Predictors of Health-related Quality of Life Outcomes in a Telephone-delivered Secondary Prevention Program (PROACTIVE HEART)

Abstract

Introduction: Participation in coronary heart disease secondary prevention programs is low. Innovative telephone-delivered programs such as 'ProActive Heart' are effective and can meet the treatment gap. We report the predictors of health-related quality of life outcomes following participation in ProActive Heart. Methods: 430 adult myocardial infarction patients were randomised to the intervention or a 'usual care' control condition. The intervention included 10 telephone healthcoaching sessions from a qualified health professional over six months. Primary outcomes were Short Form-36 subscales Mental Component Summary Score (MCS) and Physical Component Summary Score (PCS) at six months. Baseline predictors were demographics, procedure, comorbidities, participation in other cardiac rehabilitation programs, health behaviours (diet, alcohol, body mass index, waist circumference, smoking, physical activity, TV viewing), anxiety, depression, social support. Following bivariate analyses, stepwise forward multiple regression was used to build a final model. Results are presented as [Coefficient (95%CI); p value]. Results: Baseline MCS [0.3(0.2, 0.4); p < 0.001], having no anxiety or depression [7.7(4.1,11.3);p < 0.001], greater social support [0.4(0.1, 0.6); p = 0.001], age >60 yrs [2.6(0.5,4.8); p = 0.016], less TV viewing [-0.1(-0.2,-0.0); p < 0.018] and being in the intervention group [2.5(0.4,4.6); p < 0.018]were strong predictors of higher MCS at six months. Baseline PCS [0.4(0.2,0.5); p < 0.001], higher confidence levels in meeting sufficient physical activity guidelines [1.8(1.2,2.5); p = 0.001], intention to be physically active [8.5(3.7,13.3); p < 0.001], less TV viewing [-0.2(-0.3,-0.1); p < 0.001] and not being a current smoker [3.9(1.7,6.9); p = 0.001] were strong predictors of higher PCS at 6 months. Conclusion: This study has clinical implications by highlighting indicators of improved mental and physical quality of life outcomes following participation in a telephone-delivered secondary prevention program.