JAGS 49:1052–1058, 2001 © 2001 by the American Geriatrics Society 0002-8614/01/$15.00 Changes in Health-Related Quality of Life in Older Patients with Acute Myocardial Infarction or Congestive Heart Failure: A Prospective Study Cornelia H. M. van Jaarsveld, PhD,* Robbert Sanderman, PhD,* Ida Miedema, MSc,* Adelita V. Ranchor, PhD,* and Gertrudis I. J. M. Kempen, PhD † OBJECTIVES: To study changes in health-related quality of life (HR-QL) following acute myocardial infarction (AMI) or congestive heart failure (CHF) in older people (  57 yr). DESIGN: Prospective cohort study. SETTING: Primary healthcare registers. PARTICIPANTS: Patients were enrolled on the basis of primary healthcare records. Eighty-nine AMI patients (mean age = 69.5) and 119 CHF patients (mean age = 74.5) were included for analysis. MEASUREMENTS: HR-QL was conceptualized and mea- sured by means of physical (activities of daily living (ADL), instrumental activities of daily living (IADL)), psychological (depressive symptoms, anxiety), social, and role functioning. Premorbid data (T0) were available from a 1993 community- based survey. Incident AMI and CHF cases, developed after 1993, were prospectively followed for 12 months. Assess- ments were performed at 6 weeks (T1) and 6 (T2) and 12 months (T3) after diagnosis. RESULTS: At the premorbid assessment, AMI patients did not significantly differ on HR-QL from a reference group of older people, whereas CHF patients were on average older and had worse HR-QL compared to the reference group. Although CHF had not yet been diagnosed at T0, symptoms were already present and resulted in decreased levels of functioning. At T1, all HR-QL measures showed worse functioning compared with T0, except for depres- sive symptoms that presented later (at T2). In contrast to the delay in depressive symptoms, a significant increase in anxiety was already seen at T1. The effect of the somatic conditions was the largest on physical functioning. Effects on psychological and social functioning were less pro- nounced but still significant. Effects were maintained dur- ing the 12 months of follow-up. CONCLUSION: The negative consequences on HR-QL in both AMI and CHF patients are not temporary. No re- covery of function was seen in AMI patients, and function- ing of CHF patients continued to decline in the first year after diagnosis. J Am Geriatr Soc 49:1052–1058, 2001. Key words: health-related quality of life; cardiovascular disease; older C ardiovascular diseases, including acute myocardial in- farction (AMI) and congestive heart failure (CHF), are a major healthcare problem, especially with an aging population. Although, AMI is the result of progressive ar- teriosclerosis, a heart attack often takes patients by sur- prise. The mortality rate among patients with AMI is high and increases with age. The 1-year cardiac mortality rate is 12% for persons under age 75 and 18% for persons age 75 and older. 1 CHF is a pathophysiological disease charac- terized by the inability of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues of the body. It is a common illness. The incidence is still increasing, both because of the aging of the popula- tion and the higher AMI survival rate. The prognosis for those with chronic CHF is poor, with a mortality rate as high as 30% within 1 year of onset of heart failure symp- toms. 2 For those who survive, AMI and CHF may have considerable impact on functioning and well-being. The effects of both diseases might be similar, although some are disease specific. Persons who experience an AMI are suddenly confronted with a life-threatening event. The first heart attack comes unannounced and might provoke ini- tial feelings of fear and despair. By contrast, CHF occurs From the *Northern Centre for Healthcare Research, Department of Public Health and Health Psychology, University of Groningen, Groningen, The Netherlands; † Department of Health Care Studies, Section of Medical Soci- ology, Maastricht University, Maastricht, The Netherlands. This research is part of the Groningen Longitudinal Aging Study (GLAS). GLAS is executed by the Northern Centre for Healthcare Research (NCH) and various Departments of the University of Groningen in the Netherlands. The primary departments involved are Health Sciences, Family Medicine, Psychiatry, Sociology (ICS) and Human Movement Sciences. GLAS and its sub studies are financially supported by the Dutch government (through NESTOR), the University of Groningen, the Faculty of Medical Sciences, the Dutch Cancer Foundation (NKB/KWF), and the Netherlands Organization for Scientific Research (NWO). The coordinating office of GLAS is housed at the NCH, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands (http:// www.med.rug.nl/nch/). Grant support received from The Netherlands Orga- nization for Scientific Research (NWO), Grant 905–59–104. Address correspondence to C. H. M. van Jaarsveld, Northern Centre for Healthcare Research, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands.