1
|
Fia'Ali'i J, Law M, O'Donovan C, Skinner JR, Broadbent E. Perspectives and experiences of Māori and Pasifika peoples living with cardiac inherited disease: a qualitative study. Psychol Health 2024; 39:728-748. [PMID: 35912632 DOI: 10.1080/08870446.2022.2105336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 06/25/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Cardiac inherited diseases can have considerable psychosocial effects, including lifestyle limitations, anxiety and depression. Most research to date on patient experiences of CID has been conducted with people from Western cultures, yet culture can shape patient views and experiences of health. The aim of this research was to explore the experiences and perspectives of Māori and Pasifika living with a cardiac inherited disease (CID). METHODS AND MEASURES Semi-structured interviews were conducted with 14 Māori and 14 Pasifika patients living with a cardiac inherited disease and seven of their family members, using Talanoa and Kaupapa Māori methodologies. Themes from the interviews were identified using interpretative phenomenological analysis. RESULTS Three common themes were identified as important in shaping participants' perceptions and experiences of CID: (1) difficulty in understanding the disease as separate from symptoms, (2) considering ancestors and future generations and (3) the role of spirituality and religion. CONCLUSION This study highlights a gap between indigenous patients' understanding of CID and the western biomedical approach. Patients' understanding and treatment behaviours depend on symptoms, familial ties and spirituality. The findings support the need for transparency and culturally appropriate practices in healthcare. Considering these aspects may help to reduce health inequities for these populations.
Collapse
Affiliation(s)
- Jessee Fia'Ali'i
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mikaela Law
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Claire O'Donovan
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group New Zealand, Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
van Pottelberghe S, Kupper N, Scheirlynck E, Amin AS, Wilde AAM, Hofman N, Callus E, Biller R, Nekkebroeck J, Van Dooren S, Hes FJ, van der Crabben SN. Are disease-specific patient-reported outcomes measures (PROMs) used in cardiogenetics? A systematic review. Eur J Hum Genet 2024; 32:607-618. [PMID: 38097768 PMCID: PMC11153546 DOI: 10.1038/s41431-023-01510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 06/07/2024] Open
Abstract
Patient-reported outcome measures (PROMs) are used to facilitate patient-centered care (PCC). While studies in patients with cardiac conditions have revealed poorer health-related quality of life (HRQoL) and elevated emotional stress, studies in inherited cardiac conditions (ICC) seem rare. A systematic review evaluated which (specific domains of) PROMs are used in patients with ICC. From three databases (PubMed, PsychINFO, and Web of Science) quantitative studies investigating PROMs in patients with ICC were included. A Cochrane-based assessment tool was used to evaluate quality and potential risk of bias per subdomain. Data from 17 eligible articles were extracted. Among the included studies, risk of bias was predominantly high (35%) or unclear (30%). Most (n = 14) studies used a generic health status measure (SF-36, SF-12); 3 studies used a disease-specific PROM (KCCQ- cardiomyopathy and MLFHQ-heart failure). In addition to HRQoL measures, several studies used affective psychological measures (i.e., HADS, CAQ-18, IES-R, and IPQ). The mental health component of the PROMs showed lower scores overall in patients with ICC compared to population norms. Nine studies using HADS and GAD-7/PHQ-9 showed a prevalence of clinically significant anxiety (17-47%) and depression levels (8.3-28%) that were higher than the population norm (8.3% and 6.3%, respectively). HRQoL in patients with ICC is primarily assessed with generic PROMs. Results further confirmed high psychological morbidity in this population. Generic PROMS measures evaluate overall health status, but lack sensitivity to ICC-specific factors like heredity-related concerns. We propose developing a PROM specific for ICC to optimize PCC.
Collapse
Affiliation(s)
- Saar van Pottelberghe
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands.
| | - Nina Kupper
- Center of Research on Psychological Disorders and Somatic Diseases; Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Esther Scheirlynck
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Cardiology Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ahmad S Amin
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Nynke Hofman
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Edward Callus
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Clinical Psychology Service, IRCCS Policlinico San Donato Research and University Hospital, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ruth Biller
- European Patient Advocacy Group of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- ARVC-Selbsthilfe e.V., ARVC Patient Association, Munich, Germany
| | - Julie Nekkebroeck
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
| | - Sonia Van Dooren
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Clinical Sciences, Research Group Reproduction and Genetics, Brussel Interuniversity Genomics High Throughput Core (BRIGHTcore), Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Frederik J Hes
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
| | - Saskia N van der Crabben
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Fia’Ali’i J, Law M, O’Donovan C, Skinner JR, Broadbent E. Cultural Differences in Psychological Distress and Illness Perceptions Amongst People Living With Cardiac Inherited Diseases. Heart Lung Circ 2022; 31:1255-1262. [DOI: 10.1016/j.hlc.2022.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 10/16/2022]
|
4
|
Amedro P, Werner O, Abassi H, Boisson A, Souilla L, Guillaumont S, Calderon J, Requirand A, Vincenti M, Pommier V, Matecki S, De La Villeon G, Lavastre K, Lacampagne A, Picot MC, Beyler C, Delclaux C, Dulac Y, Guitarte A, Charron P, Denjoy-Urbain I, Probst V, Baruteau AE, Chevalier P, Di Filippo S, Thambo JB, Bonnet D, Pasquie JL. Health-related quality of life and physical activity in children with inherited cardiac arrhythmia or inherited cardiomyopathy: the prospective multicentre controlled QUALIMYORYTHM study rationale, design and methods. Health Qual Life Outcomes 2021; 19:187. [PMID: 34321045 PMCID: PMC8317438 DOI: 10.1186/s12955-021-01825-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023] Open
Abstract
Background Advances in paediatric cardiology have improved the prognosis of children with inherited cardiac disorders. However, health-related quality of life (QoL) and physical activity have been scarcely analysed in children with inherited cardiac arrhythmia or inherited cardiomyopathy. Moreover, current guidelines on the eligibility of young athletes with inherited cardiac disorders for sports participation mainly rely on expert opinions and remain controversial. Methods The QUALIMYORYTHM trial is a multicentre observational controlled study. The main objective is to compare the QoL of children aged 6 to 17 years old with inherited cardiac arrhythmia (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, or arrhythmogenic right ventricular dysplasia), or inherited cardiomyopathy (hypertrophic, dilated, or restrictive cardiomyopathy), to that of age and gender-matched healthy subjects. The secondary objective is to assess their QoL according to the disease’s clinical and genetic characteristics, the level of physical activity and motivation for sports, the exercise capacity, and the socio-demographic data. Participants will wear a fitness tracker (ActiGraph GT3X accelerometer) for 2 weeks. A total of 214 children are required to observe a significant difference of 7 ± 15 points in the PedsQL, with a power of 90% and an alpha risk of 5%. Discussion After focusing on the survival in children with inherited cardiac disorders, current research is expanding to patient-reported outcomes and secondary prevention. The QUALIMYORYTHM trial intends to improve the level of evidence for future guidelines on sports eligibility in this population. Trial registration ClinicalTrials.gov Identifier: NCT04712136, registered on January 15th, 2021 (https://clinicaltrials.gov/ct2/show/NCT04712136).
Collapse
Affiliation(s)
- Pascal Amedro
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital, Avenue de Magellan, 33604, Pessac Cedex, France. .,INSERM, Bordeaux Cardio-Thoracic Research Centre, U1045, University of Bordeaux, Pessac, France. .,IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, Pessac, France.
| | - Oscar Werner
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Aymeric Boisson
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Luc Souilla
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, Institut-Saint-Pierre, Palavas-Les-Flots, France
| | - Johanna Calderon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Marie Vincenti
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Victor Pommier
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, Institut-Saint-Pierre, Palavas-Les-Flots, France
| | - Stefan Matecki
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, Institut-Saint-Pierre, Palavas-Les-Flots, France
| | - Kathleen Lavastre
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Alain Lacampagne
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
| | - Constance Beyler
- Paediatric Cardiology and Physiology Department, Robert Debré University Hospital, University of Paris, AP-HP, Paris, France
| | - Christophe Delclaux
- Paediatric Cardiology and Physiology Department, Robert Debré University Hospital, University of Paris, AP-HP, Paris, France
| | - Yves Dulac
- Paediatric Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse, France
| | - Aitor Guitarte
- Paediatric Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse, France
| | - Philippe Charron
- Department of Cardiology, National Reference Centre for Inherited Cardiomyopathy, University of Paris, AP-HP, Paris, France
| | - Isabelle Denjoy-Urbain
- Department of Cardiology, National Reference Centre for Inherited Cardiomyopathy, University of Paris, AP-HP, Paris, France
| | - Vincent Probst
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, L'Institut du Thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Philippe Chevalier
- Department of Congenital Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, University of Lyon, Lyon University Hospital, Lyon, France
| | - Sylvie Di Filippo
- Department of Congenital Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, University of Lyon, Lyon University Hospital, Lyon, France
| | - Jean-Benoit Thambo
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital, Avenue de Magellan, 33604, Pessac Cedex, France.,INSERM, Bordeaux Cardio-Thoracic Research Centre, U1045, University of Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, Pessac, France
| | - Damien Bonnet
- Paediatric Cardiology Department, Necker-Enfants malades, M3C National Reference Centre, University of Paris, AP-HP, Paris, France
| | - Jean-Luc Pasquie
- Cardiology Department of Cardiology, Regional Reference Centre for Inherited Cardiac Arrhythmia, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| |
Collapse
|
5
|
Capota R, Militaru S, Ionescu AA, Rosca M, Baicus C, Popescu BA, Jurcut R. Quality of life status determinants in hypertrophic cardiomyopathy as evaluated by the Kansas City Cardiomyopathy Questionnaire. Health Qual Life Outcomes 2020; 18:351. [PMID: 33126893 PMCID: PMC7602300 DOI: 10.1186/s12955-020-01604-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/20/2020] [Indexed: 01/17/2023] Open
Abstract
Purpose The present study evaluated how heart failure (HF) negatively impacts health-related quality of life (HRQoL) in hypertrophic cardiomyopathy (HCM) patients and explored the major clinical determinants associated with HRQoL impairment in this population. Methods This was a cross-sectional single-center study of health-related HRQoL that included 91 consecutive patients with HCM. Evaluation was performed based on a comprehensive protocol that included the recommended diagnostic studies, as well as administration of the translated validated version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) (CV Outcomes Inc) as a health status measure. Results The cohort included 52 (57%) males, median age 58 (20–85) years. The median global KCCQ score was 67 (12.5–100) corresponding to a moderate impairment in HRQoL. There was an inverse correlation between the median global KCCQ score and NYHA class (Kendall’s tau b coefficient r − 0.33, p = 0.001). Patients with pulmonary hypertension (PHT), defined as resting pulmonary artery systolic pressure of ≥ 45 mmHg, presented a significantly worse HRQoL as compared to those without PHT (median KCCQ score 56.2 vs 77.5, p = 0.013). The KCCQ score mildly correlated with age (r − 0.18, p = 0.014), history of syncope (r − 0.18, p = 0.045), estimated glomerular filtration rate (eGFR) (r 0.31, p < 0.001), plasmatic creatinine (r − 0.18, p = 0.017) and urea levels (r − 0.27, p < 0.001), left ventricular (LV) end-systolic dimensions (r − 0.18, p = 0.014), maximal provoked intraventricular gradient (r 0.20, p = 0.039), LV ejection fraction (r 0.15, p = 0.04), average E/e′ (r − 0.16, p = 0.039), pulmonary acceleration time (r 0.21, p = 0.007), pulmonary artery systolic pressure (r − 0.20, p = 0.016). In ordinal regression, the independent predictors of HRQoL were NYHA class and eGFR. Conclusions Patients with HCM and HF present a moderate degree of alteration in HRQoL. This is especially true for patients with PHT and more severe functional impairment. Renal failure and NYHA class are potential markers of HRQoL in clinical practice.
Collapse
Affiliation(s)
- Razvan Capota
- Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof.Dr.C.C.Iliescu", Sos. Fundeni 258, 022322, Bucharest, Romania
| | - Sebastian Militaru
- Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof.Dr.C.C.Iliescu", Sos. Fundeni 258, 022322, Bucharest, Romania
| | - Alin Alexandru Ionescu
- Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof.Dr.C.C.Iliescu", Sos. Fundeni 258, 022322, Bucharest, Romania
| | - Monica Rosca
- Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof.Dr.C.C.Iliescu", Sos. Fundeni 258, 022322, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Cristian Baicus
- Colentina Clinical Hospital, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Bogdan Alexandru Popescu
- Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof.Dr.C.C.Iliescu", Sos. Fundeni 258, 022322, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Ruxandra Jurcut
- Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof.Dr.C.C.Iliescu", Sos. Fundeni 258, 022322, Bucharest, Romania. .,University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
| |
Collapse
|
6
|
Ingles J. Psychological Issues in Managing Families with Inherited Cardiovascular Diseases. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036558. [PMID: 31548222 DOI: 10.1101/cshperspect.a036558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The field of cardiovascular genetic counseling has evolved dramatically in recent years largely to manage the unique psychological needs of the inherited cardiovascular disease patient population. For many, there can be difficulty in coming to terms with a diagnosis, whether it be adjusting to lifestyle recommendations such as exclusion from competitive sports or living with a small but remarkable risk of sudden cardiac death. For those considered at risk of life-threatening ventricular arrhythmias, the decision to have an implantable cardioverter defibrillator can be difficult. Living with the device, especially for those who are young and those who receive multiple shocks, can precipitate psychological distress and poor adaptation to the device. Family members who experience a sudden cardiac death of a young relative have a significant risk of poor psychological outcomes. The roles of the cardiac genetic counselor in facilitating patients' adaptation to their diagnoses and management and recognizing when additional support from a clinical psychologist is needed are key to ensuring families receive the best possible care.
Collapse
Affiliation(s)
- Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, New South Wales NSW 2042, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales NSW 2000, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales NSW 2050, Australia
| |
Collapse
|
7
|
Psychosocial Impact of a Positive Gene Result for Asymptomatic Relatives at Risk of Hypertrophic Cardiomyopathy. J Genet Couns 2018; 27:1040-1048. [DOI: 10.1007/s10897-018-0218-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/16/2018] [Indexed: 12/14/2022]
|
8
|
Smagarinsky Y, Burns C, Spinks C, Semsarian C, Ingles J. Development of a communication aid for explaining hypertrophic cardiomyopathy genetic test results. Pilot Feasibility Stud 2017; 3:53. [PMID: 29152326 PMCID: PMC5680798 DOI: 10.1186/s40814-017-0205-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/31/2017] [Indexed: 01/10/2023] Open
Abstract
Background Large gene panels are now commonplace for hypertrophic cardiomyopathy (HCM), increasing the yield of uncertain genetic findings. Few resources exist which aim to facilitate communication of HCM genetic test results. We sought to develop, pilot, and refine a communication aid for probands receiving HCM genetic test results. Methods Development was a multi-step process involving expertise of a multidisciplinary team, literature review, and empirical experience. The aid went through an iterative revision process throughout the piloting phase to incorporate feedback. HCM probands attending a specialized multidisciplinary HCM clinic, aged ≥ 18 years and genetic test results available for disclosure between May and August 2016, or recently received their gene results (January–April 2015) were eligible. A purposive sampling strategy was employed, recruiting those attending clinic during the study period or those who could attend without difficulty. Results We developed and pilot tested a genetic counsellor-led communication aid. Based on clinical expertise, the aid addresses (a) what genetic testing is, (b) implications for the patient, (c) reasoning for variant classification, and (d) implications for the family. Pilot data were sought to assess knowledge, feasibility, and acceptability using a self-report survey 2 weeks post-intervention. Twelve of 13 participants completed the follow-up questionnaire. Participants valued the individualised nature of the aid, recommended use of the aid, and indicated genetic knowledge, and family communication was better facilitated. Iterative modification of images helped to more simply depict important genetic concepts. Conclusions We have developed a tool that is feasible, acceptable, and helpful to patients receiving genetic results. This is an important first step, and trial of the aid to assess effectiveness compared to usual care will follow.
Collapse
Affiliation(s)
- Yana Smagarinsky
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Charlotte Burns
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Catherine Spinks
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
9
|
Richardson E, Spinks C, Davis A, Turner C, Atherton J, McGaughran J, Semsarian C, Ingles J. Psychosocial Implications of Living with Catecholaminergic Polymorphic Ventricular Tachycardia in Adulthood. J Genet Couns 2017; 27:549-557. [DOI: 10.1007/s10897-017-0152-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/31/2017] [Indexed: 02/08/2023]
|
10
|
Attitudes, knowledge and consequences of uncertain genetic findings in hypertrophic cardiomyopathy. Eur J Hum Genet 2017; 25:809-815. [PMID: 28594412 DOI: 10.1038/ejhg.2017.66] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/23/2017] [Accepted: 03/28/2017] [Indexed: 01/22/2023] Open
Abstract
With the surge of next-generation sequencing (NGS) technologies making almost all genetic tests more affordable and available, cardiac genetic testing now routinely encompasses a large number of genes within a panel setting. The additional sensitivity of this practice is limited and has the potential to inflict a spectrum of uncertainty. We sought to explore attitudes, preferences, recall and psychological consequences of informative and uninformative genetic results amongst probands diagnosed with hypertrophic cardiomyopathy (HCM). We conducted semi-structured interviews and analysed the qualitative data using a framework analysis process. In general, we found probands were more concerned with their clinical diagnosis than gene result and in some, recall and understanding of genetic diagnosis was poor. Several participants expected genetic testing would alleviate uncertainty, often holding an altruistic view of participation in testing, removing their sense of self and failing to appreciate fully the familial implications. With the key utility of HCM genetic testing and counselling being for greater risk prediction for at-risk relatives, effective communication within the family is critical. While communication appeared adequate, further questioning found it was often vague, failing to translate into meaningful action by relatives. Based on these findings, a framework of key outcomes to assist multidisciplinary teams in genetic counselling of probands receiving an HCM gene result was developed.
Collapse
|
11
|
Caleshu C, Kasparian NA, Edwards KS, Yeates L, Semsarian C, Perez M, Ashley E, Turner CJ, Knowles JW, Ingles J. Interdisciplinary psychosocial care for families with inherited cardiovascular diseases. Trends Cardiovasc Med 2016; 26:647-53. [DOI: 10.1016/j.tcm.2016.04.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/23/2016] [Accepted: 04/23/2016] [Indexed: 12/21/2022]
|
12
|
McTaggart DR, Ogden KJ, Marathe JA. A Long Term Follow-up Study of Carriers of Hypertrophic Cardiomyopathy Mutations. Heart Lung Circ 2016; 26:18-24. [PMID: 27373729 DOI: 10.1016/j.hlc.2016.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/24/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Adults who test positive for a mutation associated with the development of hypertrophic cardiomyopathy (HCM) but who have not manifested left ventricular hypertrophy (LVH) at the time of that diagnosis are now commonly identified in the era of genetic testing. There are little published data, however, on the long-term outlook for these phenotypically normal gene carriers. METHODS Fifteen genotype positive/LVH negative patients with HCM were identified, seven of which were children when first diagnosed as gene carriers. Fourteen were followed up with clinical examinations, electrocardiography and echocardiography to determine if their clinical status had changed over time. Measurements included electrocardiographic changes, changes in wall thickness, diastolic function and global longitudinal stain. RESULTS Ten participants were followed up for a total of 18 years, two for a total of 17 years, one for 11 years and one for 8 years. In addition, magnetic resonance imaging (MRI) studies were performed on 11 participants. Eleven participants carried a mutation for the MYBPC3 gene and three carried a mutation for the MYH7 gene. One patient, an adult at the time of initial investigation, developed phenotypic features of HCM on echocardiography and MRI, one an increase in wall thickness diagnostic for HCM only on MRI and another to be borderline for HCM on MRI. CONCLUSION Hypertrophic cardiomyopathy can develop in adult life in carriers who may be negative for LVH at the time of gene diagnosis and warrants periodic supervision of carriers throughout their lives.
Collapse
Affiliation(s)
- Don R McTaggart
- Cardiology, Launceston General Hospital, Launceston, Tas, Australia.
| | - Kathryn J Ogden
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | | |
Collapse
|
13
|
Magnusson P, Mörner S, Gadler F, Karlsson J. Health-related quality of life in hypertrophic cardiomyopathy patients with implantable defibrillators. Health Qual Life Outcomes 2016; 14:62. [PMID: 27079917 PMCID: PMC4832478 DOI: 10.1186/s12955-016-0467-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/08/2016] [Indexed: 01/18/2023] Open
Abstract
Background Health-related quality of life (HRQL) in hypertrophic cardiomyopathy (HCM) patients with implantable cardioverter-defibrillators (ICDs) is largely unknown. The aim was to assess HRQL, including comparisons between groups, using the questionnaire SF-36, and compare it to a Swedish age- and sex-matched population. Methods and Results Validated data on adult HCM patients with ICDs were used. The SF-36 response rate was 82.5 % and 245 patients (mean age 55.9 years, 70.2 % men) were analyzed using the Mann-Whitney U-test, t-test, Spearman correlation and effect size calculations. In all SF-36 domains the patients’ score was lower (p-value of <0.0001) than norms except for bodily pain. The general health domain showed the highest effect size (0.77) and the impact was more pronounced in the SF-36 physical component summary score (0.62) than the mental component summary score (0.46). Older age was correlated with lower scores on the physical component and higher scores on the mental component. Atrial fibrillation and/or systolic heart failure were associated with worse physical health. HRQL was similar in primary vs secondary prevention cases. Inappropriate ICD shock was associated with worse mental health while appropriate therapy trended toward better mental health. Conclusion HCM patients with ICDs suffer from poor HRQL regardless of age, sex, or primary vs secondary prevention indication. Atrial fibrillation and systolic heart failure are determinants of poor physical health. Inappropriate shocks, but not appropriate therapies, are associated with poorer mental health.
Collapse
Affiliation(s)
- Peter Magnusson
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital/Solna, Stockholm, SE-171 76, Sweden. .,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, SE-801 87, Sweden.
| | - Stellan Mörner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE-90187, Sweden
| | - Fredrik Gadler
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital/Solna, Stockholm, SE-171 76, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-70182, Örebro, Sweden
| |
Collapse
|
14
|
Ingles J, Burns C, Barratt A, Semsarian C. Application of Genetic Testing in Hypertrophic Cardiomyopathy for Preclinical Disease Detection. ACTA ACUST UNITED AC 2015; 8:852-9. [DOI: 10.1161/circgenetics.115.001093] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jodie Ingles
- From the Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney NSW, Australia (J.I., C.B., C.S.); Central Clinical School, Sydney Medical School, University of Sydney, Sydney NSW, Australia (J.I., C.B., C.S.); School of Population Health, Sydney Medical School, University of Sydney, Sydney NSW, Australia (A.B.); and Department of Cardiology, Royal Prince Alfred Hospital, Sydney NSW, Australia (J.I., C.B., C.S.)
| | - Charlotte Burns
- From the Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney NSW, Australia (J.I., C.B., C.S.); Central Clinical School, Sydney Medical School, University of Sydney, Sydney NSW, Australia (J.I., C.B., C.S.); School of Population Health, Sydney Medical School, University of Sydney, Sydney NSW, Australia (A.B.); and Department of Cardiology, Royal Prince Alfred Hospital, Sydney NSW, Australia (J.I., C.B., C.S.)
| | - Alexandra Barratt
- From the Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney NSW, Australia (J.I., C.B., C.S.); Central Clinical School, Sydney Medical School, University of Sydney, Sydney NSW, Australia (J.I., C.B., C.S.); School of Population Health, Sydney Medical School, University of Sydney, Sydney NSW, Australia (A.B.); and Department of Cardiology, Royal Prince Alfred Hospital, Sydney NSW, Australia (J.I., C.B., C.S.)
| | - Christopher Semsarian
- From the Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney NSW, Australia (J.I., C.B., C.S.); Central Clinical School, Sydney Medical School, University of Sydney, Sydney NSW, Australia (J.I., C.B., C.S.); School of Population Health, Sydney Medical School, University of Sydney, Sydney NSW, Australia (A.B.); and Department of Cardiology, Royal Prince Alfred Hospital, Sydney NSW, Australia (J.I., C.B., C.S.)
| |
Collapse
|
15
|
Burns C, McGaughran J, Davis A, Semsarian C, Ingles J. Factors influencing uptake of familial long QT syndrome genetic testing. Am J Med Genet A 2015; 170A:418-425. [PMID: 26544151 DOI: 10.1002/ajmg.a.37455] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 10/15/2015] [Indexed: 12/21/2022]
Abstract
Ongoing challenges of clinical assessment of long QT syndrome (LQTS) highlight the importance of genetic testing in the diagnosis of asymptomatic at-risk family members. Effective access, uptake, and communication of genetic testing are critical for comprehensive cascade family screening and prevention of disease complications such as sudden cardiac death. The aim of this study was to describe factors influencing uptake of LQTS genetic testing, including those relating to access and family communication. We show those who access genetic testing are overrepresented by the socioeconomically advantaged, and that although overall family communication is good, there are some important barriers to be addressed. There were 75 participants (aged 18 years or more, with a clinical and/or genetic diagnosis of LQTS; response rate 71%) who completed a survey including a number of validated scales; demographics; and questions about access, uptake, and communication. Mean age of participants was 46 ± 16 years, 20 (27%) were males and 60 (80%) had genetic testing with a causative gene mutation in 42 (70%). Overall uptake of cascade testing within families was 60% after 4 years from proband genetic diagnosis. All participants reported at least one first-degree relative had been informed of their risk, whereas six (10%) reported at least one first-degree relative had not been informed. Those who were anxious or depressed were more likely to perceive barriers to communicating. Genetic testing is a key aspect of care in LQTS families and intervention strategies that aim to improve equity in access and facilitate effective family communication are needed.
Collapse
Affiliation(s)
- Charlotte Burns
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Julie McGaughran
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Davis
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Marathe JA, Woodroffe J, Ogden K, Hughes C. General Practitioners' knowledge and use of genetic counselling in managing patients with genetic cardiac disease in non-specialised settings. J Community Genet 2015; 6:375-82. [PMID: 25963807 PMCID: PMC4567985 DOI: 10.1007/s12687-015-0229-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/21/2015] [Indexed: 10/23/2022] Open
Abstract
There have been over 40 cardiac diseases with a genetic cause identified to date. The management of most genetic cardiac diseases (GCDs) now necessitates multidisciplinary care, including the provision of genetic counselling. This study investigated the knowledge and management of GCDs by General Practitioners (GPs). Questionnaires were mailed out to 685 doctors working in general practice in Tasmania, Australia, with 144 responses (21 %) received. Results showed that the majority (77.8 %) of the responding doctors are managing at least one patient with GCD in their practice. However, GPs identified having limited confidence in the appropriate management of these conditions and indicated that they are very dependent on guidance from a cardiologist, including whether to refer a patient to genetic counselling. To our knowledge, this is the first Australian study that looks at the care of patients with GCD in the primary care sector. The knowledge gained will help us provide more appropriate care for patients who do not have immediate access to specialised services, particularly those outside metropolitan areas, and provides evidence for what resources can be offered to doctors working in general practice to help provide quality care for these patients.
Collapse
Affiliation(s)
- Jessica A Marathe
- Department of Medicine, Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, 5011, South Australia, Australia.
- Centre for Rural Health, University of Tasmania, Tasmania, Australia.
| | - Jessica Woodroffe
- Centre for Rural Health, University of Tasmania, Tasmania, Australia
- Launceston Clinical School, University of Tasmania, Tasmania, Australia
| | - Kathryn Ogden
- Launceston Clinical School, University of Tasmania, Tasmania, Australia
| | - Clarissa Hughes
- Centre for Rural Health, University of Tasmania, Tasmania, Australia
| |
Collapse
|
17
|
Minto C, Bauce B, Calore C, Rigato I, Folino F, Soriani N, Hochdorn A, Iliceto S, Gregori D. Is Internet use associated with anxiety in patients with and at risk for cardiomyopathy? Am Heart J 2015; 170:87-95, 95.e1-4. [PMID: 26093868 DOI: 10.1016/j.ahj.2015.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the study was to determine the relation between online health information seeking behavior and anxiety level among a sample of patients with manifested cardiomyopathy or at risk for cardiomyopathy. METHODS The research is a cross-sectional study conducted among 104 patients with cardiomyopathy diagnosis and patients at risk for cardiomyopathy. Patients completed 3 different questionnaires: Use of Internet Health Information questionnaire about the use of Internet, Short Form SF-12 items questionnaire on quality of life, and State-Trait Anxiety Inventory measuring general anxiety levels. RESULTS Forty-eight patients had a diagnosis of primary or secondary cardiomyopathy, and 56 patients, with conditions predisposing to cardiomyopathy. Eighty-five percent of the considered population is surfing the Internet to obtain nonspecific information about health in general, and the 65% use it to look specifically for heart disease. For both groups of patients with cardiomyopathy and at risk for cardiomyopathy, online health information seeking behavior is associated with substantially lower state anxiety levels (P = .041). CONCLUSION Web use, as a source of health information, has been shown to be associated with anxiety reduction in patients with or at risk for cardiomyopathy, suggesting that Internet technology can be a useful instrument due to its informational power and its potentially therapeutic value.
Collapse
|
18
|
Brouwers C, Caliskan K, Bos S, Van Lennep JER, Sijbrands EJ, Kop WJ, Pedersen SS. Health Status and Psychological Distress in Patients with Non-compaction Cardiomyopathy: The Role of Burden Related to Symptoms and Genetic Vulnerability. Int J Behav Med 2015; 22:717-25. [PMID: 25778470 DOI: 10.1007/s12529-015-9475-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Non-compaction cardiomyopathy (NCCM) is a cardiomyopathy characterized by left ventricular tribeculae and deep intertrabecular recesses. Because of its genetic underpinnings and physical disease burden, noncompaction cardiomyopathy is expected to be associated with a lower health status and increase in pscyhological distress. PURPOSE This study determined the health status and psychological distress in NCCM patients. We also examined the potential contribution of genetic predisposition and cardiac symptoms to health status and distress in NCCM, by comparing NCCM patients with (1) patients with familial hypercholesterolemia (FH) and (2) patients with acquired dilated cardiomyopathy (DCM). METHODS Patients were recruited from the Erasmus Medical Center, Rotterdam, The Netherlands. Using a case-control design, NCCM patients (N = 45, mean age 46.7 ± 15.1 years, 38 % male) were compared with 43 FH patients and 42 DCM patients. Outcome measures were health status (Short Form Health Survey-12), anxiety (Generalized Anxiety Disorder 7-item scale) and depression (Patient Health Questionnaire 9-item scale). RESULTS NCCM patients showed significantly worse health status (Physical Component Score F(1,84) = 9.58, P = .003; Mental Component Score F(1,84) = 16.65, P < .001), anxiety (F(1,85) = 9.63, P = .003) and depression scores (F(1,82) = 5.4, P = .023) compared to FH patients, also after adjusting age, sex, comorbidity, educational level and time since diagnosis. However, NCCM patients did not differ from DCM patients (Physical Component Score F(1,82) = 2,61, P = .11; Mental Component Score F(1,82) = .55, P = .46), anxiety (F(1,82) = 1.16, P = .28) and depression scores (F(1,82) = 1,95, P = .17). CONCLUSION Cardiac symptoms are likely to play a role in the observed poor health status and elevated levels of anxiety and depressive symptoms in NCCM, whereas the burden of having a genetic condition may contribute less to these health status and psychological measures.
Collapse
Affiliation(s)
- Corline Brouwers
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sven Bos
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Eric J Sijbrands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Willem J Kop
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Susanne S Pedersen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. .,Institute of Psychology, University of Southern Denmark, Odense, Denmark. .,Department of Cardiology, Odense University Hospital, Odense, Denmark.
| |
Collapse
|
19
|
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant, cardiovascular disorder that carries the risk of sudden cardiac death. The prevalence of HCM is 1:500 persons. The purpose of this article is to provide an overview of the pathophysiology, symptoms, complications, diagnostic testing, and treatment. The silent presentation of HCM presents unique diagnostic challenges and complicates prompt identification. Diagnostic testing and management strategies for the care of a person with HCM are discussed. HCM has individualized presentation and therefore requires individualized therapy.
Collapse
Affiliation(s)
- Kim Subasic
- Department of Nursing, University of Scranton, Linden Street, Scranton, PA 18510, USA.
| |
Collapse
|
20
|
Psychological wellbeing and posttraumatic stress associated with implantable cardioverter defibrillator therapy in young adults with genetic heart disease. Int J Cardiol 2013; 168:3779-84. [PMID: 23835269 DOI: 10.1016/j.ijcard.2013.06.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/26/2013] [Accepted: 06/15/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sudden cardiac death is a tragic complication of a number of genetic heart diseases. Implantable cardioverter defibrillator (ICD) therapy plays an important role in prevention of sudden death. The psychological consequences of ICD therapy in young people with genetic heart disease are poorly understood. This study sought to better understand psychological wellbeing and identify symptoms of posttraumatic stress in young people who had experienced an ICD shock. METHODS Eligible patients (ICD implanted over 12 months prior) with an inherited cardiomyopathy or primary arrhythmogenic disorder, enrolled in the Australian Genetic Heart Disease Registry were included. Ninety patients completed the Hospital Anxiety and Depression Scale (HADS). Those patients who had an ICD shock (n=31) also completed the Impact of Events Scale-Revised (IES-R). RESULTS While the mean HADS-Anxiety and IES-R scores were within the normal range in the total group (n=90), a significant subgroup reported symptoms of anxiety (38%), depression (17%) and posttraumatic stress (31%) indicative of the potential need for referral to clinical care. Overall, greater psychological distress in ICD patients was associated with female gender, a history of syncope, other comorbid medical conditions, and reporting of other distressing events (i.e., ICD complications). In those with an ICD shock, higher posttraumatic stress scores were associated with female gender and longer time to first shock. CONCLUSIONS Patients with genetic heart diseases can experience psychological difficulties, including anxiety, depression and posttraumatic stress, related to ICD implantation and subsequent shocks. This signals the importance of offering patients access to targeted interventions, including psychological care and support.
Collapse
|
21
|
Christiaans I. Sudden cardiac death in the young. What's the rationale behind the irrationality in their surviving relatives? Eur J Cardiovasc Nurs 2013; 12:414-5. [PMID: 23698753 DOI: 10.1177/1474515113490607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Imke Christiaans
- Academic Medical Centre, Department of Clinical Genetics, Amsterdam, Netherlands
| |
Collapse
|
22
|
Ingles J, Yeates L, Hunt L, McGaughran J, Scuffham PA, Atherton J, Semsarian C. Health status of cardiac genetic disease patients and their at-risk relatives. Int J Cardiol 2013; 165:448-53. [DOI: 10.1016/j.ijcard.2011.08.083] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 08/24/2011] [Accepted: 08/24/2011] [Indexed: 12/21/2022]
|
23
|
Yeates L, Hunt L, Saleh M, Semsarian C, Ingles J. Poor psychological wellbeing particularly in mothers following sudden cardiac death in the young. Eur J Cardiovasc Nurs 2013; 12:484-91. [PMID: 23568895 DOI: 10.1177/1474515113485510] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIMS Sudden cardiac death (SCD) in the young is a devastating event and often due to an underlying genetic heart disease. Managing these families is complicated by uncertainty regarding clinical management and profound grief. This study sought to evaluate psychological wellbeing and experiences of at-risk relatives following SCD in the young. METHODS Relatives who attended a specialized clinic following the SCD of a relative were invited to complete the Hospital Anxiety and Depression Scale (HADS) and a series of open-ended questions. Primary outcome measures were the HADS anxiety and depression subscales and a thematic qualitative analysis of the open-ended responses was performed. Clinical and genetic data were collected from the medical record. RESULTS Fifty relatives from 29 families returned surveys. The mean time since death was 4±2 years (mean age at death 23±10 years, 79% males). There was significant impairment in mean anxiety (8.7±4.3, p<0.0001) and depression (5.8±3.6, p<0.0001) scores compared to the general population. Mothers showed significantly impaired anxiety (10.9±4.0, p=0.001) and depression (7.3±3.3, p=0.001) scores, with 53% having an anxiety score above 11 suggesting probable anxiety disorder. Participants revealed a number of factors that have helped and hindered their ability to cope with the death, and their decisions relating to clinical screening. CONCLUSION The SCD of a young relative has significant and long-term emotional implications for the family, particularly for the mother.
Collapse
Affiliation(s)
- Laura Yeates
- 1Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Australia
| | | | | | | | | |
Collapse
|
24
|
McGorrian C, Constant O, Harper N, O'Donnell C, Codd M, Keelan E, Green A, O'Neill J, Galvin J, Mahon NG. Family-based cardiac screening in relatives of victims of sudden arrhythmic death syndrome. ACTA ACUST UNITED AC 2013; 15:1050-8. [DOI: 10.1093/europace/eus408] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
25
|
McGorrian C, McShane C, McQuade C, Keelan T, Neill JO, Galvin J, Malone K, Mahon NG, Codd M. Family-based associations in measures of psychological distress and quality of life in a cardiac screening clinic for inheritable cardiac diseases: a cross-sectional study. BMC MEDICAL GENETICS 2013; 14:1. [PMID: 23295100 PMCID: PMC3553038 DOI: 10.1186/1471-2350-14-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 12/17/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Family-based cardiac screening programmes for persons at risk for genetic cardiac diseases are now recommended. However, the psychological wellbeing and health related quality of life (QoL) of such screened patients is poorly understood, especially in younger patients. We sought to examine wellbeing and QoL in a representative group of adults aged 16 and over in a dedicated family cardiac screening clinic. METHODS Prospective survey of consecutive consenting patients attending a cardiac screening clinic, over a 12 month period. Data were collected using two health measurement tools: the Short Form 12 (version 2) and the Hospital Anxiety and Depression Scale (HADS), along with baseline demographic and screening visit-related data. The HADS and SF-12v.2 outcomes were compared by age group. Associations with a higher HADS score were examined using logistic regression, with multi-level modelling used to account for the family-based structure of the data. RESULTS There was a study response rate of 86.6%, with n=334 patients providing valid HADS data (valid response rate 79.5%), and data on n=316 retained for analysis. One-fifth of patients were aged under 25 (n=61). Younger patients were less likely than older to describe significant depression on their HADS scale (p<0.0001), although there were overall no difference between the prevalence of a significant HADS score between the younger and older age groups (18.0% vs 20.0%, p=0.73). Significant positive associates of a higher HADS score were having lower educational attainment, being single or separated, and being closely related to the family proband. Between-family variance in anxiety and depression scores was greater than within-family variance. CONCLUSIONS High levels of anxiety were seen amongst patients attending a family-based cardiac screening clinic.Younger patients also had high rates of clinically significant anxiety. Higher levels of anxiety and depression tends to run in families, and this has implications for family screening and intervention programmes.
Collapse
Affiliation(s)
- Catherine McGorrian
- The Heart House, Mater Misericordiae University Hospital, Dublin 7, Ireland.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Day SM. Anxiety in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Implantable Cardioverter Defibrillators. ACTA ACUST UNITED AC 2012; 5:2-4. [DOI: 10.1161/circgenetics.111.962639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Sharlene M. Day
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI
| |
Collapse
|
27
|
Predictors of Heart-Focused Anxiety in Patients Undergoing Genetic Investigation and Counseling of Long QT Syndrome or Hypertrophic Cardiomyopathy: A One Year Follow-up. J Genet Couns 2011; 21:72-84. [DOI: 10.1007/s10897-011-9393-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 07/07/2011] [Indexed: 12/20/2022]
|
28
|
Aatre RD, Day SM. Psychological Issues in Genetic Testing for Inherited Cardiovascular Diseases. ACTA ACUST UNITED AC 2011; 4:81-90. [DOI: 10.1161/circgenetics.110.957365] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Rajani D. Aatre
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Sharlene M. Day
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|