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Moons P, Norekvål TM, Arbelo E, Borregaard B, Casadei B, Cosyns B, Cowie MR, Fitzsimons D, Fraser AG, Jaarsma T, Kirchhof P, Mauri J, Mindham R, Sanders J, Schiele F, Torbica A, Zwisler AD. Placing patient-reported outcomes at the centre of cardiovascular clinical practice: implications for quality of care and management. Eur Heart J 2023; 44:3405-3422. [PMID: 37606064 DOI: 10.1093/eurheartj/ehad514] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/01/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Patient-reported outcomes (PROs) provide important insights into patients' own perspectives about their health and medical condition, and there is evidence that their use can lead to improvements in the quality of care and to better-informed clinical decisions. Their application in cardiovascular populations has grown over the past decades. This statement describes what PROs are, and it provides an inventory of disease-specific and domain-specific PROs that have been developed for cardiovascular populations. International standards and quality indices have been published, which can guide the selection of PROs for clinical practice and in clinical trials and research; patients as well as experts in psychometrics should be involved in choosing which are most appropriate. Collaborations are needed to define criteria for using PROs to guide regulatory decisions, and the utility of PROs for comparing and monitoring the quality of care and for allocating resources should be evaluated. New sources for recording PROs include wearable digital health devices, medical registries, and electronic health record. Advice is given for the optimal use of PROs in shared clinical decision-making in cardiovascular medicine, and concerning future directions for their wider application.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35 PB7001, 3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, 7700 Cape Town, South Africa
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Jonas Lies veg, 875021 Bergen, Norway
| | - Elena Arbelo
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS). Rosselló 149-153, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
| | - Barbara Casadei
- Division of Cardiovascular Medicine, RDM, University of Oxford; Headley Way, Headington Oxford OX3 9DU, UK
- NIHR Biomedical Research Centre, Headley Way, Headington Oxford OX3 9DU, UK
| | - Bernard Cosyns
- Department of Cardiology, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Martin R Cowie
- Royal Brompton Hospital & School of Cardiovascular Medicine, Faculty of Medicine & Lifesciences, King's College London, Sydney St, London SW3 6NP, UK
| | - Donna Fitzsimons
- School of Nursing & Midwifery, Queens University Belfast, 97 Lisburn Road, Belfast | BT9 7BL, Northern Ireland
| | - Alan G Fraser
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XW, UK
| | - Tiny Jaarsma
- Department of Medicine, Health and Caring Sciences, Linköping University, Campus Norrköping, 601 74 Norrköping, Sweden
- Nursing Science, Julius Center, University Medical Centre Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Martinistrasse 52, D-20246 Hamburg, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston Birmingham B15 2TT, UK
| | - Josepa Mauri
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Richard Mindham
- European Society of Cardiology (ESC) Patient Forum, 2035 route des colles, CS 80179 Biot, 06903 Sophia Antipolis Cedex, France
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, 3 Bd Alexandre Fleming, 25030 Besançon, France
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Sarfatti, 10 20136 Milan, Italy
| | - Ann Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
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Wu Y, Wen J, Wang X, Wang Q, Wang W, Wang X, Xie J, Cong L. Associations between e-health literacy and chronic disease self-management in older Chinese patients with chronic non-communicable diseases: a mediation analysis. BMC Public Health 2022; 22:2226. [PMID: 36447176 PMCID: PMC9710041 DOI: 10.1186/s12889-022-14695-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Chronic non-communicable diseases (CNCDs) are an urgent public health issue in China, especially among older adults. Hence, self-management is crucial for disease progression and treatment. Electronic health (e-health) literacy and self-efficacy positively correlate with self-management. However, we know little about their underlying mechanisms in older adults with CNCDs. OBJECTIVE To explore the factors that influence chronic disease self-management (CDSM) and verify self-efficacy as the mediator between e-health literacy and self-management behavior in older patients with CNCDs. METHODS This cross-sectional study included 289 older patients with CNCDs from Hunan province, China, between July and November 2021. E-health literacy, self-efficacy, social support, and CDSM data were collected through questionnaires. The influence of each factor on CDSM was explored with multiple linear regression analysis. Intermediary effects were computed via a structural equation model. RESULTS The total CDSM score in the patients was 29.39 ± 9.60 and only 46 (15.92%) patients used smart healthcare devices. The regression analysis showed e-health literacy, self-efficacy, and social support were the factors that affected CDSM. Furthermore, the structural equation model revealed that self-efficacy directly affected CDSM (β = 0.45, P < 0.01), whereas e-health literacy affected it directly (β = 0.42, P < 0.01) and indirectly (β = 0.429, P < 0.01) through self-efficacy. CONCLUSIONS This study revealed that self-management among older patients with CNCDs is at a low level, and few of them use smart healthcare devices. Self-efficacy plays a partial intermediary role between e-health literacy and self-management in older patients with CNCDs. Thus, efforts to improve their CDSM by targeting e-health literacy may be more effective when considering self-efficacy.
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Affiliation(s)
- Ying Wu
- grid.411427.50000 0001 0089 3695School of Medicine, Hunan Normal University, Changsha, 410013 People’s Republic of China
| | - Jing Wen
- grid.411427.50000 0001 0089 3695School of Medicine, Hunan Normal University, Changsha, 410013 People’s Republic of China
| | - Xiaohui Wang
- grid.411427.50000 0001 0089 3695School of Medicine, Hunan Normal University, Changsha, 410013 People’s Republic of China
| | - Qingyao Wang
- grid.411427.50000 0001 0089 3695School of Medicine, Hunan Normal University, Changsha, 410013 People’s Republic of China
| | - Wen Wang
- grid.216417.70000 0001 0379 7164Xiangya Hospital, Central South University, Changsha, 41008 People’s Republic of China
| | - Xiangjia Wang
- grid.411427.50000 0001 0089 3695School of Medicine, Hunan Normal University, Changsha, 410013 People’s Republic of China
| | - Jiang Xie
- grid.411427.50000 0001 0089 3695School of Medicine, Hunan Normal University, Changsha, 410013 People’s Republic of China
| | - Li Cong
- grid.411427.50000 0001 0089 3695School of Medicine, Hunan Normal University, Changsha, 410013 People’s Republic of China
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Yang H, Tian J, Li J, Han L, Han G, Zhao J, Han Q, Zhang Y. Social and therapeutic decline earlier than physical and psychological domains after discharge in heart failure patients: A patient-reported outcome measurements of latent transition analysis. Front Cardiovasc Med 2022; 9:965201. [PMID: 36204569 PMCID: PMC9530707 DOI: 10.3389/fcvm.2022.965201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Among patients with chronic heart failure (CHF), response shifts are common in assessing treatment effects. However, few studies focused on potential response shifts in these patients. Materials and methods Data of CHF patient-reported outcome measures (PROMs) were obtained from three hospitals in Shanxi, China, from 2017 to 2019. A total of 497 patients were enrolled and followed up at 1 month and 6 months after discharge. Latent transition analysis (LTA) was employed to determine the longitudinal transition trajectories of latent subtypes in CHF patients in the physiological, psychological, social, and therapeutic domains. Results The patients were divided into high- and low-level groups in the four domains according to the LTA. One month after discharge, the physiological and psychological domains improved, while the social and therapeutic domains remained unchanged. Six months after discharge, the former remained stable, but the latter deteriorated. The factors affecting the state transition in four domains were as follows. The influencing factor of the physiological domains are gender, age, tea consumption, smoking, alcohol consumption, physical activity, and light diet; those of the psychological domain are gender, occupation, smoking, alcohol consumption, and physical activity; those of the social domains are age; those of the therapeutic domains are education and income. Conclusion The disease status of CHF patients has shifted over time. Risk factors accelerate the deterioration of patients' condition. Furthermore, the risk factors of social and therapeutic domains deteriorate patients' condition faster than those of physiological and psychological domains. Therefore, individualized intervention programs should be given for CHF patients who may be transferred to the low-level groups to maintain the treatment effect and improve the prognosis.
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Affiliation(s)
- Hong Yang
- Department of Health Statistics, Shanxi Medical University, Taiyuan, China
| | - Jing Tian
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Li
- Department of Health Statistics, Shanxi Medical University, Taiyuan, China
| | - Linai Han
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Gangfei Han
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinghua Zhao
- Department of Health Statistics, Shanxi Medical University, Taiyuan, China
| | - Qinghua Han
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanbo Zhang
- Department of Health Statistics, Shanxi Medical University, Taiyuan, China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, China
- School of Health Services and Management, Shanxi University of Chinese Medicine, Taiyuan, China
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