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HRQL assessment useful for identifying high risk patients

Health-related quality of life (HRQL) is an increasingly well-recognized measure of health outcome in cardiology. HRQL was examined as predictor of unplanned rehospitalization for cardiac reasons in patients after coronary revascularization over a period of 3 years. Two independent studies found the MacNew to be a helpful predictor for identifying high risk patients.

Bender et al enrolled 791 patients in a study, 743 completed the MacNew HRQL questionnaire after coronary revascularization. MacNew HRQL scores were used as predictors of unplanned rehospitalization.

Within the 3-year follow-up period, 125 patients (16.8 %) were rehospitalized. After adjustment for age, gender, and myocardial infarction as the initiating event, there were significant differences in unplanned rehospitalization rates between patients with low or moderate vs. high MacNew HRQL global scores (HR: 1.8, 95 % CI: 1.2–2.7) and both physical (HR: 2.2, 95 % CI: 1.4–3.5) and social (HR: 1.8, 95 % CI: 1.2–2.7) subscale scores.

Poor HRQL assessed after coronary revascularization appears to be a powerful predictor of rehospitalization over a 3-year period. (Benzer et al. 2016)

Baldi et al. (2016) analyzed in a retrospective study 210 patients. The clinical sheets of these patients were examined as regards the information provided in the specific questionnaires (MacNew Italian version) routinely administered during the hospitalization prescribed for recovering from recent interventions of coronary percutaneous or surgery revascularization. Every patient undergoing the psychological test with MacNew questionnaire was followed up for 3 years.

Using univariate analysis, a global score’s high value (i.e., above the median of the whole examined population) was shown to be associated with a significantly decreased risk of rehospitalization (HR (hazard ratio): 0.4312; 95% CI: 0.3463 – 0.5370; P < 0.0001). After adjustment for age, gender and myocardial infarction as initiating event, using a multivariate Cox proportional hazards regression model, the protection exerted by a high MacNew score against the risk of hospitalizations remained significant (HR: 0.0885; 95% CI: 0.0317 – 0.2472; P < 0.0001).

A relatively elevated MacNew global score appears to be associated with a significantly decreased risk of unscheduled hospitalizations after coronary revascularization over a 3-year follow-up.

The MacNew can be used for risk stratification in clinical routine.