SpringerLink
Log in

The association between health-related quality of life, self-reported characteristics and 1- and 3-year mortality amongst cardiac patients with and without type 2 diabetes

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

The objectives amongst cardiac patients with and without type 2 diabetes were to (i) describe self-reported characteristics as health-related quality of life (HRQoL), health behaviour, body mass index (BMI) and physical shape and to (ii) investigate the association between self-reported characteristics and 1- and 3-year mortality.

Methods

Adult patients (≥ 18 years) discharged with a cardiac diagnosis were invited to participate in a national survey, DenHeart. Self-reported characteristics included HRQoL (EQ-5D-5L and HeartQol), health behaviour (alcohol and smoking), BMI and physical shape. Data were linked to national registries. The association between self-reported characteristics and 1- and 3-year mortality were investigated using the Cox Proportional Hazard Regression model, reported as hazard ratios (HR) with 95% confidence intervals (CI).

Results

In total, 16,659 cardiac responders were included (n = 2,205 with type 2 diabetes, n = 14,454 without type 2 diabetes). Self-reported characteristics were worse amongst cardiac patients with type 2 diabetes compared to those without. After three years, the mortality rate was 14% amongst responders with diabetes and 7% amongst responders without type 2 diabetes (p ≤ 0.001). Better HRQoL was associated with a reduced risk of mortality amongst both groups. “Never been smoking” significantly reduced the risk of 1- and 3-year mortality amongst cardiac patients without diabetes, whereas good physical shape was associated with a reduced risk across both groups.

Conclusion

HRQoL, health behaviour, BMI and physical shape are significantly worse amongst cardiac patients with type 2 diabetes. Better HRQoL was associated with a reduced risk of mortality amongst both groups, whereas other self-reported characteristics and the mortality risk varied.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (France)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Leon, B. M., & Maddox, T. M. (2015). Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World Journal of Diabetes, 6(13), 1246–1258.

    Article  Google Scholar 

  2. Cosentino, F., Grant, P. J., Aboyans, V., Bailey, C. J., Ceriello, A., Delgado, V., Federici, M., Filippatos, G., Grobbee, D. E., Hansen, T. B., & Huikuri, H. V. (2019). ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collabration with the EASD. European Heart Journal, 2019, 1–69.

    Google Scholar 

  3. Joubert, M., Manrique, A., Cariou, B., & Prieur, X. (2019). Diabetes-related cardiomyopathy: The sweet story of glucose overload from epidemiology to cellular pathways. Diabetes & Metabolism, 45(3), 238–247.

    Article  CAS  Google Scholar 

  4. Golicki, D., Dudzinska, M., Zwolak, A., & Tarach, J. S. (2015). Quality of life in patients with type 2 diabetes in Poland - comparison with the general population using the EQ-5D questionnaire. Advances in Clinical and Experimental Medicine: Official organ Wroclaw Medical University, 24(1), 139–146.

    Article  Google Scholar 

  5. Anillo Arrieta, L. A., Acosta Vergara, T., Tuesca, R., Rodríguez Acosta, S., Flórez Lozano, K. C., Aschner, P., Gabriel, R., De La Rosa, S., Nieto Castillo, J. P., & Barengo, N. C. (2021). Health-related quality of life (HRQoL) in a population at risk of type 2 diabetes: A cross-sectional study in two Latin American cities. Health and Quality of Life Outcomes, 19(1), 269.

    Article  Google Scholar 

  6. Adriaanse, M. C., Drewes, H. W., van der Heide, I., Struijs, J. N., & Baan, C. A. (2016). The impact of comorbid chronic conditions on quality of life in type 2 diabetes patients. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 25(1), 175–182.

    Article  Google Scholar 

  7. Sajobi, T. T., Wang, M., Awosoga, O., Santana, M., Southern, D., Liang, Z., Galbraith, D., Wilton, S. B., Quan, H., Graham, M. M., & James, M. T. (2018). Trajectories of health-related quality of life in coronary artery disease. Circulation: Cardiovascular Quality and Outcomes, 11(3), e003661.

    Google Scholar 

  8. Berg, S. K., Rasmussen, T. B., Thrysoee, L., Lauberg, A., Borregaard, B., Christensen, A. V., Ekholm, O., Juel, K., & Svanholm, J. R. (2017). DenHeart: Differences in physical and mental health across cardiac diagnoses at hospital discharge. Journal of Psychosomatic Research, 94, 1–9.

    Article  Google Scholar 

  9. Landman, G. W., van Hateren, K. J., Kleefstra, N., Groenier, K. H., Gans, R. O., & Bilo, H. J. (2010). Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18). Diabetes Care, 33(11), 2378–2382.

    Article  Google Scholar 

  10. Berg, S. K., Thorup, C. B., Borregaard, B., Christensen, A. V., Thrysoee, L., Rasmussen, T. B., Ekholm, O., Juel, K., & Vamosi, M. (2019). Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey. European Journal of Preventive Cardiology, 26(6), 624–637.

    Article  Google Scholar 

  11. Pelsmacker, Pd., Geuens, M., & Bergh, JVd. (2018). Marketing communications : a European perspective (6th ed.). Harlow, Essex: Pearson Education Limited.

    Google Scholar 

  12. Kotseva, K., Wood, D., De Bacquer, D., De Backer, G., Ryden, L., Jennings, C., Gyberg, V., Amouyel, P., Bruthans, J., Castro Conde, A., & Cífková, R. (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.

    Article  Google Scholar 

  13. Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M. T., Corrà, U., Cosyns, B., Deaton, C., Graham, I., Hall, M. S., Hobbs, F. D. R., Løchen, M. L., Löllgen, H., Marques-Vidal, P., Perk, J., Prescott, E., Redon, J., … Verschuren, W. M. M. (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.

    Article  Google Scholar 

  14. Berg, S. K., Svanholm, J., Lauberg, A., Borregaard, B., Herning, M., Mygind, A., Christensen, A. V., Christensen, A. I., Ekholm, O., Juel, K., & Thrysøe, L. (2014). Patient-reported outcomes at hospital discharge from Heart Centres, a national cross-sectional survey with a registerbased follow-up: the DenHeart study protocol. British Medical Journal Open, 4, 1–6.

    Google Scholar 

  15. Pedersen, C. B. (2011). The Danish civil registration system. Scandinavian Journal of Public Health, 39(7), 22–25.

    Article  Google Scholar 

  16. Jensen, V. M., & Rasmussen, A. W. (2011). Danish education registers. Scandinavian Journal of Public Health, 39(7), 91–94.

    Article  Google Scholar 

  17. Lynge, E., Sandegaard, J. L., & Rebolj, M. (2011). The Danish national patient register. Scandinavian Journal of Public Health, 39(7), 30–33.

    Article  Google Scholar 

  18. Tu, J. V., Austin, P. C., Walld, R., Roos, L., Agras, J., & McDonald, K. M. (2001). Development and validation of the ontario acute myocardial infarction mortality prediction rules. Journal of the American College of Cardiology, 37(4), 992–997.

    Article  CAS  Google Scholar 

  19. Rabin, R. (2009). Charro Fd: EQ-SD: A measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343.

    Article  Google Scholar 

  20. Oldridge, N., Sanerb, H., & McGe, H. M. (2005). The Euro Cardio-QoL project. An international study to develop a core heart disease health-related quality of life questionnaire, the HeartQoL. European Society of Cardiology, 12(2), 87–94.

    Google Scholar 

  21. Nolan, C. M., Longworth, L., Lord, J., Canavan, J. L., Jones, S. E., Kon, S. S., & Man, W. D. (2016). The EQ-5D-5L health status questionnaire in COPD: Validity, responsiveness and minimum important difference. Thorax, 71(6), 493–500.

    Article  Google Scholar 

  22. Smedt, D. D., Clays, E., Höfer, S., Oldridge, N., Kotseva, K., Maggioni, A. P., Janssen, B., Bacquer, D. D., & Investigators, E. (2016). Validity and reliability of the HeartQoL questionnaire in a large sample of stable coronary patients: The EUROASPIRE IV Study of the European society of cardiology. European Journal of Preventive Cardiology, 23(7), 714–721.

    Article  Google Scholar 

  23. De Smedt, D., Clays, E., Höfer, S., Oldridge, N., Kotseva, K., Maggioni, A. P., Janssen, B., & De Bacquer, D. (2016). Validity and reliability of the HeartQoL questionnaire in a large sample of stable coronary patients: The EUROASPIRE IV study of the European society of cardiology. European journal of preventive cardiology, 23(7), 714–721.

    Article  Google Scholar 

  24. StatensInstitutforFolkesundhedforSundhedsstyrelsen: [Alkohol i Danmark 2015] Alcohol in Denmark In. Copenhagen; 2016: 1-50

  25. Makrilakis, K., Liatis, S., Tsiakou, A., Stathi, C., Papachristoforou, E., Perrea, D., Katsilambros, N., Kontodimopoulos, N., & Niakas, D. (2018). Comparison of health-related quality of Life (HRQOL) among patients with pre-diabetes, diabetes and normal glucose tolerance, using the 15D-HRQOL questionnaire in Greece: The DEPLAN study. BMC Endocrine Disorders, 18(1), 32.

    Article  Google Scholar 

  26. Rosiek, A., Kornatowski, T., Maciejewska, N. F., Kryszewska, A. R., Wyzgowski, P., & Leksowski, K. (2016). Health behaviours of patients diagnosed with type 2 diabetes mellitus and their influence on the patients satisfaction with life. Therapeutics and Clinical Risk Management, 12, 1783–1792.

    Article  Google Scholar 

  27. Cosentino, F., Grant, P. J., Aboyans, V., Bailey, C. J., Ceriello, A., Delgado, V., Federici, M., Filippatos, G., Grobbee, D. E., Hansen, T. B., Huikuri, H. V., Johansson, I., Jüni, P., Lettino, M., Marx, N., Mellbin, L. G., Östgren, C. J., Rocca, B., Roffi, M., … Wheeler, D. C. (2020). 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). European Heart Journal, 41(2), 255–323.

    Article  Google Scholar 

  28. Copay, A. G., Subach, B. R., Glassman, S. D., Polly, D. W., Jr., & Schuler, T. C. (2007). Understanding the minimum clinically important difference: A review of concepts and methods. The Spine Journal, 7(5), 541–546.

    Article  Google Scholar 

  29. Friis, K., Jensen, M. L., Lasgaard, M., & Maindal, H. T. (2015). Sundhedskompetence blandt personer med kronisk sygdom. Region Midtjylland.

    Google Scholar 

  30. Arx, L. B. W. V., Gydesen, H., & Skovlund, S. (2016). Treatment beliefs, health behaviors and their association with treatment outcome in type 2 diabetes. BMJ Open Diabetes Research & Care, 4(1), 1–10.

    Google Scholar 

  31. Zhu, D., Zhao, G., & Wang, X. (2021). Association of smoking and smoking cessation with overall and cause-specific mortality. American Journal of Preventive Medicine, 60(4), 504–512.

    Article  Google Scholar 

  32. Pan, A., Wang, Y., Talaei, M., & Hu, F. B. (2015). Relation of smoking with total mortality and cardiovascular events among patients with diabetes mellitus: A meta-analysis and systematic review. Circulation, 132(19), 1795–1804.

    Article  Google Scholar 

  33. Thompson, D. R., Ski, C. F., Garside, J., & Astin, F. (2016). A review of health-related quality of life patient-reported outcome measures in cardiovascular nursing. European Journal of Cardiovascular Nursing, 15(2), 114–125.

    Article  Google Scholar 

  34. Rumsfeld, J. S., Alexander, K. P., Goff, D. C., Jr., Graham, M. M., Ho, P. M., Masoudi, F. A., Moser, D. K., Roger, V. L., Slaughter, M. S., Smolderen, K. G., Spertus, J. A., Sullivan, M. D., Treat-Jacobson, D., & Zerwic, J. J. (2013). Cardiovascular Health: The importance of measuring patient-reported health status. Circulation, 127(22), 2233–2249.

    Article  Google Scholar 

  35. Oldridge, N., Höfer, S., McGee, H., Conroy, R., Doyle, F., & Saner, H. (2014). The HeartQoL: Part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease. European Journal of Preventive Cardiology, 21(1), 90–97.

    Article  Google Scholar 

  36. Oldridge, N., Höfer, S., McGee, H., Conroy, R., Doyle, F., & Saner, H. (2014). The HeartQoL: part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease. European Journal of Preventive Cardiology, 21(1), 98–106.

    Article  Google Scholar 

  37. Patoulias, D., Stavropoulos, K., Imprialos, K., Athyros, V., Doumas, M., & Karagiannis, A. (2020). Pharmacological management of cardiac disease in patients with type 2 diabetes: Insights into clinical practice. Current Vascular Pharmacology, 18(2), 125–138.

    Article  CAS  Google Scholar 

  38. Ceriello, A., Catrinoiu, D., Chandramouli, C., Cosentino, F., Dombrowsky, A. C., Itzhak, B., Lalic, N. M., Prattichizzo, F., Schnell, O., Seferović, P. M., Valensi, P., & Standl, E. (2021). Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management. Cardiovascular Diabetology, 20(1), 218.

    Article  CAS  Google Scholar 

  39. Anker, S., Agewall, S., Borggrefe, M., Calvert, M., Caro, J. J., Cowie, M. R., Ford, I., Paty, J. A., Riley, J. P., Swedberg, K., Tavazzi, L., Wiklund, I., & Kirchhof, P. (2014). The importance of patient-reported outcomes: a call for their comprehensive integration in cardiovascular clinical trials. European Heart Journal, 35, 2001–2009.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the patients who took their time to participate in the survey, the heart centres for prioritising this study and the 800 cardiac nurses involved in the data collection.

Funding

The overall DenHeart study was supported by Helsefonden; the Danish heart centres; the Danish Heart Association, the substudy received no additional funding.

Author information

Authors and Affiliations

  1. Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark

    Maria Olesen Brylle, Lars Thrysoee, Kirstine Nørregaard Hansen, Axel Diederichsen & Britt Borregaard

  2. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Maria Olesen Brylle, Lars Thrysoee, Kirstine Nørregaard Hansen, Axel Diederichsen & Britt Borregaard

  3. Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark

    Trine Bernholdt Rasmussen

  4. University of Copenhagen, Copenhagen, Denmark

    Trine Bernholdt Rasmussen & Selina Kikkenborg Berg

  5. Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark

    Rikke Mols

  6. The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Anne Vinggaard Christensen & Selina Kikkenborg Berg

  7. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark

    Ola Ekholm

  8. Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark

    Charlotte Brun Thorup

  9. Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark

    Britt Borregaard

Authors
  1. Maria Olesen Brylle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trine Bernholdt Rasmussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rikke Mols
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lars Thrysoee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kirstine Nørregaard Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Axel Diederichsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne Vinggaard Christensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ola Ekholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Charlotte Brun Thorup
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Selina Kikkenborg Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Britt Borregaard
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SKB conceived the overall idea for the DenHeart study, and MOB and BBO the idea of the current substudy. MOB and BBO made the statistical analyses, and MOB wrote the first draft of the manuscript in collaboration with BBO. All revised the manuscript critically. All have given their final approval of the version to be published.

Corresponding author

Correspondence to Britt Borregaard.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

The DenHeart study was registered at ClinicalTrials.gov (NCT01926145), approved by the Danish Data Protection Agency (2007–58-0015/30–0937) and complies with the principles outlined in the Declaration of Helsinki. According to Danish legislation, this type of study does not require approval from a local ethics committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 346 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brylle, M.O., Rasmussen, T.B., Mols, R. et al. The association between health-related quality of life, self-reported characteristics and 1- and 3-year mortality amongst cardiac patients with and without type 2 diabetes. Qual Life Res 32, 59–69 (2023). https://doi.org/10.1007/s11136-022-03223-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-022-03223-x

Keywords

Search

Navigation