Quality of life and ethics-patients with ischemic heart disease

University dissertation from Dept of Medical Ethics, Lund University, Sweden

Abstract: One month and one year after acute myocardial infarction (AMI) (n=296), coronary artery bypass grafting (CABG) (n=99) and percutaneous coronary intervention (PCI) (n=18) patients completed a questionnaire for self-assessment of quality of life (QoL) during the period 1989?1991. Patients differed from age- and sex-matched controls (n=88) in both somatic and emotional dimensions, but less after one year of follow-up. Women experienced worse quality of life than men in several dimensions. Patients with AMI in need of CABG or PCI during the first year had worse QoL after one month. The dimensions general health, experience of sex life, breathlessness, arrhythmia, and self-esteem were related to death within ten years after the one-year assessment. QoL assessments and medical ethics emphasize the experience and will of the individual. The patient's own evaluation of health has a predictive value and should be included in the clinical monitoring. A questionnaire can capture a decreased quality of life, identify groups in need of extra care and even on a long-term basis predict mortality. From an ethical point of view this possibility is of prime importance. After a cardiac event, first-rate compliance by the patient in secondary prevention is needed. However, if the patient does not feel involved, this may result in a lower adherence to recommendations. Medical ethics may help to identify and analyse possible problems if the autonomy of the patient comes in conflict with the principle of beneficence. Thus, a patient-centered approach with QoL assessments is of paramount importance to improve health-care.

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