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Patient-reported outcomes, sociodemographic and clinical factors are associated with 1-year mortality in patients with ischemic heart disease—findings from the DenHeart cohort study

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Abstract

Purpose

In patients with ischemic heart disease, the objectives were (1) to explore associations between patient-reported outcomes, sociodemographic, and clinical factors at discharge and 1-year all-cause mortality and (2) to investigate the discriminant predictive performance of the applied patient-reported outcome instruments on 1-year all-cause mortality.

Methods

Data from the Danish national DenHeart cohort study were used. Eligible patients (n = 13,476) were invited to complete a questionnaire-package, of which 7167 (53%) responded. Questionnaires included the 12-item Short form health survey (SF-12), Hospital anxiety and depression scale (HADS), EQ-5D, HeartQoL, Edmonton symptom assessment scale (ESAS), and ancillary questions on, e.g., social support. Clinical and demographic characteristics were obtained from registers, as were data on mortality. Comparative analyses were used to investigate differences in patient-reported outcomes. Mortality associations were explored using multifactorially adjusted Cox regression analyses. Predictive performance was analyzed using receiver operating characteristics (ROC).

Results

Patient-reported outcomes at discharge differed among those alive versus those deceased at one year, e.g., depression (HADS-Depression ≥ 8) 19% vs. 44% (p < 0.001). Associations with 1-year mortality included feeling unsafe about returning home from the hospital; hazard ratio (HR) 2.07 (95% CI 1.2–3.61); high comorbidity level, HR 3.6 (95% CI 2.7–4.8); and being unmarried, HR 1.60 (95% CI 1.33–1.93). Best predictive performance was observed for SF-12 physical component summary (Area under the curve (AUC) 0.706).

Conclusion

Patient-reported health, sociodemographic, and clinical factors are associated with 1-year mortality. We propose systematic screening with robust predictive tools to identify patients at risk and healthcare initiatives to explore and offer effective treatment to modify patient-reported health indicators.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

Our gratitude to all the patients who took the time at a difficult stage in their life to fill out our questionnaire and to the healthcare staff who assisted us in the data collection. Thank you to Novo Nordisk Foundation and the participating heart centers for funding the DenHeart survey and to Herlev and Gentofte University Hospital, department of cardiology, for funding the current study. Finally, a special thank you to Phil Helfter for proof-reading the manuscript.

Funding

The study was funded by the five participating Heart centers and the Novo Nordisk Foundation (NNF130C0007229). The Heart centers participated in the collection of patient-reported outcomes, but neither they nor the Novo Nordisk Foundation influenced any part of study design or data interpretation.

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Authors and Affiliations

Authors

Contributions

SKB conceived the idea for the DenHeart survey and TBR for the current sub-study. TBR and BB performed the statistical analyses. TBR drafted the manuscript. All co-authors revised the manuscript critically.

Corresponding author

Correspondence to Trine Bernholdt Rasmussen.

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Conflict of interest

Authors have no competing interests.

Ethical approval

The study was approved by the national data protection agency (reg. 2007-58-0015/30-0937). The Danish National Board of Health approved the use of register data (FSEID-01131). The study fully complies with the declaration of Helsinki and was registered at ClinicalTrials.gov (NCT 019-6145) and approved by the institutional boards of the participating heart centers. Surveys are not required by Danish legislation to be approved by humans’ ethics committee.

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All included patients signed informed consent.

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With their informed consent, participants agreed to the publication of results.

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Rasmussen, T.B., Borregaard, B., Palm, P. et al. Patient-reported outcomes, sociodemographic and clinical factors are associated with 1-year mortality in patients with ischemic heart disease—findings from the DenHeart cohort study. Qual Life Res 31, 389–402 (2022). https://doi.org/10.1007/s11136-021-02956-5

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