Purpose: The aim of this study was to validate the English version of the HeartQoL health-related quality of life questionnaire for use in patients with angina or myocardial infarction. Methods: Patients living in the United States and referred, either for percutaneous coronary intervention or to cardiac rehabilitation, completed the HeartQoL, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale at baseline and 3-months later. The data were analyzed for validity, reliability, and responsiveness. Results: Patients (n = 313 with angina and n = 97 with myocardial infarction) who were referred either for percutaneous coronary intervention (n = 164) or to cardiac rehabilitation (n = 246) completed baseline questionnaires. Patients with angina had significantly lower HeartQoL scores (poorer health-related quality of life) compared with patients with myocardial infarction. Exploratory factor analysis largely supported the 2-factor structure of the HeartQoL in both diagnoses, but further investigation is warranted. Internal consistency reliability was adequate, convergent validity correlations were significant, and discriminative validity was fully confirmed in patients with angina and largely confirmed in patients with myocardial infarction. Responsiveness was largely confirmed in patients who underwent percutaneous coronary intervention (n = 67) and those referred to cardiac rehabilitation (n = 167) with conventional statistical tests and clinically with the effect size, a standardized measure of change. Conclusions: The English HeartQoL health-related quality of life questionnaire is valid, reliable, and responsive in patients with angina and myocardial infarction allowing (1) assessment of baseline, (2) between-diagnosis comparisons, and (3) evaluation of change over time.

PURPOSE Current guidelines call for nitroglycerin to be prescribed in patients with coronary heart disease, including those with stable angina and those recovering from acute coronary syndromes and myocardial infarction. These patients are at risk for coronary events, and nitroglycerin may be required to treat acute symptoms of myocardial ischemia. Nitroglycerin rapidly loses potency when stored improperly, compromising effectiveness. Previous studies indicate that patients frequently fail to store nitroglycerin properly. Accordingly, pharmacists routinely advise patients to renew nitroglycerin tablets every 6 months. The purpose of this study was to determine frequency of prescription of nitroglycerin and the relationship to potency in patients participating in exercise-based cardiac rehabilitation programs. METHODS A survey was performed over a 3-month period of 617 patients enrolled in 9 exercise-based cardiac rehabilitation centers in New York, Michigan, and Rhode Island. Patient data were evaluated according to cardiac diagnoses and the use of sublingual nitroglycerin. RESULTS A total of 38% of patients did not have a prescription for nitroglycerin. Patients with potentially subpotent nitroglycerin tablets included 23% whose prescription was older than 1 year and an additional 15% whose tablets were between 6 and 12 months old. CONCLUSIONS The prescription of nitroglycerin is frequently omitted in patients with coronary heart disease. Those who are prescribed nitroglycerin frequently carry a potentially subpotent medication. Education is necessary for both patients and physicians. The findings have implications for counseling patients who are enrolled in exercise-based cardiac rehabilitation programs.

2008 AACVPR President-Elect and Program Co-Chair (Low) Chair, Program Planning Committee and Program Co-Chair (Gavic)