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Determinants of Health-Related Quality of Life in Coronary Artery Disease Patients: A Prospective Study Generating a Structural Equation Model

Received Oct. 7, 2003; revision received Feb. 17, 2004; accepted Aug. 12, 2004. From the Departments of Medical Psychology and Psychotherapy, Cardiology, Heart Surgery, and Psychiatry, Medical University Innsbruck, Innsbruck, Austria; the Department of Psychology, Royal College of Surgeons in Ireland, Dublin; the Department of Interventional Cardiology, Academic Hospital, Feldkirch, Austria; and the Departments of Prosthodontics, Psychosomatics and Psychotherapy, University of Muenster, Germany. Address correspondence and reprint requests to Dr. Höfer, Department of Medical Psychology and Psychotherapy, University of Innsbruck, Sonnenburgstr. 9, A-6020 Innsbruck, Austria; stefan.hoefer{at}uibk.ac.at (e-mail).

The authors used structural equation modeling to test a conceptual model of HRQL in coronary artery disease. The model, which included biomedical factors and individual and environmental characteristics, was tested in a multicenter group of 465 patients at three timepoints (baseline evaluation of chest pain and 1- and 3-month follow-ups). A satisfactory fit was obtained for the model over time. Depression and anxiety symptoms exerted the most significant influence on HRQL. HRQL and the mediating factors were found to be distinct phenomena. The authors concluded that mediating factors, especially depression and anxiety symptoms, should be taken into consideration in clinical routine if HRQL is regarded as a clinical outcome.

Key Words: Health related quality of life • cardiac disease • structural equation modeling • anxiety • depression • outcome

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