Matza et al.
Acute and Chronic Impact of Cardiovascular Events on Health State Utilities
BMC Cardiovascular Disorders
Additional file: Cardiovascular Health States
1
2
HEALTH STATE A: STROKE (1-YEAR WITH EVENT)
3
1. Event
4
5
6

Early in the year, you develop a blockage in one of the major arteries of your brain so
blood can no longer flow through it. As a result, part of your brain is damaged, and you
suddenly have the following symptoms:
o Weakness in your arm, leg, and face on one side of your body.
7
8
9

Your arm feels weak and uncoordinated. For example, you have difficulty using
a fork to eat
10

Your leg feels weak. You have difficulty walking on your own.
11
12

You have muscle weakness on one side of your face. This side appears droopy,
and you have difficulty smiling.
13
o You have difficulty swallowing.
14
15
o Your speech becomes slurred and unclear. People around you say your speech is
hard to understand.
16
o You feel confused.
17
2. Hospital
18
19
20
21
22

You are quickly taken to hospital. Immediately, several doctors and nurses speak with
you, and you begin receiving a range of tests including a blood test, ECG (heart rhythm
test), a CT scan of brain tissue, and a scan of arteries in your neck and brain. The scans
help doctors see what is happening so they can determine the most appropriate course of
treatment.
23
24

You are monitored closely in hospital for the first few days. Then, you remain
hospitalized for 3 to 4 weeks for treatment, care, and rehabilitation.
25

During rehabilitation, you receive 3 kinds of therapy:
26
1. Physiotherapy to help you strengthen muscles (e.g., walking).
27
28
2. Speech therapy to help you speak more clearly and reduce confusion. A speech
therapist also helps you re-learn how to swallow and eat without choking.
29
30
3. Occupational therapy to help you cope with your new problems and begin to re-learn
skills (e.g., using a fork, writing).
31
32
33
34
35

Because of your difficulty swallowing, you eat softer foods so that you do not choke.
You need other people to cut your food for you.
3. First 6 Months After the Event

After returning home, your symptoms gradually improve for the first few months, but
you continue to have difficulties:
Matza et al.
Acute and Chronic Impact of Cardiovascular Events on Health State Utilities
BMC Cardiovascular Disorders
36
37
o Your speech gradually becomes clearer, but you are frustrated and angry because you
have difficulty speaking clearly.
38
o You need a walking stick or Zimmer frame to walk.
39
o You still have some weakness on one side of your body.
40
o You have difficulty remembering things and thinking clearly.
41
42
 You take several medications each day including aspirin, a cholesterol lowering tablet,
and a blood pressure lowering tablet. You see a doctor about once every 3 months.
43
 Because of your difficulties, you can no longer work.
44
45
 You rely on family and friends to help you with many daily activities, such as getting
around and shopping.
46
47
 You now have increased responsibility for managing your health. You try to follow your
doctor’s recommendations, including:
48
o Maintaining a healthy weight.
49
o Exercising regularly (although you still have physical limitations).
50
o Reducing the amount of fat and salt in your diet.
51
o Trying to stop smoking (if you were a smoker).
52
53
4. 7 to 12 Months After the Event

Although you have regained many of your abilities, you still have limitations:
54
55
o Your pronunciation is improving, but you still do not speak as clearly as before the
event.
56
o You can walk by yourself, but you walk more slowly than before the event.
57
o You cannot think as clearly as before the event.
58
o You have some difficulty remembering things and learning new information.
59
60
61

You take several medications each day including aspirin, a cholesterol lowering tablet,
and a blood pressure lowering tablet. You see a health care provider one or two times
during this 6-month period.
62
63

You still have increased responsibility for managing your health. You continue trying to
follow your doctor’s recommendations.
64
65

You can no longer work, but you can get around by yourself and perform most daily
activities.
66
67
HEALTH STATE B: ACUTE CORONARY SYNDROME (ACS) (1-YEAR WITH
EVENT)
68
1. Event
Matza et al.
Acute and Chronic Impact of Cardiovascular Events on Health State Utilities
BMC Cardiovascular Disorders
69
70

Early in the year, you have a sudden blockage in one of the arteries that supplies blood to
your heart.
71
72

You have chest discomfort that feels like heaviness, tightness, and a burning feeling. It
feels like your chest is being pressed or crushed by a large object.
73

You are pale and sweaty.
74
2. Hospital
75
76
77

You are quickly taken to hospital. Immediately, several doctors and nurses speak with
you, and you begin receiving blood thinners and other medication. You receive a range
of tests including a blood test, ECG (heart rhythm test), and a chest x-ray.
78
79
80
81
82

You are taken to the operating room for a procedure to restore blood flow to your blocked
artery. In this procedure, a very small balloon is threaded through an artery from your
wrist or groin to the blockage in your heart. This balloon is inflated to open the artery so
that blood can flow to your heart, and a very small mesh tube is placed inside the artery
to keep it open.
83

After the procedure, you are monitored in hospital for about 3 days before going home.
84
3. First 6 Months After the Event
85
86
87

You participate in a cardiac rehabilitation program in a hospital or other health care
setting 2 to 3 days each week, for three months. Each session lasts 1 ½ hours. The
sessions include mild exercise.
88
89

After the rehabilitation program, you are able to continue regular physical activity, but it
may be more difficult due to your heart condition.
90
91

You take several medications each day including aspirin, a cholesterol lowering tablet,
and a blood pressure lowering tablet.
92
93

You see a doctor 3 times during this 6-month period. In at least one of these visits, you
undergo testing to assess your heart.
94
95

You now have increased responsibility for managing your health. You try to follow your
doctor’s recommendations, including:
96
o Maintaining a healthy weight.
97
o Exercising regularly.
98
o Reducing the amount of fat and salt in your diet.
99
o Limiting stress (e.g., by working at a less stressful job).
o Trying to stop smoking (if you were a smoker).
100
101
102
103

You worry about the possibility of another heart problem.
4. 7 to 12 Months After the Event

You return to the level of physical activity you had before the event.
Matza et al.
Acute and Chronic Impact of Cardiovascular Events on Health State Utilities
BMC Cardiovascular Disorders
104
105

You take several medications each day including aspirin, a cholesterol lowering tablet,
and a blood pressure lowering tablet.
106

You see a doctor 2 times during this 6-month period.
107
108

You still have increased responsibility for managing your health. You continue trying to
follow your doctor’s recommendations.
109
110

You sometimes worry about the possibility of another heart problem or a related
cardiovascular disease.
111
112
HEALTH STATE C: HEART FAILURE (1-YEAR WITH EVENT)
113
1. Past Event (before the current year)
114
115
116

In the past, you had a sudden blockage in one of the arteries supplying blood to your
heart.
2. Current Health
117

You can participate in regular physical activity.
118
119

You take several medications each day including aspirin, a cholesterol lowering tablet,
and a blood pressure lowering tablet.
120
121
122

You see a doctor at least once every year. At these visits, you receive a range of tests
including a blood test and a blood pressure test. At some of these visits, you also receive
an ECG (heart rhythm test).
123
124

You have increased responsibility for managing your health. You try to follow your
doctor’s recommendations, including:
125
o Maintaining a healthy weight.
126
o Exercising regularly.
127
o Maintaining a low-fat and low-salt diet.
128
o Limiting stress (e.g., at work).
129
o Avoiding smoking.
130
131
132
133
134

You sometimes worry about the possibility of another heart problem or a related
cardiovascular disease.
3. Event (during the current year)

Because of your past heart-related event, your heart is weakened. At some point in the
current year, over the course of a week, you gradually develop the following symptoms:
135
o Weight gain and bloating from excess fluid.
136
137
o Shortness of breath that makes you feel like you are suffocating. You feel panicked
because you are desperate for breath.
Matza et al.
Acute and Chronic Impact of Cardiovascular Events on Health State Utilities
BMC Cardiovascular Disorders
138
o Swelling in your legs resulting from excess fluid.
139
o Fatigue.
140
o Chest pain.
141
142
143
144

You are taken to the hospital where several doctors and nurses speak with you. You
receive a range of tests including having blood drawn, ECG (heart rhythm test),
echocardiogram (ultrasound test to check how well the heart is pumping), and chest xray.
145
146
147

You are given an intravenous (IV) diuretic medication that causes frequent urination to
reduce the excess fluid in your body. You are weighed frequently to monitor your fluid
retention.
148
149

To improve heart function, you receive medication which controls your heart rate and
blood pressure.
150
151

You stay in the hospital for about 7-10 days, where you are monitored and your
medications are adjusted.
152
153

You return home after the symptoms (swelling, chest pain, shortness of breath, fatigue)
have improved and you have lost fluid weight.
154

You worry about the possibility that this could happen again.
155
156
157
HEALTH STATE D: STROKE (CHRONIC HEALTH STATE, LONG-TERM EFFECTS
OF PRIOR STROKE)
158
1. Past Event
159
160
161
162

In the past, you developed a blockage in one of the major arteries of your brain so blood
can no longer flow through it. As a result, part of your brain was damaged.
2. Current Health

Although you have regained many of your abilities, you still have limitations.
163
o You can pronounce words clearly, but not as clearly as before the event.
164
o You can walk by yourself, but you walk more slowly than before the event.
165
o You cannot think as clearly as before the event.
166
o You have some difficulty remembering things and learning new information.
167
168

You take several medications each day including aspirin, a cholesterol lowering tablet,
and a blood pressure lowering tablet. You see a doctor about once every 6-12 months.
169
170

You have increased responsibility for managing your health. You try to follow your
doctor’s recommendations, including:
171
o Maintaining a healthy weight.
Matza et al.
Acute and Chronic Impact of Cardiovascular Events on Health State Utilities
BMC Cardiovascular Disorders
172
o Exercising regularly (although you still have physical limitations).
173
o Reducing the amount of fat and salt in your diet.
174
o Trying to stop smoking (if you were a smoker).
175
176

You can no longer work, but you can get around by yourself and perform most daily
activities.
177
178
179
HEALTH STATE E: ACUTE CORONARY SYNDROME (CHRONIC HEALTH STATE,
LONG-TERM EFFECTS OF PRIOR ACS)
180
1. Past Event
181
182
183

In the past, you had a sudden blockage in one of the arteries that supplies blood to your
heart.
2. Current Health
184

You can participate in regular physical activity.
185
186

You take several medications each day including aspirin, a cholesterol lowering tablet,
and a blood pressure lowering tablet.
187
188
189

You see a doctor at least once every year. At these visits, you receive a range of tests
including a blood test and a blood pressure test. At some of these visits, you also receive
an ECG (heart rhythm test).
190
191

You have increased responsibility for managing your health. You try to follow your
doctor’s recommendations, including:
192
o Maintaining a healthy weight.
193
o Exercising regularly.
194
o Maintaining a low-fat and low-salt diet.
195
o Limiting stress (e.g., at work).
196
o Avoiding smoking.
197
198

You sometimes worry about the possibility of another heart problem or a related
cardiovascular disease.
199
200
HEALTH STATE F: CHRONIC HEART FAILURE
201
1. Past Event
202
203
204

In the past, you had a sudden blockage in one of the arteries that supplies blood to your
heart.
2. Current Health
Matza et al.
Acute and Chronic Impact of Cardiovascular Events on Health State Utilities
BMC Cardiovascular Disorders
205
206

Because of your past heart-related event, your heart is weakened, and you have persistent
symptoms.
207
208
209
o You feel fatigued, which means you have low energy. This limits your ability to
perform daily activities, such as housework and walking to your car or public
transportation.
210
211
o You have shortness of breath when performing mildly strenuous activities, such as
walking 25 meters or climbing one flight of stairs. You walk and climb stairs slowly.
212
213
o You have shortness of breath when lying down and you need to use pillows to prop
up your head and chest.
214
215

To improve heart function, you take tablets each day to control heart rate and blood
pressure. You also take aspirin and a cholesterol-lowering tablet each day.
216
217
218

Your condition causes you to have extra fluid in your body. Therefore, you take a tablet
that causes you to urinate frequently in order to reduce the amount of fluid in your body.
This frequent urination impacts your ability to be active with friends and family.
219

You can work part-time, but not full-time
220

You see a doctor twice a year.
221
222

You have increased responsibility for managing your health. You try to follow your
doctor’s recommendations, including:
223
o Maintaining a healthy weight.
224
225
o Exercising regularly (although because of your heart condition, exercise is difficult
for you).
226
o Maintaining a low-fat and low-salt diet.
227
o Avoiding smoking.
228
o Limiting how much fluid you drink.
229
o Weighing yourself regularly to monitor fluid retention.
230