[Patient education in the management of coronary heart disease]. Examination of a Nurse-led Community-based Education and Coaching Intervention for Coronary Heart Disease High-risk Individuals in China. Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Examination of the Effect of Implantable Cardioverter-Defibrillators on Health-Related Quality of Life A randomised, feasibility trial of a tele-health intervention for Acute Coronary Syndrome patients with depression ('MoodCare'): Study protocol Evaluating the efficacy of an education and treatment program for patients with coronary heart disease. Baseline quality of life as a predictor of mortality and hospitalization in 5,025 patients with congestive heart failure. SOLVD Investigations. Studies of Left Ventricular Dysfunction Investigators. Factors influencing health-related quality of life in cardiac rehabilitation patients. Health-Related Quality of Life Consequences of Implantable Cardioverter Defibrillators: Results From MADIT II Effects of a Problem-Based Learning Rehabilitation Programme on Quality of Life in Patients with Coronary Artery Disease Quality of life assessment after patient education in a randomized controlled study on asthma and chronic obstructive pulmonary disease. Health-Related Quality-of-Life Outcomes in Coronary Artery Bypass Surgery Patients and Partners Effects of phase III cardiac rehabilitation programs on health-related quality of life in elderly patients with coronary artery disease: Juntendo Cardiac Rehabilitation Program (J-CARP). Health-Related Quality of Life, Functional Status, and Cardiac Event-Free Survival in Patients With Heart Failure Long-term clinical outcomes, health-related quality of life, and costs in different treatment modalities of stable coronary artery disease Disease management produces limited quality-of-life improvements in patients with congestive heart failure: evidence from a randomized trial in community-dwelling patients. Relationship between health-related quality of life, comorbidities and acute health care utilisation, in adults with chronic conditions
The aim of the review was to assess the effect of patient education in ischaemic heart disease . Thirteen r and omised controlled trials of moderate to good quality including 68,556 patients were selected . The effect on mortality , cardiac morbidity , hospitalisation and health-related quality of life was assessed and only non-significant tendencies of effect were found . The authors of the review nevertheless conclude that the review supports current rehabilitation programmes that include patient education . Further research in patient education , especially concerning the most effective methods of education delivery , is needed PURPOSE Early detection and management of coronary heart disease ( CHD ) are embedded into many community health service and primary care practice s in western countries . The Framingham CHD risk score has been used to predict CHD and mortality for nearly 20 years , and it has predicted CHD event risk accurately in multiethnic population s. The aim of this study was to access the effect of a 6-month community-based intervention on CHD risk in individuals at high risk . METHODS A r and omized controlled trial of individuals with a high 10-year CHD risk were recruited from two communities in China . Individuals in the intervention group ( n = 53 ) received a 3-month group education and a 3-month coaching session . Physical examination and self-report question naires were used to collect both pre- and postintervention data on blood pressure , glucose , cholesterol , body mass index , smoking , depression , and health-related quality of life ( HRQoL ) . RESULTS A total of 102 participants ( 85.0 % ) completed the 6-month study . Compared with the usual care group , the intervention group had a 5 mmHg greater reduction in systolic blood pressure ( t = 2.01 , p = .047 ) , larger declines in glucose ( t = -2.49 , p = .015 ) , cholesterol ( t = -2.44 , p = .017 ) , body mass index ( t = -2.58 , p = .011 ) , and depression ( t = -2.05 , p = .043 ) , and better reports of HRQoL ( t = 3.36 , p = .001 ) . No significant group differences in smoking behaviors were reported . CONCLUSION A 6-month  community-based intervention in a CHD high-risk population improved disease-related risk factors , depression , and HRQoL. Results provide preliminary evidence for primary prevention of cardiovascular disease risk in a community high-risk population BACKGROUND We sought to examine the relationship between health-related quality of life ( HRQL ) and a first emergency rehospitalization and mortality in patients with heart failure ( HF ) having a wide variation in ventricular ejection fraction and functional status . METHODS Prospect i ve study conducted with 394 patients admitted for HF-related emergencies at 4 Spanish hospitals . Baseline HRQL was measured with a generic question naire , the Medical Outcomes Study 36-item Short Form Survey ( SF-36 ) , and with an HF-specific instrument , the Minnesota Living With Heart Failure ( MLWHF ) question naire . Cox proportional hazards models were used to calculate hazard ratios ( HRs ) for hospitalization and death on the basis of HRQL scores . RESULTS During a median follow-up of approximately 6 months , 138 patients ( 35.0 % ) underwent a first emergency rehospitalization and 70 ( 17.8 % ) died . After adjustment for biomedical , psychosocial , and health care variables , the frequency of hospital readmission was higher in patients with worse scores on the SF-36 physical functioning ( HR , 1.65 ; 95 % confidence interval [ CI ] , 1.11 - 2.44 ; P = .01 ) , general health ( HR , 1.73 ; 95 % CI , 1.19 - 2.52 ; P = .003 ) , and mental health ( HR , 1.65 ; 95 % CI , 1.10 - 2.47 ; P = .02 ) subscales . Results were similar for the mortality end point . For the MLWHF question naire , worse overall and worse physical and emotional summary scores were associated with higher mortality . CONCLUSIONS Worse HRQL is associated with hospital readmission and death in patients with HF . The magnitude of this association , for both physical and mental HRQL components , is comparable to that for other well-known predictors of hospital readmission and death , such as personal history of diabetes , previous hospitalizations , and treatment with angiotensin-converting enzyme inhibitors Background While implantable cardioverter-defibrillators ( ICDs ) improve survival , their benefit in terms of health-related quality of life ( HRQOL ) is negligible . Objective To examine how shocks and congestive heart failure ( CHF ) mediate the effect of ICDs on HRQOL . Methods The US patients from the MADIT-II ( Multicenter Automatic Defibrillator Trial-II ) trial ( n = 983 ) were r and omized to receive an ICD or medical treatment only .  HRQOL was assessed using the Health Utility Index 3 at baseline and 3 , 12 , 24 , and 36 months following r and omization . Logistic regressions were used to test for the effect of ICDs on the CHF indicator , and linear regressions were used to examine the effect of ICD shocks and CHF on HRQOL in living patients . We used a Monte Carlo simulation and a parametric Weibull distribution survival model to test for the effect of selective attrition . Observations were clustered by patients and robust st and ard errors ( RSEs ) were used to control for the non-independence of multiple observations provided by the same patient . Results Patients in the ICD arm had 41 % higher odds of experiencing CHF since their last assessment compared with those in the control arm ( RSE = 0.19 , p = 0.01 ) . Developing CHF reduced HRQOL at the subsequent visit by 0.07 ( p<0.01 ) . Having ICD shocks reduced overall HRQOL by 0.04 ( p = 0.04 ) at the subsequent assessment . The negative effect of ICD firing on HRQOL was an order of magnitude greater than the effect of CHF . Conclusions A higher prevalence of CHF and shocks among patients with ICDs and their negative effect on HRQOL may partially explain the lack of HRQOL benefit of ICD therapy Background Coronary heart disease ( CHD ) and depression are leading causes of disease burden globally and the two often co-exist . Depression is common after Myocardial Infa rct ion ( MI ) and it has been estimated that 15 - 35 % of patients experience depressive symptoms . Co-morbid depression can impair health related quality of life ( HRQOL ) , decrease medication adherence and appropriate utilisation of health services , lead to increased morbidity and suicide risk , and is associated with poorer CHD risk factor profiles and reduced survival . We aim to determine the feasibility of conducting a r and omised , multi-centre trial design ed to compare a tele-health program ( MoodCare ) for depression and CHD secondary prevention , with Usual Care ( UC ) . Methods Over 1600 patients admitted after index admission for Acute Coronary Syndrome ( ACS ) are being screened for depression at six metropolitan hospitals in the Australian states of Victoria and Queensl and . Consenting participants are then contacted at two weeks post-discharge for baseline assessment . One hundred eligible participants are to be r and omised to an intervention or a usual medical care control group ( 50 per group ) . The intervention consists of up to 10 × 30 - 40 minute structured telephone sessions , delivered by registered psychologists , commencing within two weeks of baseline screening . The intervention focuses on depression management , lifestyle factors ( physical activity , healthy eating , smoking cessation , alcohol intake ) , medication adherence and managing co-morbidities . Data collection occurs at baseline ( Time 1 ) , 6 months ( post-intervention ) ( Time 2 ) , 12 months ( Time 3 ) and 24 months follow-up for longer term effects ( Time 4 ) . We are comparing depression ( Cardiac Depression Scale [ CDS ] ) and HRQOL ( Short Form-12 [ SF-12 ] ) scores between treatment and UC groups , assessing the feasibility of the program through patient acceptability and exploring long term maintenance effects . A cost-effectiveness analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the government . Discussion This manuscript presents the protocol for a r and omised , multi-centre trial to evaluate the feasibility of a tele-based depression management and CHD secondary prevention program for ACS patients . The results of this trial will provide valuable new information about potential psychological and wellbeing benefits , cost-effectiveness and acceptability of an innovative tele-based depression management and secondary prevention program for CHD patients experiencing depression . Trial Registration NumberAustralia and New Zeal and Clinical Trials Register ( ANZCTR ) : BACKGROUND Until now , there has not been any evaluated , disease-specific education and treatment program for patients with coronary heart disease ( CHD ) in Germany . It is thought that education can improve these patients ' physical activity and quality of life and teach them how to lessen their risk factors , what to do in case of an emergency , and how to assess their own medical treatment . METHODS A r and omized controlled open intervention trial was carried out from February 2010 to September 2011 . 196 patients were assigned to receive the intervention ( patient education ) , while 199 were assigned to a control group .  In an intention-to-treat analysis , baseline and follow-up data were compared after a mean interval of 220 days . The evaluative instruments included the Freiburg Question naire of Physical Activity , the MacNew Heart Disease Quality of Life Question naire , question naires regarding knowledge about CHD , ergometric performance ability , and the body-mass index . RESULTS The patients in the intervention group reported having increased their physical activity by a mean of 9.3 MET/week ( MET = metabolic equivalent of task ) , compared to 2.5 MET/week in the control group ; the difference of 6.8 MET/week was statistically significant ( p = 0.015 ) . The patients in the intervention group also rated their quality of life higher than those in the control group ( 0.2 ± 0.56 vs. 0.09 ± 0.53 [ mean ± st and ard deviation ] , p = 0.056 ) . They were significantly better informed than patients in the control group about risk factors and about what to do in an emergency . CONCLUSION Persistently unhealthy lifestyle is a common problem of CHD patients ; the education and treatment program presented here may be a suitable means of improving patients ' lifestyle for secondary prevention . Further studies will be needed to document long-term efficacy and to determine whether occasional refresher courses will be needed as well This study examined the independent relation of health-related quality of life ( HRQL ) to mortality and congestive heart failure (CHF)-related hospitalizations  in patients with an ejection fraction of < 0.35 followed for a mean of 36.5 months . A brief HRQL question naire was administered at baseline to patients r and omized to placebo or enalapril in the Studies of Left Ventricular Dysfunction ( SOLVD ) trial . Participants had an ejection fraction of < 0.35 and either symptomatic CHF ( treatment trial , n = 2,465 ) or asymptomatic CHF ( prevention trial , n = 2,560 ) . Baseline assessment of HRQL predicted mortality and CHF-related hospitalizations in symptomatic and asymptomatic patients r and omized to enalapril and placebo treatment . Domains that were the stronger univariate predictors of mortality and CHF-related hospitalizations were activities of daily living ( relative risk [ RR ] for mortality : 1.163 , p < 0.000 ; for hospitalization : 1.215 , p < 0.000 ) , general health ( RR for mortality : 1.205 , p < 0.000 ; for hospitalization : 1.188 , p < 0.000 ) , and social functioning ( RR for mortality 1.098 , p < 0.000 ; for hospitalization : RR 1.156 , p < 0.000 ) . In the multivariate model , activities of daily living ( RR for mortality 1.41 , p < 0.000 ; for hospitalization : RR 1.43 , p < 0.002 ) , general health ( RR for mortality 1.21 , p < 0.000 ; for hospitalization RR 1.16 , p < 0.013 ) and heart failure symptoms ( RR for mortality 1.02 , p < 0.025 ; for hospitalization RR 1.03 , p < 0.004 ) were found to be independent risk factors . HRQL independently predicted mortality and CHF-related hospitalizations after adjustment for ejection fraction , age , treatment , and New York Heart Association classification in patients with an ejection fraction of < 0.35 , r and omized to enalapril and placebo treatment . HRQL provides additional clinical information regarding disease course and outcome that is not captured by traditional indexes of clinical status Associations of age , gender , cardiac procedure ( coronary artery bypass grafting or percutaneous transluminal coronary angioplasty )  , risk stratification , and number of comorbidities with health-related quality of life ( HRQL ) were examined among 217 men and 84 women ( mean age , 63+/-11 years ) consecutively enrolled in a phase II cardiac rehabilitation program . Female gender and high-risk stratification were independently associated with impaired treatment gains in most areas of HRQL . Older age and having a greater number of comorbidities were also associated with impaired gains in specific areas . HRQL was generally lower at baseline but not post-treatment in coronary artery bypass grafting vs. percutaneous transluminal coronary angioplasty patients . Cardiac rehabilitation patients also had lower HRQL scores than an age-matched , normative sample at baseline ( most areas ) and post-treatment ( mainly on role physical ) . Findings reinforce the need for cardiac rehabilitation programs to tailor assessment s and risk factor modification strategies to patient characteristics associated with low levels of HRQL , especially in women and those with higher risk stratification Background : Implantable cardioverter defibrillators ( ICDs ) improve survival and extend lives of patients with severe heart disease . Objective : We sought to evaluate the impact of ICDs on health-related quality of life ( HRQOL ) during the first 3 years after implantation . Subjects : A total of 1089 patients from the Multicenter Automatic Defibrillator Implantation Trial II ( MADIT II ) were r and omized to an ICD or medical treatment only . Measures : Health Utility Index ( HUI3 ) at baseline , 3 , 12 , 24 , and 36 months following r and omization ; survival data . Research Design : We constructed mean profiles of HRQOL for living patients , estimated overall quality -adjusted life years ( QALYs ) , separately by treatment arm , and calculated cumulative QALY gains/losses as the difference between the areas under the treatment specific HRQOL profiles . Multivariate fixed effect regression models were developed to impute the missing HRQOL data using baseline patient characteristics ( age , gender , treatment , HUI3 score , diabetes , diuretics use , and NYHA class ) . Bootstrapped st and ard errors were calculated for the estimated differences in HRQOL gains/losses between treatment arms . Similarly , we performed subgroup analyses ( by gender , age , and baseline NYHA class , blood urine nitrogen , ejection fraction , and QRS ) . Results : There were no differences in QALYs loss for living patients by treatment group ( −0.037 , P = 0.64 ) or in overall QALYs loss by treatment group ( 0.043 , P = 0.37 ) over 3 years . In subgroup analysis , female subjects demonstrated a trend towards greater survival benefit ( 0.298 , P = 0.07 ) and overall QALYs ( 0.261 , P = 0.14 ) . Conclusions : Adverse effects of the ICD on HRQOL together with lower HRQOL among survivors may offset the 3-year survival benefits of ICDs Background : The aim of cardiac rehabilitation ( CR ) is not only physical improvement but also increased quality of life ( QoL ) . A CR programme based upon problem based learning ( PBL ) philosophy was developed , to achieve and apply new knowledge related to coronary artery disease ( CAD ) . The aim of this paper was to evaluate the impact of the PBL programme on QoL. Methods : 207 consecutive patients < 70 years of age with a recent event of CAD were r and omised to a  PBL group ( n = 104 ) or a control group ( n = 103 ) . In addition to st and ard treatment , the PBL patients participated in 13 group sessions during 1 year , where individual learning needs and behavioural changes were focused upon . QoL was measured by the Ladder of Life , Self-Rated Health ( SRH ) , SF 36 , and Cardiac Health Profile ( CHP ) . Results : Significant differences between the groups , favouring the PBL patients , were found by global instruments : more optimistic expectations of the future QoL and a better general condition . No differences were found by SRH , SF 36 or subscales of CHP , but QoL increased in both groups during the year . Conclusions : The main outcome was that QoL improved in both groups with some effects favouring the PBL programme The effect of patient education in patients with asthma and Chronic Obstructive Pulmonary Disease ( COPD ) on health-related quality of life ( HRQoL ) is not previously investigated using the St. George 's Respiratory Question naire ( SGRQ ) . We r and omly allocated at our out-patient clinic 78 asthmatics and 62 patients with COPD to either a control or an intervention group . Intervention consisted of two 2-h group sessions and one to two individual sessions each by a nurse and a physiotherapist . A self-management plan was developed . Baseline quality of life assessment showed comparable scores independent of treatment groups among asthmatics and patients with COPD , but statistically significantly better scores ( p < 0.05 ) for the educated asthma group after 12 mo compared with the control group . This aligned with the 12-mo SGRQ assessment , which revealed better symptoms , activity , impact , and total scores by 11 ( p < 0.02 ) , 15 ( p < 0.01 ) , 19 ( p < 0.001 ) , and 16 ( p < 0.001 ) units , respectively . Patient education among asthmatics increased the FEV1 by a mean value of 6.1 % ( SD , 12 ) compared with the control group ( p < 0.05 ) . Education among patients with COPD did not indicate a significant increase in HRQoL as measured by the SGRQ or increased FEV1 . We conclude that patient education increased HRQoL and FEV1 among asthmatics , but not among patients with COPD PURPOSE : The purpose of this study was to examine health-related quality -of-life ( HRQOL ) outcomes in coronary artery bypass surgery ( CABS ) patients and partners enrolled together in cardiac rehabilitation versus a usual care group .  METHODS : After CABS , couples were r and omly assigned to the Partners Together in Health ( PaTH ) intervention ( n = 17 ) or usual care ( n = 17 ) groups .  Health-related quality -of-life was operationalized as physical function ( SF-36 Physical Functioning subscale ) , depression ( Patient Health Question naire ) , and marital adjustment ( Dyadic Adjustment Scale ) . Data were measured in patients and partners at the start ( T1 ) and end of cardiac rehabilitation ( T2 ) , and 3 months after cardiac rehabilitation ( T3 ) . Nonparametric statistics were used to examine changes over time and differences between groups . RESULTS : Patients in both groups , and partners in the PaTH group , significantly improved physical function between T1 and T2 . At T1 , 18 % of patients and 6 % of partners were depressed . At T2 and T3 , only 3 % of patients and no partners were depressed . Almost 12 % of patients and partners were maritally distressed at T1 . At T2 and T3 , patients ' marital distress was unchanged , but more partners reported marital distress ( 15 % ) . CONCLUSIONS : This study adds to our underst and ing of the trajectory of HRQOL outcomes  after CABS for patients and partners . These findings demonstrated promise for the PaTH intervention . Future testing of the intervention is warranted in a larger sample . Because patients and partners are impacted by CABS as a shared life experience , couple-centered interventions may improve HRQOL outcomes more than individually focused interventions The purpose of this prospect i ve r and omized controlled trial was to assess the impact of phase III comprehensive cardiac rehabilitation ( CR ) on health-related quality of life ( HRQOL ) in elderly patients with coronary artery disease ( CAD ) . Thirty-eight elderly males ( mean age , 70 years ) with CAD were stratified as the intervention group ( n=20 ) and the control group ( n=18 ) . In the intervention group , patients participated in CR for 6 months , whereas in the control group , they received st and ard care . Vali date d question naires were obtained to evaluate HRQOL using the Medical Outcome Study Short-Form 36 Health Status Survey ( SF-36 ) , State-trait anxiety inventory question naire ( STAI ) and Self-rating Depression Scale ( SDS ) at baseline and after 6 months . At baseline , scores of SF-36 except for general health , STAI and SDS were not different in either group . After 6 months , in the intervention group , scores of bodily pain , general health , vitality and mental health of SF-36 improved significantly compared with baseline . State anxiety scores also improved significantly ( p<0.01 ) , but SDS depression scores were not improved . In the control group , none of the parameters significantly changed . These results indicate that elderly patients with CAD should be vigorously encouraged to pursue CR even in chronic phase III Background : Health-related quality of life ( HRQOL ) , functional status , and cardiac event-free survival are outcomes used to assess the effectiveness of interventions in patients with heart failure ( HF ) . However , the nature of the relationships among HRQOL , functional status , and cardiac event-free survival remains unclear . Objective : The purpose of this study is to examine the nature of the relationships among HRQOL , functional status , and cardiac event-free survival in patients with HF . Methods : This was a prospect i ve , observational study of 313 patients with HF that was a secondary analysis from a registry . At baseline , patient demographic and clinical data were collected .  Health-related quality of life  was assessed using the Minnesota Living With Heart Failure Question naire and functional status was measured using the Duke Activity Status Index .  Cardiac event-free survival data were obtained by patient interview , hospital data base , and death certificate review . Multiple linear and Cox regressions were used to explore the relationships among HRQOL , functional status , and cardiac event-free survival while adjusting for demographic and clinical factors . Results : Participants ( n = 313 ) were men ( 69 % ) , white ( 79 % ) , and aged 62 ± 11 years . Mean left ventricular ejection fraction was 35 % ± 14 % .  The mean HRQOL score of 32.3 ± 20.6 indicated poor HRQOL . The mean Duke Activity Status Index score of 16.2 ± 12.9 indicated poor functional status . Cardiac event-free survival was significantly worse in patients who had worse HRQOL or poorer functional status . Patients who had better functional status had better HRQOL ( P < .001 ) . Health-related quality of life was not a significant predictor of cardiac event-free survival after entering functional status in the model ( P = .54 ) , demonstrating that it was a mediator of the relationship between HRQOL and outcome . Conclusion : Functional status was a mediator between HRQOL and cardiac event-free survival . These data suggest that intervention studies to improve functional status are needed Aims This study is a prospect i ve , observational 8-year follow-up of 300 stable unselected coronary artery disease patients entering elective coronary angiography in 2002–03 . Recorded were clinical outcomes , health-related quality of life ( HRQoL ) , and secondary care costs after coronary artery bypass graft ( CABG ) surgery , percutaneous coronary intervention ( PCI ) , or medical therapy ( MT ) . Methods and results HRQoL was measured by the 15D instrument at baseline , 6 months , and 8 years . Regression techniques with an adjustment for relevant baseline characteristics were used to compare the 8-year survival and change in HRQoL between the groups . At baseline , all groups had statistically significantly impaired HRQoL compared with age- and gender-st and ardized general population . Six months after invasive interventions the mean HRQoL score had improved in a statistically significant and clinical ly important manner . This improvement was maintained at 8 years as the HRQoL no longer differed from that of the general population , whereas MT patients were still worse off . However , after adjustment for baseline characteristics , the groups no longer differed regarding 8-year survival or change in HRQoL among survivors . Mean 8-year secondary care costs were without ( with ) adjustment for baseline characteristics : & OV0556;17 498 ( 16 730 ) for CABG , & OV0556;7245 ( 6920 ) for PCI , and & OV0556;4514 ( 4580 ) for MT , respectively . Conclusion When adjusted for baseline characteristics , no statistically significant differences were found between the patient groups in 8-year survival or change in HRQoL among survivors . The 8-year mean secondary care costs of CABG were over two-fold and almost four-fold , even after adjustment for baseline characteristics , compared with those of PCI and MT BACKGROUND Disease management programs are reported to improve clinical and quality -of-life outcomes while simultaneously lowering healthcare costs . OBJECTIVE To examine the effectiveness of disease management in improving health-related quality of life ( HRQL ) among patients with heart failure beyond 12 months . METHODS A total of 1069 community-dwelling patients 18 years and older in South Texas with echocardiographic evidence of congestive heart failure were r and omly assigned to disease management , augmented disease management , and control groups . They were followed up 18 months . Patients in the control group received usual care . Patients in the intervention groups were assigned a registered nurse as a disease manager who performed telephonic patient education and medication management .  Health-related quality -of-life data ( based on the Medical Outcomes Study 36-Item Short-Form Health Survey [ SF-36 ] ) were collected 4 times , at 6-month intervals . RESULTS Disease management has a limited effect on HRQL . Analysis of the SF-36 health transition measure showed a positive effect of the intervention on self-reported improvement in health at 6 months and at 12 months ( P = .04 and P = .004 , respectively ) . However , no effect of disease management was observed across any of the SF-36 components .  Women and patients with diastolic heart failure had poorer HRQL scores . CONCLUSIONS Participation in disease management has little effect on HRQL outcomes in congestive heart failure . Beneficial effects on the SF-36 scale scores seen at 6 and 12 months were not sustained . Therefore , it is unclear whether disease management can provide long-term improvement in HRQL for patients with congestive heart failure Background There is increased interest in developing multidisciplinary ambulatory care models of service delivery to manage patients with complex chronic diseases . These programs are expensive and given limited re sources it is important that care is targeted effectively . One potential screening strategy is to identify individuals who report the greatest decrement in health related quality of life ( HRQoL )  and thus greater need . The aim of this study was to explore the relationship between HRQoL , comorbid conditions and acute health care utilisation . Methods A prospect i ve , longitudinal cohort design was used to evaluate the impact of  HRQoL  on acute care utilisation rates over three-years of follow-up . Participants were enrolled in chronic disease management programs run by a metropolitan health service in Australia . Baseline data was collected from 2007–2009 and follow-up data until 2012 . Administrative data was used to classify patients ’ primary reasons for enrolment , number of comorbidities ( Charlson Score ) and presentations to acute care . At enrolment ,  HRQoL  was measured using  the Assessment of Quality of Life ( AQoL ) instrument  , for analysis AQoL scores were dichotomised at two st and ard deviations below the population norm . Results There were 1999 participants ( 54 % male ) with a mean age of 63 years ( range 18–101 ) , enrolled in the study . Participants ’ primary health conditions at enrolment were : diabetes 915 ( 46 % ) , chronic respiratory disease 463 ( 23 % ) , cardiac disease 260 ( 13 % ) , peripheral vascular disease , and 181 ( 9 % ) and aged care 180 ( 9 % ) . At 1-year multivariate logistic regression models demonstrated that AQOL utility score was not predictive of acute care presentations after adjusting for comorbidities . Over 3-years an AQoL utility score in the lowest quartile was predictive of both ED presentation ( OR 1.58 , 95 % CI , 1.16–2.13 , p = 0.003 ) and admissions ( OR 1.67 , 95 % CI.1.21 to 2.30 , p = 0.002 ) after adjusting for differences in age and comorbidities . Conclusion This study found that both HRQoL and comorbidities were predictive of subsequent acute care attendance over 3-years of follow-up . At 1-year , comorbidities was a better predictor of acute care representation than HRQoL. To maximise benefits , programs should initially focus on medical disease management , but subsequently switch to strategies that enhance health independence and raise
There was evidence to suggest that education can improve HRQoL and decrease healthcare costs by reductions in downstream healthcare utilization .
Conclusions : Our review had insufficient power to exclude clinical ly important effects of education on mortality and morbidity .
Background : To assess the effects of patient education on mortality , morbidity , health-related quality of life ( HRQoL ) , and healthcare costs in people with coronary heart disease ( CHD ) .