Quality of life can both influence and be an outcome of general health perceptions after heart surgery

Effect of mindfulness-based interventions on anxiety, depression, and stress in patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials

Background

Adopting lifestyle interventions is pivotal in coronary artery disease (CAD) management and prevention to amplify cardiovascular and mental well-being. This study aims to quantify the effect of mindfulness-based interventions (MBIs) on anxiety, depression and stress in CAD patients.

Methods

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching four electronic databases (PubMed, CENTRAL, Scopus, and Science Direct) through December 2023. The risk of bias was assessed using the PEDro tool, and the study outcomes were expressed as standard mean difference at 95% CI.

Results

Out of 1838 yielded results, eight RCTs involving 623 participants with a mean age of 56.96 ± 4.89 met the prespecified eligibility criteria. The pooled results showed a statistically significant and beneficial effect of MBIs on CAD patients' mental health status in regards to anxiety (SMD = -0.83; 95% CI [-1.19, -0.46], p < 0.001), depression (SMD = - 0.86; 95% CI [-1.14, -0.58], p < 0.001), and stress (SMD = -0.69; 95% CI [-1.27, -0.12], p = 0.02). The subgroup sensitivity analyses based on the region (Asia vs. Europe) indicated a statistically non-significant subgroup effect of MBIs on anxiety (I 2 = 63.9%, p = 0.10) and depression (I 2 = 25.8%, p = 0.25), and a significant effect on stress (I 2 = 80.0%, p = 0.03). Although the methodological quality of the trials was generally satisfactory, all studies lacked allocation concealment and blinding. Additionally, gender imbalances, and inadequate follow-up may have potentially compromised the validity of the trials.

Conclusion

Mindfulness-based interventions are beneficial for improving CAD patients' anxiety, depression and stress symptoms. Nevertheless, it is imperative to conduct more rigorous and robust studies with an equal gender ratio and long-term follow-up.

Bidirectional relationship between insomnia and frailty in older adults: A 2-year longitudinal study

BACKGROUND

Most previous studies that examined the association of insomnia with frailty used cross-sectional designs. The temporal relationship between these factors is therefore largely unknown. This study aimed to examine the bidirectional relationship between insomnia and frailty by sex.

METHODS

A 2-year longitudinal study involving all community-dwelling older adults living in a rural area in Japan (n = 3844). Validated measures of insomnia and frailty were employed. Insomnia was assessed using the Athens insomnia scale, and frailty using the Kihon checklist. We performed a cross-lagged panel model, adjusted for age, sex, years of education, employment status, self-rated health, complications (hypertension, diabetes, stroke, or osteoarthritis), BMI, physical activity, alcohol consumption, and smoking status, and assessed differences by sex.

RESULTS

Poor sleep predicted the onset and worsening of frailty during follow up (standardized coefficient [95% confidence interval]: 0.076 [0.045, 0.107]). Frailty also predicted severe insomnia symptoms (0.074 [0.044, 0.104]). However, the temporal association between these conditions varied by sex. In older men, the effect of frailty on insomnia was stronger than that of insomnia on frailty. However, in women, the impact of insomnia on frailty was stronger than that of frailty on insomnia.

CONCLUSIONS

The primary potential cause of the association between insomnia and frailty may vary by sex, being frailty in men and insomnia in women. Sex-specific interventions to improve sleep quality and duration, and maintain functional abilities in daily life may contribute to the prevention and management of both frailty and insomnia in older adults.

Quality of Life After Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis

Coronary heart disease is a public health problem and is one of the leading causes of loss of quality of life, disability, and death worldwide. The main procedure these patients undergo is cardiac catheterisation, which helps improve their quality of life, symptoms of myocardial ischemia, and ventricular function, thus helping increase the survival rate of sufferers. It can also, however, lead to physical consequences, including kidney failure, acute myocardial infarction, and stroke. The objective of this study was to analyse how coronary artery bypass grafting (CABG) influences quality of life. A systematic review and meta-analysis were conducted using the CINAHL, PubMed, Scopus, and Cuiden databases in June 2020. A total of 7537 subjects were included, 16 in the systematic review and 3 in the meta-analysis. The studies analysing quality of life using the SF questionnaire showed improvements in the quality of physical and mental appearance, and those using the NHP questionnaire showed score improvements and, in some cases, differences in quality of life between women and men. This operation seems to be a good choice for improving the quality of life of people with coronary pathologies, once the possible existing risks have been assessed.

A systematic review of the application of Wilson and Cleary health-related quality of life model in chronic diseases

Background

A conceptual model approach to clarify the elements of health-related quality of life (HRQL), their determinants and causal pathways is needed to aid researchers, health practitioners and policy makers in their bid to improve HRQL outcomes in patients. The aim of this systematic review was to appraise empirical evidence on the performance of the Wilson and Cleary Model of HRQL.

Methods

We conducted a search of MEDLINE, Science Direct, PsyARTICLES and CINAHL databases to identify articles that used Wilson and Cleary model to examine HRQL in chronic diseases. A narrative synthesis was employed in the review of the articles.

Results

Evidence supports linkages between adjacent concepts and between non-adjacent concepts of the Wilson and Cleary model indicating that in practice there is a need to examine relationships among constructs - or to consider interventions in terms of - both with and without mediators. Symptoms status has the highest magnitude of relative impact on health-related quality of life.

Conclusion

The Wilson and Cleary model demonstrated good features suitable for evaluating health-related quality of life in chronic diseases.

Long-term reintegration and quality of life in patients with subarachnoid hemorrhage and a good neurological outcome: findings after more than 20 years

OBJECTIVE The goal of this study was to examine long-term quality of life (QOL) and reintegration in patients with good neurological recovery after aneurysmal subarachnoid hemorrhage (aSAH) and SAH of unknown cause (SAH NUD). METHODS A long-term follow-up was performed in an original cohort of 113 individuals who had suffered SAH (93 with aSAH and 20 with SAH NUD) between 1977 and 1984. Self-reporting assessments, performed > 20 years after the bleeding episode, included the Quality of Life Scale (QOLS), Psychological General Well-Being (PGWB) index, and Reintegration to Normal Living (RNL) index, along with information on sleep disturbances and work status. RESULTS Seventy-one survivors were identified. Questionnaires were returned by 67 individuals who had suffered SAH 20-28 years previously. The QOL was rated in the normal range for both the QOLS score (aSAH 90.3 vs SAH NUD 88.6) and the PGWB index (aSAH 105.9 vs SAH NUD 102.8). Ninety percent of patients had returned to their previous employment. Complete RNL was reported by 40% of patients with aSAH and by 46% of patients with SAH NUD; mild to moderate readjustment difficulties by 55% and 38%, respectively; and severe difficulties by 5% of patients with aSAH and 15% of patients with SAH NUD. Self-rated aspects of cognition, mood, and energy resources in addition resulted in a substantial drop in overall reintegration. Sleep disturbances were reported by 26%. CONCLUSIONS More than half of patients with SAH who had early good neurological recovery experienced reintegration difficulties after > 20 years. However, the general QOL was not adversely affected by this impairment. Inability to return to work after SAH was associated with lower QOLS scores. Sleep disturbances were associated with lower PGWB scores.

Health-related quality-of-life outcomes in coronary artery bypass surgery patients and partners

PURPOSE

The purpose of this study was to examine health-related quality-of-life (HRQOL) outcomes in coronary artery bypass surgery (CABS) patients and partners enrolled together in cardiac rehabilitation versus a usual care group.

METHODS

After CABS, couples were randomly assigned to the Partners Together in Health (PaTH) intervention (n = 17) or usual care (n = 17) groups. Health-related quality-of-life was operationalized as physical function (SF-36 Physical Functioning subscale), depression (Patient Health Questionnaire), and marital adjustment (Dyadic Adjustment Scale). Data were measured in patients and partners at the start (T1) and end of cardiac rehabilitation (T2), and 3 months after cardiac rehabilitation (T3). Nonparametric statistics were used to examine changes over time and differences between groups.

RESULTS

Patients in both groups, and partners in the PaTH group, significantly improved physical function between T1 and T2. At T1, 18% of patients and 6% of partners were depressed. At T2 and T3, only 3% of patients and no partners were depressed. Almost 12% of patients and partners were maritally distressed at T1. At T2 and T3, patients' marital distress was unchanged, but more partners reported marital distress (15%).

CONCLUSIONS

This study adds to our understanding of the trajectory of HRQOL outcomes after CABS for patients and partners. These findings demonstrated promise for the PaTH intervention. Future testing of the intervention is warranted in a larger sample. Because patients and partners are impacted by CABS as a shared life experience, couple-centered interventions may improve HRQOL outcomes more than individually focused interventions.

Conceptual, classification or causal: models of health status and health-related quality of life

Instruments intended to assess health-related quality of life (HRQOL) and health status are widely used in research and clinical practice, but with little conceptual guidance there is some uncertainty about what it is that these instruments are actually tapping. Causal models have the potential to provide the required conceptual guidance, not only placing commonly discussed health concepts on a firm scientific foundation, but also allowing medical and psychosocial interventions to be developed in a more focused and efficient manner. Several models, some postulating causal relations, have been proposed over many years, and some have been supported by data. The development and validation of these models has, however, been conducted in a piecemeal fashion. The imperative to develop tailored, cost-effective interventions requires a synthesized approach to developing and testing causal models.

Outcomes reported in high-impact surgical journals

Background

With advances in operative technique and perioperative care, traditional endpoints such as morbidity and mortality provide an incomplete description of surgical outcomes. There is increasing emphasis on the need for patient-reported outcomes (PROs) to evaluate fully the effectiveness and quality of surgical interventions. The objective of this study was to identify the outcomes reported in clinical studies published in high-impact surgical journals and the frequency with which PROs are used.

Methods

Electronic versions of material published between 2008 and 2012 in the four highest-impact non-subspecialty surgical journals (Annals of Surgery, British Journal of Surgery (BJS), Journal of the American College of Surgeons (JACS), Journal of the American Medical Association (JAMA) Surgery) were hand-searched. Clinical studies of adult patients undergoing planned abdominal, thoracic or vascular surgery were included. Reported outcomes were classified into five categories using Wilson and Cleary's conceptual model.

Results

A total of 893 articles were assessed, of which 770 were included in the analysis. Some 91·6 per cent of studies reported biological and physiological outcomes, 36·0 per cent symptoms, 13·4 per cent direct indicators of functional status, 10·6 per cent general health perception and 14·8 per cent overall quality of life (QoL). The proportion of studies with at least one PRO was 38·7 per cent overall and 73·4 per cent in BJS (P &lt; 0·001). The proportion of studies using a formal measure of health-related QoL ranged from 8·9 per cent (JAMA Surgery) to 33·8 per cent (BJS).

Conclusion

The predominant reporting of clinical endpoints and the inconsistent use of PROs underscore the need for further research and education to enhance the applicability of these measures in specific surgical settings.

Independent contributors to overall quality of life in people with advanced cancer

Background:

The definition of health for people with cancer is not focused solely on the physiology of illness and the length of life remaining, but is also concerned with improving the well-being and the quality of the life (QOL) remaining to be lived. This study aimed to identify the constructs most associated with QOL in people with advanced cancer.

Methods:

Two hundred three persons with recent diagnoses of different advanced cancers were evaluated with 65 variables representing individual and environmental factors, biological factors, symptoms, function, general health perceptions and overall QOL at diagnosis. Three independent stepwise multiple linear regressions identified the most important contributors to overall QOL. R² ranking and effect sizes were estimated and averaged by construct.

Results:

The most important contributor of overall QOL for people recently diagnosed with advanced cancer was social support. It was followed by general health perceptions, energy, social function, psychological function and physical function.

Conclusions:

We used effect sizes to summarise multiple multivariate linear regressions for a more manageable and clinically interpretable picture. The findings emphasise the importance of incorporating the assessment and treatment of relevant symptoms, functions and social support in people recently diagnosed with advanced cancer as part of their clinical care.

Functional status, life-space mobility, and quality of life: a longitudinal mediation analysis

PURPOSE

Using the Wilson-Cleary model of patient outcomes as a conceptual framework, the impact of functional status on health-related quality of life (HRQoL) among older adults was examined, including tests of the mediation provided by life-space mobility.

METHODS

Participants were enrollees in a population-based, longitudinal study of mobility among community-dwelling older adults. Data from four waves of the study equally spaced approximately 18 months apart (baseline, 18, 36, and 54 months) were used for participants who survived at least 1 year beyond the 54-month assessment (n = 677). Autoregressive mediation models using longitudinal data and cross-sectional mediation models using baseline data were evaluated and compared using structural equation modeling.

RESULTS

The longitudinal autoregressive models supported the mediating role of life-space mobility and suggested that this effect is larger for the mental component summary score than the physical component summary score of the SF-12. Evidence for a reciprocal relationship over time between functional status, measured by ADL difficulty, and life-space mobility was suggested by modification indices; these model elaborations did not alter the substantive meaning of the mediation effects. Mediated effect estimates from longitudinal autoregressive models were generally larger than those from cross-sectional models, suggesting that mediating relationships would have been missed or were potentially underestimated in cross-sectional models.

CONCLUSIONS

These results support a mediating role for life-space mobility in the relationship between functional status and HRQoL. Functional status limitations might cause diminished HRQoL in part by limiting mobility. Mobility limitations may precede functional status limitations in addition to being a consequence thereof.

Systematic review of health-related quality of life models

Background

A systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models.

Methods

Online search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria.

Results

Of 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues’ model was a revision of Wilson and Cleary’s model and appeared to have the greatest potential to guide future HRQOL research and practice.

Conclusions

Recommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues’ model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL.

Pathways leading to self-perceived general health and overall quality of life in burned adults

PURPOSE

The aim of the study was to explore pathways leading to self-perceived general health and overall quality of life in burn patients.

MATERIALS AND METHODS

Data on burn-specific health, generic health, overall quality of life, injury characteristics and socio-demographics were obtained from 95 adult burn patients 47.0 (23.8) [mean (SD)] months after injury. A theoretical path model was established based on the concepts of Wilson and Cleary's model on health-related quality of life [1], and the proposed model was examined by structural equation modelling.

RESULTS

Two main paths were identified, one leading to general health perception and the other leading to overall quality of life. Together, direct and indirect paths explained 63% of the variance of perceived general health and 43% of the variance in overall quality of life. The total effects of the SF-36 domain Vitality on perceived general health and overall quality of life were 0.62 and 0.66, respectively. No statistically significant path could be revealed between general health perception and overall quality of life.

CONCLUSION

The results indicate that self-perceived general health and overall quality of life are related but distinct constructs. Moreover, vitality seems to be an important factor for the perception of both general health and overall quality of life in burned adults.

Two-year changes in quality of life in elderly patients with low-energy hip fractures. A case-control study

BACKGROUND

The long-term effect of hip fracture on health-related quality of life (HRQOL) and global quality of life (GQOL) has not been thoroughly studied in prospective case-control studies.

AIMS

a) to explore whether patients with low-energy hip fracture regain their pre-fracture levels in HRQOL and GQOL compared with changes in age- and sex-matched controls over a two year period; b) to identify predictors of changes in HRQOL and GQOL after two years.

METHODS

We examined 61 patients (mean age = 74 years, SD = 10) and 61 matched controls (mean age = 73 years, SD = 8). The Short Form 36 assessed HRQOL and the Quality of Life Scale assessed GQOL. Paired samples t tests and multiple linear regression analyses were applied.

RESULTS

HRQOL decreased significantly between baseline and one-year follow-up in patients with hip fractures, within all the SF-36 domains (p < 0.04), except for social functioning (p = 0.091). There were no significant decreases within the SF-36 domains in the controls. Significantly decreased GQOL scores (p < 0.001) were observed both within patients and within controls between baseline and one-year follow-up. The same pattern persisted between baseline and two-year follow-up, except for the HRQOL domain mental health (p = 0.193). The patients with hip fractures did not regain their HRQOL and GQOL. Worsened physical health after two years was predicted by being a patient with hip fracture (B = -5.8, p < 0.001) and old age (B = -1.0, p = 0.015), while worsened mental health was predicted by co-morbidity (B = -2.2, p = 0.029). No significant predictors of differential changes in GQOL were identified.

CONCLUSION

A hip fracture has a long-term impact on HRQOL and is a strong predictor of worsened physical health. Our data emphasize the importance of preventing hip fracture in the elderly to maintain physical health. This knowledge should be included in decision-making and health care plans.

Preoperative echocardiographic parameters influencing quality of life five years after coronary artery bypass graft surgery

BACKGROUND/AIM

Factors associated with mortality and morbidity following coronary artery bypass graft surgery have been well defined and the Parsonnet score is widely used in mortality prediction. The evaluation of quality of life has not been still implemented in everyday work and preoperative echocardiographic factors affecting the quality of life in patients undergoing coronary artery bypass graft surgery have been poorly documented. The aim of this study was to evaluate echocardiographic parameters influencing quality of life following coronary artery bypass graft surgery and its correlation with widely used Parsonnet score.

METHODS

A total of 449 consecutive patients with myocardial revascularization, operated during 1999 and 2000 were enrolled in this retrospective-prospective study. The patients with comorbidities were excluded as well as those with in complete myocardial revascularization. A group of 180 patients who accepted to participate in quality of life evaluation was followed for 60 months. The quality of life was evaluated using a questionnaire SF-36.

RESULTS

The mean patients' age was 57.8 +/- 7.8 years, 79.4% were males. A 5-year survival was 84.2%. The mean number of risk factors was 3.4 +/- 1.0. Most of the patients were in New York Heart Association (NYHA) II class (104 of them or 59.4%), 61 of them (34.9%) in NYHA III class and only 10 patients or 5.7% of them were in NYHA IV class. The mean End-Diastolic Diameter (EDD) was 55.3 +/- 5.6 mm, mean End-Systolic Diameter (ESD) 38.7 +/- 5.6 mm and mean ejection fraction (EF) 51.7 +/- 9.6%. Left atrium dilatation (p < 0.001), as well as left ventricle dilatation (p < 0.001), low left ventricle ejection fraction (p < 0.001), multisegmental disorders of contractility (p < 0.001), and severe mitral regurgitation (p < 0.001) were in negative correlation with almost all dimensions of quality of life. ROC analysis showed that left ventricle EDD of 54.5 mm can be used as good cut-off value for prediction of optimal quality of life, with sensitivity of 57% and specificity of 70% (RR = 1.386), left ventricle ESD of 37.5 mm with sensitivity of 65% and specificity of 57% (RR = 0.855) and left ventricle EF of 50% with sensitivity of 61% and specificity of 70% (RR = 0.916).

CONCLUSION

Echocardiographic parameters, that can easily be obtained preoperatively, have strong predictive value not only in postoperative survival, but also in determination of the quality of life of the patients five years after coronary artery bypass graft surgery.

No long-term impact of low-energy distal radius fracture on health-related quality of life and global quality of life: a case-control study

BACKGROUND

Changes in patient-reported outcomes like health related quality of life (HRQOL) and global quality of life (GQOL) in patients with low-energy distal radius fracture might be related to fracture, or be within the normal range of variation in an elderly population. Hence, the present study aims to examine: Whether patients with low-energy distal radius fracture attain their pre-fracture levels in HRQOL and GQOL one year after the fracture and compare these levels with age- and sex-matched controls; and whether objective factors predict changes in HRQOL and GQOL during the same one year period.

METHODS

We examined 160 patients and 169 age- and sex matched controls, respectively (mean +/- SD) 67 +/- 9 and 66 +/- 9 years of age. HRQOL was assessed by the Modified Health Assessment Questionnaire (MHAQ) and the Short-Form 36 (SF-36). The Quality of Life Scale (QOLS) assessed GQOL. Paired sample t-tests and multiple linear regression analyses were applied.

RESULTS

After one year no differences were found in HRQOL (assessed as arm functions, physical health and mental health) compared to pre-fracture level in the patient group. Both patients with distal radius fracture and controls reported a reduced GQOL after one year (p < 0.001). Low-energy distal radius fracture did not predict worsened HRQOL or GQOL one year after inclusion, and few predictors of changes were identified. Worsened arm function was predicted by low BMI (B = -0.20, p = 0.019) at baseline, worsened physical health was predicted by low education (B = 1.37, p = 0.017) at baseline, and living with someone predicted worsened mental health (B = 2.85, p = 0.009)

CONCLUSION

Patients with a distal radius fracture seem to manage well despite the fracture, and distal radius fracture is not an independent predictor of worsened HRQOL and GQOL.

Associations between disease severity, coping and dimensions of health-related quality of life in patients admitted for elective coronary angiography - a cross sectional study

Background

In patients with suspected coronary artery disease (CAD), the overall aim was to analyse the relationships between disease severity and both mental and physical dimensions of health related quality of life (HRQOL) using a modified version of the Wilson and Cleary model.

Methods

Using a cross-sectional design, 753 patients (74% men), mean age 62 years, referred for elective cardiac catheterisation were included. The measures included 1) physiological factors 2) symptoms (disease severity, self-reported symptoms, anxiety and depression 3) self-reported functional status, 4) coping, 5) perceived disease burden, 6) general health perception and 7) overall quality of life. To analyse relationships, we performed linear and ordinal logistic regressions.

Results

CAD and left ventricular ejection fraction (LVEF) were significantly associated with symptoms of angina pectoris and dyspnea. CAD was not related to symptoms of anxiety and depression, but less depression was found in patients with low LVEF. Angina pectoris and dyspnea were both associated with impaired physical function, and dyspnea was also negatively related to social function. Overall, less perceived burden and better overall QOL were observed in patients using more confronting coping strategy.

Conclusion

The present study demonstrated that data from cardiac patients to a large extent support the suggested model by Wilson and Cleary.