Thompson, D. R., & Yu, C. M. (2003). Quality of life in patients with coronary heart disease-I: Assessment tools. Health Qual Life Outcomes,1, 42.CrossRefGoogle Scholar
  2. 2.
    Schipper, H., Clinch, J., & Olweny, C. L. (1996). Quality of life studies: Definitions and conceptual issues. In S. B. Editor (Ed.), Quality of life and pharmacoeconomics in clinical trials. Philadelphia, PA: Lippincott-Raven.Google Scholar
  3. 3.
    WHO, Top 10 Causes of Death. Retrieved December 12, 2018, from
  4. 4.
    Wilkins, E., Wilson, L., Wickramasinghe, K., Bhatnagar, P., Leal, J., Luengo-Fernandez, R., et al. (2017). European cardiovascular disease statistics. Retrieved December 12, 2018, from
  5. 5.
    IHME. (2017). Global burden of disease. Retrieved December 12, 2018, from
  6. 6.
    Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., et al. (2016). 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). European Heart Journal,37(29), 2315–2381.CrossRefGoogle Scholar
  7. 7.
    De Smedt, D., Clays, E., Annemans, L., Pardaens, S., Kotseva, K., & De Bacquer, D. (2015). Self-reported health status in coronary heart disease patients: A comparison with the general population. The European Journal of Cardiovascular Nursing,4(2), 117–125.CrossRefGoogle Scholar
  8. 8.
    Dickens, C., Cherrington, A., & McGowan, L. (2012). Depression and health-related quality of life in people with coronary heart disease: A systematic review. The European Journal of Cardiovascular Nursing,11(3), 265–275.CrossRefGoogle Scholar
  9. 9.
    Mollon, L., & Bhattacharjee, S. (2017). Health related quality of life among myocardial infarction survivors in the United States: A propensity score matched analysis. Health and Quality of Life Outcomes,15(1), 235.CrossRefGoogle Scholar
  10. 10.
    Schweikert, B., Hunger, M., Meisinger, C., König, H. H., Gapp, O., & Holle, R. (2009). Quality of life several years after myocardial infarction: Comparing the MONICA/KORA registry to the general population. European Heart Journal,30(4), 436–443.CrossRefGoogle Scholar
  11. 11.
    Lee, H. T., Shin, J., Lim, Y. H., Kim, K. S., Kim, S. G., Kim, J. H., et al. (2015). Health-related quality of life in coronary heart disease in Korea: The Korea National Health and Nutrition Examination Survey 2007 to 2011. Angiology,66(4), 326–332.CrossRefGoogle Scholar
  12. 12.
    EuroQol. Retrieved December 12, 2018, from
  13. 13.
    Feng, Y., Devlin, N., & Herdman, M. (2015). Assessing the health of the general population in England: How do the three- and five-level versions of EQ-5D compare? Health and Quality of Life Outcomes,13, 171.CrossRefGoogle Scholar
  14. 14.
    Parkin, D., Devlin, N., & Feng, Y. (2016). What determines the shape of an EQ-5D index distribution? Medical Decision Making,36(8), 941–951.CrossRefGoogle Scholar
  15. 15.
    Parkin, D., Rice, N., & Devlin, N. (2010). Statistical analysis of EQ-5D profiles: Does the use of value sets bias inference? Medical Decision Making,30(5), 556–565.CrossRefGoogle Scholar
  16. 16.
    Devlin, N., Parkin, D., & Browne, J. (2010). Patient-reported outcome measures in the NHS: New methods for analysing and reporting EQ-5D data. Health Economics,19(8), 886–905.CrossRefGoogle Scholar
  17. 17.
    Dyer, M. T., Goldsmith, K. A., Sharples, L. S., & Buxton, M. J. (2010). A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health and Quality of Life Outcomes,8, 13.CrossRefGoogle Scholar
  18. 18.
    Gencer, B., Rodondi, N., Auer, R., Nanchen, D., Räber, L., Klingenberg, R., et al. (2016). Health utility indexes in patients with acute coronary syndromes. Open Heart,3, e000419.CrossRefGoogle Scholar
  19. 19.
    Kotseva, K., Wood, D., De Bacquer, D., De Backer, G., Rydén, L., Jennings, C., et al. (2016). EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. European Journal of Preventive Cardiology,23(6), 636–648.CrossRefGoogle Scholar
  20. 20.
    Janssens, M. F., Bonsel, G. J., & Luo, N. (2018). Is EQ-5D-5L better than EQ-5D-3L? A head-to-head comparison of descriptive systems and value sets from seven countries. Pharmacoeconomics,36(6), 675–697.CrossRefGoogle Scholar
  21. 21.
    Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. L., Castro, A. F., 3rd, Feldman, H. I., et al. (2009). A new equation to estimate glomerular filtration rate. Annals of Internal Medicine,150(9), 604–612.CrossRefGoogle Scholar
  22. 22.
    Xie, J., Wu, E. Q., Zheng, Z. J., Sullivan, P. W., Zhan, L., & Labarthe, D. R. (2008). Patient-reported health status in coronary heart disease in the United States: Age, sex, racial, and ethnic differences. Circulation,118(5), 491–497.CrossRefGoogle Scholar
  23. 23.
    Tusek-Bunc, K., & Petek, D. (2016). Comorbidities and characteristics of coronary heart disease patients: Their impact on health-related quality of life. Health and Quality of Life Outcomes,14(1), 159.CrossRefGoogle Scholar
  24. 24.
    De Smedt, D., Clays, E., Annemans, L., & De Bacquer, D. (2014). EQ-5D versus SF-12 in coronary patients: Are they interchangeable? Value in Health,17(1), 84–89.CrossRefGoogle Scholar
  25. 25.
    De Luca, L., Temporelli, P. L., Lucci, D., Colivicchi, F., Calabrò, P., Riccio, C., et al. (2018). Characteristics, treatment and quality of life of stable coronary artery disease patients with or without angina: Insights from the START study. PLoS ONE,13(7), e0199770.CrossRefGoogle Scholar
  26. 26.
    Höfer, S., Kullich, W., Graninger, U., Brandt, D., Gassner, A., Klicpera, M., et al. (2006). Cardiac rehabilitation in Austria: Short term quality of life improvements in patients with heart disease. Wiener Klinische Wochenschrift,118(23–24), 744–753.CrossRefGoogle Scholar
  27. 27.
    Cavrini, G., Broccoli, S., Puccini, A., Zoli, M. (2012). EQ-5D as a predictor of mortality and hospitalization in elderly people. Quality of Life Research, 21(2), 269–280.CrossRefGoogle Scholar
  28. 28.
    De Smedt, D., Clays, E., Höfer, S., Oldridge, N., Kotseva, K., Maggioni, A. P., et al. (2013). Health related quality of life in coronary patients and its association with their cardiovascular risk profile: Results from the EUROASPIRE III survey. International Journal of Cardiology,168(2), 898–903.CrossRefGoogle Scholar
  29. 29.
    Ose, D., Rochon, J., Campbell, S. M., Wensing, M., van Lieshout, J., Uhlmann, L., et al. (2012). Secondary prevention in patients with coronary heart diseases: What factors are associated with health status in usual primary care? PLoS ONE,7(12), e51726.CrossRefGoogle Scholar
  30. 30.
    Szende, A., & Williams, A. (2004). Measuring self-reported population health: An international perspective based on EQ-5D. Retrieved December 12, 2018, from
  31. 31.
    Sach, T. H., Barton, G. R., Doherty, M., Muir, K. R., Jenkinson, C., & Avery, A. J. (2007). The relationship between body mass index and health-related quality of life: Comparing the EQ-5D, EuroQol VAS and SF-6D. International Journal of Obesity (London),31(1), 189–196.CrossRefGoogle Scholar
  32. 32.
    Busutil, R., Espallardo, O., Torres, A., Martínez-Galdeano, L., Zozaya, N., & Hidalgo-Vega, Á. (2017). The impact of obesity on health-related quality of life in Spain. Health and Quality of Life Outcomes,15(1), 197.CrossRefGoogle Scholar
  33. 33.
    Ludt, S., Wensing, M., Szecsenyi, J., van Lieshout, J., Rochon, J., Freund, T., et al. (2011). Predictors of health-related quality of life in patients at risk for cardiovascular disease in European primary care. PLoS ONE,6(12), e29334.CrossRefGoogle Scholar
  34. 34.
    Fortuno-Godes, J., Guerra-Balic, M., & Cabedo-Sanroma, J. (2013). Health-related quality of life measures for physically active elderly in community exercise programs in catalonia: Comparative analysis with sedentary people. Current Gerontology and Geriatrics Research,2013, 168482.CrossRefGoogle Scholar
  35. 35.
    Dagner, V., Clausson, E. K., & Jakobsson, L. (2019). Prescribed physical activity maintenance following exercise based cardiac rehabilitation: Factors predicting low physical activity. The European Journal of Cardiovascular Nursing,18, 21–27.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Public Health and Primary CareGhent UniversityGhentBelgium
  2. 2.National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland
  3. 3.Imperial College Healthcare NHS TrustLondonUK
  4. 4.National Heart and Lung Institute, Imperial College LondonLondonUK

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