The importance of the quality of life in relation to disease is increasingly being recognized. Quality of life, however, is a heterogeneous entity that can be measured in several
ways. Questionnaires have been developed with this aim for specific groups of patients,
but their use in assessing patients with ischemic disease of the heart or brain is limited.
In chapter 2 an overview is given of the literature with respect to those aspects of
quality of life considered to be impOliant by patients with heart disease and stroke.
Several questiomlaires developed for the measurement of quality of life in patients with
cardiovascular and cerebrovascular disease are discussed. TIn'ee questionnaires appeared
attractive enough to be further investigated in patients with a history of a myocardial
infarction; the Nottingham Health Profile (NHP) , the Sickness Impact Profile (SIP), and
the Hospital Anxiety and Depression scale (HAD).
In a preparatory phase the interobserver variability was investigated of the Rankin
scale, a six-point handicap scale. One hundred stroke patients were assessed by pairs of
neurologists. The agreement was satisfactory, indicating that the Rankin scale is valid for
the assessment of handicap in stroke patients. The results of this study are described in
chapter 3.1.
In the next phase the agreement between neurologists and cardiologists was tested
with respect to the Rankin scale and the four-point scale of the New York Heart
Association (NYHA) in 51 patients with a histOlY of a myocardial infarction (MI) or
angina pectoris. The agreement among neurologists and cardiologists was similar. This
study, described in chapter 3.2, indicated that the Rankin scale may be useful for the
assessment of the degree of handicap from heart disease, also in patients with
neurological disease.