Research letter East-West divide in health-related quality of life across Europe: Results from the HeartQoL sub-study Alexandra Huber 1 , Stefan Ho ¨ fer 1 , Hugo Saner 2 and Neil Oldridge 3 ; on behalf of the HeartQoL Project investigators Although there have been remarkable health gains in the 53 member states of the World Health Organization European region, striking health inequities within Europe are still evident. There is a well-documented East-West Europe health divide that is attributed lar- gely to the legacy of 20th century European political divisions and healthcare policies in Central and Eastern Europe countries and the former Soviet Union. 1,2 Higher smoking prevalence, higher alcohol consump- tion and higher numbers of overweight and obese people in the Eastern European countries may explain lower self-reported health and lower life expectancy in these countries to a great extent. 3 Patient-reported health status and health-related quality of life (HRQL) are strong, independent predictors of mortal- ity, cardiovascular events and hospitalization in patients with ischaemic heart disease (IHD) 4 which is predicted to be the leading cause of death globally until at least 2030. 5 Only a few observational studies (e.g. EUROASPIRE IV study) 6 or reports (e.g. Social Progress Imperative) 7 have referred to country-specific HRQL data or given country rankings, providing some evidence of an East-West Europe HRQL divide in patients with cardiovascular disease. Therefore, the aim of this analysis was to compare self-reported HRQL across different European regions, measured by the heart disease-specific ‘HeartQoL’ questionnaire that has been developed and validated in the international HeartQoL Project with 6384 IHD-patients from 22 countries with 15 languages spoken. 8,9 For this sub-analysis, only mainland European patients with angina, myocardial infarction (MI) or ischaemic heart failure (HF) recruited in the original project were included. The remaining 16 coun- tries were assigned to four regions: Eastern Europe (EE; Hungary, Poland, Russia, Ukraine), Scandinavia (SC; Denmark, Norway, Sweden), Southern Europe (SE; Italy, Portugal, Spain), and Western Europe (WE; Austria, Belgium, France, Germany, the Netherlands, Switzerland). The 14-item HeartQoL assesses the most ‘bothersome’ physical and emotional aspects of heart disease-specific HRQL on a four-point scale from 0–3, with higher scores indicating higher HRQL. Proportions and HRQL differences across or within regions and/or diagnoses were compared with either Chi-square tests or analyses of co-variance, adjusted for non-modifiable and modifiable risk vari- ables. Adjusted minimal important differences (MIDs) were calculated based on half of the baseline HRQL standard deviation which is considered a useful surro- gate estimate for the minimal important difference threshold. 10 The data analysis included only mainland European patients with complete data on diagnosis (n ¼ 4720; angina: n ¼ 1527, 32.4%; MI 1–6 months previously: n ¼ 1755, 37.2%; ischaemic HF with left ventricular dysfunction and ejection fraction < 40%: n ¼ 1438, 30.4%) from the 16 remaining countries of the original project. The mean age was 61.6  10.9 years with SC patients being the oldest (65.3  10.5; p  0.001), 76.4% were male (WE patients were most likely to be male 82.2%, and EE patients most likely to be female 67.0%; p  0.001). EE patients were most likely to have hypertension (74.5%; p  0.001), be current smo- kers (21.6%; p  0.001), the least likely to be physically active (73.5%; p  0.01) and the most likely to have a high body mass index (BMI) (28.5  4.2; p  0.001). Only SE patients had a higher proportion of diabetes 1 Department of Medical Psychology, Medical University Innsbruck, Austria 2 Preventive Cardiology and Sports Medicine, University Hospital Bern, Inselspital Bern, Switzerland 3 College of Health Sciences, University of Wisconsin-Milwaukee, USA Corresponding authors: Stefan Ho ¨fer, Medical University Innsbruck, Department of Medical Psychology, Speckbacherstraße 23, 6020 Innsbruck, Austria. Email: stefan.hoefer@i-med.ac.at European Journal of Preventive Cardiology 0(00) 1–4 ! The European Society of Cardiology 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2047487319876042 journals.sagepub.com/home/cpr