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European Heart Journal Advance Access originally published online on February 12, 2007
European Heart Journal 2007 28(5):601-607; doi:10.1093/eurheartj/ehl485
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Physical functioning and mental well-being in association with health outcome in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial II

Katarzyna Piotrowicz1, Katia Noyes2, Jeffrey M. Lyness3, Scott McNitt1, Mark L. Andrews1, Andrew Dick2, W. Jackson Hall4, Arthur J. Moss1 and Wojciech Zareba1,*

1 Heart Research Follow-up Program, Cardiology Division, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, PO Box 653, Rochester, NY 14642, USA
2 Department of Community and Preventive Medicine, University of Rochester Medical Center, NY, USA
3 Department of Psychiatry, University of Rochester Medical Center, NY, USA
4 Department of Biostatistics University of Rochester Medical Center, NY, USA

Received 15 May 2006; revised 21 December 2006; accepted 3 January 2007; online publish-ahead-of-print 12 February 2007.

* Corresponding author. Tel: +1 585 275 5391; fax: +1 585 273 5283. E-mail address: wojciech_zareba{at}urmc.rochester.edu

Aims: The association of psychosocial and physical factors with health outcome in patients with congestive heart failure (CHF) has not been fully explored. The aim of this study was to assess the physical and mental health in relationship to health outcome in post-infarction patients with advanced left ventricular dysfunction.

Methods and results: A total of 1058 patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) completed the Medical Outcome Trust Short Form (SF-12) at baseline. Physical component summary (PCS) and mental component summary (MCS) of SF-12 were analysed in relationship to survival, hospitalization due to CHF, and implantable cardioverter-defibrillator (ICD) therapy. Both baseline PCS and MCS were significantly associated with death (P < 0.001 and P < 0.016, respectively) and hospitalization due to CHF (P ≤ 0.001). After adjustment for significant clinical covariates and treatment group, low PCS and low MCS groups remained significant predictors of mortality and CHF hospitalization. Neither PCS nor MCS was associated with appropriate ICD therapy for ventricular tachyarrhythmias. Patients who experienced appropriate ICD shocks had a statistically significant deterioration of PCS but not MCS from baseline to 12 months.

Conclusion: Lower baseline PCS and MCS are associated with unfavourable health outcome in MADIT II patients, but not with appropriate ICD therapy for ventricular tachyarrhythmias. Patients who experience ICD shock reported a decrease in PCS, but little or no changes in MCS.

Key Words: Heart failure • ICD • Quality of life • Prognosis


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