Quality of Life and Associated Factors among Patient with Coronary Artery Disease who Underwent Coronary Revascularization Interventions at Jakaya Kikwete Cardiac Institute

Abstract

Background: Both percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) have shown to improve health related quality of life (HRQOL) in terms of physical, emotional, and social functions. This is probably related to reduction of angina symptoms and ischemic complications in patients with coronary artery disease (CAD). To our knowledge, the nature of HRQOL among this group of patients remains unknown in Tanzania. Objective: We aimed at assessing the quality of life and associated factors following PCI and CABG amongst patients with CAD who attended Jakaya Kikwete Cardiac Institute (JKCI). Methodology: We conducted a descriptive cross-sectional study amongst patients who underwent PCI and CABG from January 2018 to December 2019 at JKCI. The HRQOL was assessed by using the MacNew heart disease HRQOL questionnaire. The tool has 27 questions, each question has maximum of 7 scores with a total of 189 scores measured as continuous data. The tool assesses each individual in terms of 3 domains. Physical functioning 13 elements, social functioning 13 elements, emotional functioning 14 elements and 5 elements for angina symptoms. One question out of 27 can have more than 2 elements. We used the following mean scoring algorithm: low ( 4.9), moderate (5 - 6), high (>6) for the global scale and for physical, emotional and social subscale scores. HRQOL before and after procedure was not assessed, we assessed patients six months to twenty months after the procedure. Clinical data include BMI, RBG, type of procedure, number of vessels involved, comorbidities example; hypertension, diabetes, stroke, heart failure and others were obtained from the patients and the hospital medical records. Data were analyzed using SPSS version 23. Summary statistics was reported as means with standard deviation for continuous data, inferential statistics and frequency for categorical data. ANOVA and T-Test were used to compare different means of continuous variables. Multiple linear regression model was used to determine factors related to the quality of life in patients underwent coronary interventions Results: This study found that, among 424 coronary artery disease patients who attended JKCI between January 2018 and December 2019, 181 patients underwent CABG and PCI. 162(89.5) patients with complete clinical data were included in this study. The mean (SD) age was 66 ± 9. Male patients were 114(70.4%), 89(54.9%) were residing in Dar es salaam, 105(64.8%) had history of cigarette smoking, 159(98.1%) had health insurance coverage, 128(79%) had body mass index > 25kg/m2 , (138(85%) had diabetes mellitus, and 65(41%) had single vessel involvement, 47(29%) had double vessels involvement, 48(30%) had triple vessels disease. The internal consistency for the three domains in the MacNew questionnaire (Cronbach’s alpha coefficient) was 0.94. An overall HRQOL mean (SD) score was 5.51(0.92). The mean (SD) scores were statistically significant higher in the emotional 5.84(0.68) than social 5.5(0.93) and physical domains 5.01(1.34) {p<0.001}. CABG has better mean (SD) score as compared to PCI in terms of all domains i.e., emotional 6.12(0.63) vs 5.76(0.67) than social 5.84(0.88) vs 5.40(0.93) and physical domains 5.37(1.46) vs 4.90(1.29) Multiple linear regression analysis revealed that being a resident of Dar es Salaam (p=0.047), having a secondary and college education (p=0.003 and p=0.024 respectively), absence of history of taking alcohol (p=0.002), absence of history of cigarette smoking (p=0.002), and single vessels involved (p= 0.003) were determinants of better quality of life Conclusion and recommendation This study showed improvement in QOL with an overall moderate HRQOL scores among patients who underwent PCI and CABG at JKCI. The independent predictors for the better HRQOL were being residing in Dar es Salaam, higher level of education, absence of history of alcohol intake, absence of history of cigarette smoking, and single vessel disease. These factors should be addressed by health care providers while planning for PCI and CABG interventions by providing health education on how to address the modifiable risk factors. Patients who undergoing cardiac interventions should be routinely screened for HRQOL since MacNew was shown to be reliable in our study