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Minerva Cardioangiologica 2020 Feb 20

DOI: 10.23736/S0026-4725.20.05074-4


language: English

Health-related quality of life and unscheduled re-hospitalizations after coronary revascularization: significant predictive role of the MacNew questionnaire

Renato DE VECCHIS 1 , Andrea PACCONE 2 , Marco DI MAIO 3

1 Medical and Polyspecialist Centre, DSB 29 “S. Gennaro dei Poveri Hospital”, Napoli, Italy; 2 Department of Cardiology, University of Bari “Aldo Moro”, Bari, Italy; 3 Department of Cardiology, University of Campania “Luigi Vanvitelli”, Naples, Italy

BACKGROUND: The MacNew questionnaire in its original version is a diagnostic tool which consists of a number of questions answered on a seven-point scale. Among the multiple possible choices, each marked by a box, the examined patient will have to tick only one. In fact, more than one answer for each proposed question is not allowed, for the formulation of the final score. Global and subscale( physical, social and emotional subscales) scores are computed by dividing the sum of the scores achieved for each individual item by the number of items listed in the questionnaire.
METHODS: The study consisted of a retrospective analysis that involved patients followed up for 3 years after a procedure of revascularization (coronary angioplasty with stent or coronary artery bypass graft). According to customary practice conducted at the two institutes for cardiovascular rehabilitation involved in the study, all of the patients underwent an evaluation using the MacNew questionnaire, in the context of the practices of psychological and psychosomatic assessment that are routinely implemented in patients who are treated in order to recover from recent interventions of coronary percutaneous or surgical revascularization.
RESULTS: In the total study population of 210 patients retrospectively enrolled, the mean MacNew health - related quality of life (HRQL) scores were 4.38 ± 1.56 on the global scale, 4.46 ± 1.1 on the physical, 4.54 ± 1.1 on the social and 4.384 ± 1.5 on the emotional subscale. After adjustment for several variables, namely age, gender, history of myocardial infarction, left ventricular ejection fraction and diabetes, using a multivariate Cox proportional hazards regression model, the protection exerted by a high MacNew score against the risk of hospitalizations resulted to be significant ( hazard ratio [ HR] 0.2856, 95% IC: 0,1670 to 0,4884; p <0.0001).
CONCLUSIONS: In patients with low scores on the MacNew questionnaire, the unplanned hospitalizations should be considered more likely and therefore the clinicians should activate all precautions to avoid them, such as critically reviewing and reconsidering the medication dosages or changing the type of molecules that had been originally prescribed. In these cases, a low MacNew global score would serve as a wake-up call that would be able to direct the doctor’s attention on the possibility of concealed procedure-related complications or of greater disease severity or of non-procedural complications.

KEY WORDS: Cardiac rehabilitation; Questionnaire; Prediction; Re-hospitalizations

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