Survivors of an Acute Coronary Syndrome With Lower Patient Activation Are More Likely to Experience Declines in Health-Related Quality of Life.
Nathaniel A Erskine, Barbara Gandek, Molly E Waring and 6 others
PMID 28574974WHAT IT FOUND
One month after acute coronary syndrome, patients with the lowest self-care confidence and skills were more likely to have meaningful mental and disease-specific quality-of-life declines by 6 months; physical quality-of-life changes did not differ.
Key findings
01Patients with the lowest patient activation had 1.95 times the odds of a clinically meaningful decline in mental HRQOL between 1 and 6 months after discharge compared with the most activated patients.
02Patients with the lowest patient activation had 2.69 times the odds of a clinically meaningful decline in disease-specific HRQOL between 1 and 3 months and 2.18 times the odds between 1 and 6 months after discharge compared with the most activated patients.
03Lower patient activation was not associated with clinically meaningful changes in generic physical HRQOL.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
1,042 of 1,529 patients who completed the 1-month interview were analysed, and excluded patients were younger, more likely to be non-Hispanic Black, less educated, more likely to report financial strain, and more likely to lack health insurance. The study was observational and did not test an activation intervention, so it shows associations rather than proof that low activation causes worse quality of life. Completion of cardiac rehabilitation was not included in the analysis, so it could have influenced the results. The 6-item activation measure has more limited data for patients with an acute coronary syndrome than the longer 13-item version. The paper did not find an association between lower activation and meaningful changes in physical quality of life.
Declared interests
The authors declared no conflicts of interest. The supplied publication types indicate NIH extramural research support, but the article text does not state that a sponsor designed or wrote the study.
The easy way to misread this
Do not conclude that low patient activation causes quality-of-life decline or that an activation intervention would prevent it. This was an observational cohort, and the study did not test an intervention; it also found no association with physical HRQOL changes.