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Christensen J, Winkel BG, Kirkeskov L, Folke F, Winther-Jensen M, Eckhardt-Bentsen C, Kjærgaard J, Hassager C, Wagner MK. The ROCK trial-a multidisciplinary Rehabilitation intervention for sudden Out-of-hospital Cardiac arrest survivors focusing on return-to-worK: a pragmatic randomized controlled trial protocol. Trials 2024; 25:99. [PMID: 38303019 PMCID: PMC10835971 DOI: 10.1186/s13063-024-07911-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Most cardiac arrest survivors are classified with mild to moderate cognitive impairment; roughly, 50% experience long-term neurocognitive impairment. Postarrest challenges complicate participation in society and are associated with social issues such as failure to resume social activities and impaired return to work. The effectiveness of rehabilitation interventions for out-of-hospital cardiac arrest survivors are sparsely described, but the body of evidence describes high probabilities of survivors not returning to work, returning to jobs with modified job descriptions, returning to part-time employment, and often in combination with extensive unmet rehabilitation needs. Hence, there is a need to develop and test a pragmatic individual targeted intervention to facilitate return to work (RTW) in survivors of OHCA. The overall aim of the ROCK trial is to evaluate the effectiveness of a comprehensive individually tailored multidisciplinary rehabilitation intervention for survivors of OHCA on RTW compared to usual care. METHODS AND ANALYSIS The ROCK trial is a two-arm parallel group multicentre investigator-initiated pragmatic randomized controlled superiority trial with primary endpoint measured 12 months after the cardiac arrest. Adult survivors who were part of the labour force prior to the OCHA and had at least 2 years until they are qualified to receive retirement state pensions are eligible for inclusion. Survivors will be randomized 1:1 to usual care group or usual care plus a comprehensive tailored rehabilitation intervention focusing on supporting RTW. After comprehensive assessment of individual rehabilitation needs, the intervention is ongoingly coordinated within a multidisciplinary rehabilitation team, and the intervention can be delivered for up until 12 months. Data for the primary outcome will be obtained from the national register on social transfer payments. The primary outcome will be analysed using logistic regression assessing RTW status at 12 months adjusting for the intervention and age at OHCA, sex, marital status, and occupation prior to OHCA. DISCUSSION The ROCK trial is the first RCT to investigate the effectiveness of a rehabilitation intervention focusing on return to work after cardiac arrest. TRIAL REGISTRATION ClinicalTrials.gov NCT05173740. Registered on May 2018.
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Affiliation(s)
- Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital-Rigshospitalet, 2100, Copenhagen, Denmark.
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lilli Kirkeskov
- Center of Social Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christine Eckhardt-Bentsen
- Center of Social Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Kosobucka-Ozdoba A, Pietrzykowski Ł, Michalski P, Ratajczak J, Grzelakowska K, Kasprzak M, Kubica J, Kubica A. Achieving Cardiovascular Risk Management Goals and Patient Quality of Life. J Cardiovasc Dev Dis 2024; 11:45. [PMID: 38392259 PMCID: PMC10888579 DOI: 10.3390/jcdd11020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Eliminating or reducing the severity of modifiable risk factors of cardiovascular disease (CVD) and undertaking health-promoting behaviors is the basis for prevention. (2) Methods: This study included 200 subjects without a history of CVD, aged 18 to 80 years, who had been diagnosed with hypertension, hypercholesterolemia, or diabetes 6 to 24 months before study enrolment. (3) Results: The median 10-year CV risk assessed by the SCORE2 and SCORE2-OP algorithms was 3.0 (IQR 1.5-7.0). An increase in mean cardiovascular risk in the range from low and moderate to very high was associated with a decrease in quality of life both in individual subscales and the overall score. The median number of controlled risk factors was 4.0 (IQR 3.0-5.0). As the mean number of controlled risk factors increased, the quality of life improved in both of HeartQoL questionnaire subscales (emotional p = 0.0018; physical p = 0.0004) and the overall score (global p = 0.0001). The median number of reported health-promoting behaviors undertaken within 3 years before study enrolment was 3.0 (IQR 2.0-4.0). The highest quality of life in each of the studied dimensions was found in people who reported undertaking three health-promoting behaviors. (4) Conclusions: Controlling CVD risk factors and undertaking health-promoting behaviors has a positive impact on the quality of life of patients without a history of atherosclerotic CVD.
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Affiliation(s)
- Agata Kosobucka-Ozdoba
- Department of Cardiac Rehabilitation and Health Promotion, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Łukasz Pietrzykowski
- Department of Cardiac Rehabilitation and Health Promotion, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Piotr Michalski
- Department of Cardiac Rehabilitation and Health Promotion, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Jakub Ratajczak
- Department of Cardiac Rehabilitation and Health Promotion, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Klaudyna Grzelakowska
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Aldona Kubica
- Department of Cardiac Rehabilitation and Health Promotion, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
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Sethi S, Ravindhran B, Long J, Gurung R, Huang C, Smith GE, Carradice D, Wallace T, Ibeggazene S, Chetter IC, Pymer S. A preoperative supervised exercise program potentially improves long-term survival after elective abdominal aortic aneurysm repair. J Vasc Surg 2024; 79:15-23.e3. [PMID: 37714500 DOI: 10.1016/j.jvs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE A preoperative supervised exercise program (SEP) improves cardiorespiratory fitness and perioperative outcomes for patients undergoing elective abdominal aortic aneurysm (AAA) repair. The aim of this study was to assess the effect of a preoperative SEP on long-term survival of these patients. A secondary aim was to consider long-term changes in cardiorespiratory fitness and quality of life. METHODS Patients scheduled for open or endovascular AAA repair were previously randomized to either a 6-week preoperative SEP or standard management, and a significant improvement in a composite outcome of cardiac, pulmonary, and renal complications was seen following SEP. For the current analysis, patients were followed up to 5 years post-surgery. The primary outcome for this analysis was all-cause mortality. Data were analyzed on an intention to treat (ITT) and per protocol (PP) basis, with the latter meaning that patients randomized to SEP who did not attend any sessions were excluded. The PP analysis was further interrogated using a complier average causal effect (CACE) analysis on an all or nothing scale, which adjusts for compliance. Additionally, patients who agreed to follow-up attended the research center for cardiopulmonary exercise testing and/or provided quality of life measures. RESULTS ITT analysis demonstrated that the primary endpoint occurred in 24 of the 124 participants at 5 years, with eight in the SEP group and 16 in the control group (P = .08). The PP analysis demonstrated a significant survival benefit associated with SEP attendance (4 vs 16 deaths; P = .01). CACE analysis confirmed a significant intervention effect (hazard ratio, 0.36; 95% confidence interval, 0.16-0.90; P = .02). There was no difference between groups for cardiorespiratory fitness measures and most quality of life measures. CONCLUSIONS These novel findings suggest a long-term mortality benefit for patients attending a SEP prior to elective AAA repair. The underlying mechanism remains unknown, and this merits further investigation.
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Affiliation(s)
- Sifut Sethi
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | | | - Judith Long
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Roji Gurung
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Chao Huang
- Institute for Applied Clinical and Health Research, Hull York Medical School, Hull, United Kingdom
| | - George E Smith
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Daniel Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Tom Wallace
- Leeds Vascular Institute, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Said Ibeggazene
- College of Health, Wellbeing, and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Sean Pymer
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom.
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Anastasiadis F, Antoniadis D, Chountis D, Mantas I, Lekakis I, Elisaf M, Karvounis C, Manolis A, Hahalis G, Kogias I, Tourtoglou T, Gourlis D, Tsounis D. Long-term risk, clinical management, and healthcare resource utilization of stable patients with coronary artery disease and post-myocardial infarction in Greece - TIGREECE study. Hellenic J Cardiol 2023; 72:24-33. [PMID: 36746373 DOI: 10.1016/j.hjc.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In light of the scarcity of evidence, TIGREECE evaluated the clinical management and long-term outcomes of patients at high risk for an atherothrombotic event who have suffered a myocardial infarction (MI), managed by cardiologists/internists in routine hospital and private office settings in Greece. METHODS TIGREECE, a multicenter, 3-year prospective cohort study, enrolled patients ≥50 years old, with a history of MI 1-3 years before enrollment and with at least one of the following risk factors: age ≥65 years, diabetes mellitus requiring medication, second prior MI, multivessel coronary artery disease, and creatinine clearance 15-60 mL/min. The primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death. RESULTS Between 5 June 2014 and 25 July 2015, 305 eligible consented patients (median age: 67.3 years; 81.3% males; 14.8% active smokers; 80.7% overweight/obese) were enrolled; 52.5% had ≥2 qualifying risk factors. The median time from the index MI [ST-segment elevation myocardial infarction (STEMI) in 51.1%, non-STEMI in 33.1%] to enrollment was 1.7 years. Of the patients, 65.9% had been discharged on dual antiplatelet therapy. At enrollment, 94.4% were receiving antiplatelets: 60.0% single [acetylsalicylic acid (ASA): 43.3%; clopidogrel: 15.7%] and 34.4% dual (ASA + clopidogrel: 31.8%) therapy. The Kaplan-Meier estimated 3-year primary composite event rate was 9.3% [95% confidence interval (CI): 6.4-13.0), and the ischemic composite event rate was 6.7% (95% CI: 4.2-9.9). CONCLUSIONS Study results indicate that in the routine care of Greece one in ten patients experience a recurring cardiovascular event or death, mainly of ischemic origin, 1-3 years post-MI.
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Affiliation(s)
| | | | | | - Ioannis Mantas
- Cardiologist, General Hospital of Chalkida, Central Greece, Greece
| | - Ioannis Lekakis
- Professor of Cardiology, Attikon University General Hospital, Attica, Greece
| | - Moses Elisaf
- Professor of Internal Medicine, University General Hospital of Ioannina, Epirus, Greece
| | - Charalampos Karvounis
- Professor of Cardiology, AHEPA University General Hospital of Thessaloniki, Central Macedonia, Greece
| | | | - Georgios Hahalis
- Professor of Cardiology, University General Hospital of Patras, Western Greece, Greece
| | - Ioannis Kogias
- Cardiologist, General Hospital of Karditsa, Thessaly, Greece
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Wang L, Shi Y, Hu Z, Li Y, Ang Y, Jing P, Zhang B, Cao X, Loerbroks A, Li J, Zhang M. Longitudinal Associations of Work Stress with Changes in Quality of Life among Patients after Acute Coronary Syndrome: A Hospital-Based Study. Int J Environ Res Public Health 2022; 19:17018. [PMID: 36554897 PMCID: PMC9779479 DOI: 10.3390/ijerph192417018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Targeting a sample of Chinese employees in this study, the correlation of work stress with changes in quality of life (QoL) was explored subsequent to acute coronary syndrome (ACS). (2) Methods: Patients suffering from the first ACS episode, with regular paid work before ACS, were eligible for this one-year longitudinal study. Effort-reward imbalance (ERI), together with job strain (JS) models, were employed to evaluate work stress before discharge, and QoL prior to discharge (baseline), as well as at 1, 6, and 12 months following discharge, were measured using the 8-Items Short Form (SF-8), in addition to the Seattle Angina Questionnaire (SAQ). Moreover, generalized estimating equations were used to determine the relationship of work stress to longitudinal QoL variations. (3) Results: After adjusting for covariates, high work stress at the baseline measured by JS was associated with the slow recovery of both mental health (p < 0.01) and physical health (p < 0.05) in SF-8, while ERI-measured work stress was related to slower improvement in SF-8 physical health (p < 0.001), SAQ-angina stability (AS) (p < 0.05), SF-8 mental health (p < 0.001), and SAQ-angina frequency (AF) (p < 0.05). After mutual adjustment for JS and ERI, high work stress as assessed by JS displayed no correlation with any QoL alteration (all p > 0.05), whereas ERI-determined work stress at a high level still presented a relationship to slow improvement in SF-8 physical health, SAQ-AS, SF-8 mental health, and SAQ-AF (all p < 0.05). (4) Conclusion: Work stress was associated with slow recovery of QoL in patients with ACS across one year. For ACS patients, ERI was a stronger predictor of QoL variations than JS.
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Affiliation(s)
- Luqiao Wang
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yunke Shi
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Zhao Hu
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yanyan Li
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yan Ang
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Pan Jing
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Bangying Zhang
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Xingyu Cao
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
- School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Min Zhang
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
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Parry M, Visintini S, Johnston A, Colella TJ, Kapur D, Liblik K, Gomes Z, Dancey S, Liu S, Goodenough C, Hay JL, Noble M, Adreak N, Robert H, Tang N, O'Hara A, Wong A, Mullen KA. Peer-support interventions for women with cardiovascular disease: protocol for synthesising the literature using an evidence map. BMJ Open 2022; 12:e067812. [PMID: 36198466 PMCID: PMC9535150 DOI: 10.1136/bmjopen-2022-067812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The leading cause of death for women is cardiovascular disease (CVD), including ischaemic heart disease, stroke and heart failure. Previous literature suggests peer support interventions improve self-reported recovery, hope and empowerment in other patient populations, but the evidence for peer support interventions in women with CVD is unknown. The aim of this study is to describe peer support interventions for women with CVD using an evidence map. Specific objectives are to: (1) provide an overview of peer support interventions used in women with ischaemic heart disease, stroke and heart failure, (2) identify gaps in primary studies where new or better studies are needed and (3) describe knowledge gaps where complete systematic reviews are required. METHODS AND ANALYSIS We are building on previous experience and expertise in knowledge synthesis using methods described by the Evidence for Policy and Practice Information (EPPI) and the Coordinating Centre at the Institute of Education. Seven databases will be searched from inception: CINAHL, Embase, MEDLINE, APA PsycINFO, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials, and Scopus. We will also conduct grey literature searches for registered clinical trials, dissertations and theses, and conference abstracts. Inclusion and exclusion criteria will be kept broad, and studies will be included if they discuss a peer support intervention and include women, independent of the research design. No date or language limits will be applied to the searches. Qualitative findings will be summarised narratively, and quantitative analyses will be performed using R. ETHICS AND DISSEMINATION The University of Toronto's Research Ethics Board granted approval on 28 April 2022 (Protocol #42608). Bubble plots (ie, weighted scatter plots), geographical heat/choropleth maps and infographics will be used to illustrate peer support intervention elements by category of CVD. Knowledge dissemination will include publication, presentation/public forums and social media.
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Affiliation(s)
- Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy Johnston
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Tracey Jf Colella
- Toronto Rehabilitation Cardiovascular Prevention & Rehabilitation Program, KITE - University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Deeksha Kapur
- Lawrence S. Bloomberg Faculty of Nursing (Research Assistant), University of Toronto, Toronto, Ontario, Canada
| | - Kiera Liblik
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Zoya Gomes
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sonia Dancey
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shuangbo Liu
- Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Goodenough
- Canadian Women's Heart Health Alliance, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jacqueline L Hay
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Meagan Noble
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Indigenous Services Canada, Toronto, Ontario, Canada
| | - Najah Adreak
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Robert
- Canadian Women's Heart Health Alliance, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Natasha Tang
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Arland O'Hara
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Anice Wong
- Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Outi K, Anne O, Heikki M, Hannu V, Helvi K, Juha H. A concise and informative title: Perceived health among percutaneous coronary intervention patients over a six‐year follow‐up period. J Clin Nurs 2022. [DOI: 10.1111/jocn.16545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/24/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kähkönen Outi
- Research Unit of Health Sciences and Technology, Faculty of Medicine University of Oulu Oulu Finland
- Heart Center University Hospital of Kuopio Kuopio Finland
| | - Oikarinen Anne
- Research Unit of Health Sciences and Technology, Faculty of Medicine University of Oulu Oulu Finland
- Heart Center University Hospital of Kuopio Kuopio Finland
| | - Miettinen Heikki
- Infrastructure of Population Studies University of Oulu Oulu Finland
| | | | - Kyngäs Helvi
- Research Unit of Health Sciences and Technology, Faculty of Medicine University of Oulu Oulu Finland
- Heart Center University Hospital of Kuopio Kuopio Finland
- Oulu University Hospital Oulu Finland
| | - Hartikainen Juha
- Infrastructure of Population Studies University of Oulu Oulu Finland
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Conradie A, Atherton J, Chowdhury E, Duong M, Schwarz N, Worthley S, Eccleston D. Health-Related Quality of Life (HRQoL) and the Effect on Outcome in Patients Presenting with Coronary Artery Disease and Treated with Percutaneous Coronary Intervention (PCI): Differences Noted by Sex and Age. J Clin Med 2022; 11. [PMID: 36079161 DOI: 10.3390/jcm11175231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background and aim: poor quality of life (QoL) has been identified as an independent risk factor for mortality and major cardiac events (MACE) in patients with cardiovascular disease (CVD). The aim of this study was to assess health-related quality of life (HRQoL) at baseline and its association with outcome in patients with coronary artery disease presenting for percutaneous coronary intervention (PCI). The outcome was measured by mortality and MACE at 1-year, and whether there was any difference for sex and different age groups. Methods and results: all patients prospectively enrolled into the GenesisCare Outcome Registry (GCOR) over a 11-year period were included in the study. The EQ-5D-5L and VAS patient survey were used for assessment of baseline HRQoL. Of the 15,198 patients, only 6591 (43.4%) completed the self-assessment. Women had significantly more impairment of all five dimensions of the EQ-5D-5L survey, and their self-reported QoL was significantly lower than men (68.3 in women vs. 71.9 in men, p < 0.001). Poor QoL was strongly associated with increased mortality (HR 2.85; 95% CI 1.76 to 4.62, p < 0.001) and MACE (HR 1.40; 95% CI 1.10 to 1.79, p = 0.01). A similar trend was noted for women and men, but did not reach significance in women due to the smaller number of female patients. Conclusion: poor HRQoL is associated with subsequent mortality and MACE in patients undergoing PCI. By not assessing quality of life as a standard of care, an opportunity is lost to identify high-risk patients who may benefit from targeted interventions to improve health outcomes.
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Won MH, Choi J, Son YJ. Multiple mediating effects of self-efficacy and physical activity on the relationship between frailty and health-related quality of life in adults with CVD. Eur J Cardiovasc Nurs 2022; 22:382-391. [PMID: 35974670 DOI: 10.1093/eurjcn/zvac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/12/2022]
Abstract
AIMS Poor health-related quality of life is prevalent among individuals with cardiovascular disease (CVD) and may be associated with frailty as well as low levels of self-efficacy and physical activity. This study aimed to identify the multiple mediating effects of exercise self-efficacy and physical activity on the relationship between frailty and health-related quality of life among community-dwelling adults with CVD. METHODS AND RESULTS This cross-sectional study included 489 Korean patients aged >20 years diagnosed with CVD. Data were collected through an online survey conducted in June, 2021. The mediation hypothesis was tested using a serial multiple mediation model and the bootstrapping method. Approximately 39.5% of patients in this study were in a frail state. Our main finding revealed that frailty had an indirect effect on health-related quality of life through all three different pathways: each single mediation of exercise self-efficacy and physical activity, and the serial multiple mediation of exercise self-efficacy and physical activity as the first and second mediators, respectively. The direct effect of frailty on the health-related quality of life was also significant. CONCLUSION Frail adults with CVD tended to have lower levels of self-efficacy, physical activity, and poor health-related quality of life. Thus, early identification of frailty and interventions targeting the promotion of self-efficacy and physical activity may improve health-related quality of life in adults with CVD. Longitudinal studies are necessary to further refine our findings across other samples and to address the limitations of the current study.
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Affiliation(s)
- Mi Hwa Won
- Associate Professor, Department of Nursing, Wonkwang University, Iksan, South Korea. E-mail address:
| | - JiYeon Choi
- Associate Professor, Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea E-mail:
| | - Youn Jung Son
- Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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Kähkönen O, Oikarinen A, Vähänikkilä H, Kyngäs H. Association between perceived health and adherence to treatment after percutaneous coronary intervention: A long-term follow-up study. J Adv Nurs 2022; 78:1653-1664. [PMID: 34636444 DOI: 10.1111/jan.15069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/16/2021] [Accepted: 09/26/2021] [Indexed: 12/17/2022]
Abstract
AIMS To identify associations between perceived health and treatment adherence six years after percutaneous coronary intervention. DESIGN A non-experimental descriptive long-term follow-up study. METHODS Baseline data (n = 416) were collected in 2013, with follow-up data collected in 2019 (n = 154), using the EuroQoL scale, EuroQoL visual analogue scale, and Adherence of Patients with Chronic Disease Instrument. Data were analysed using descriptive statistics and multivariate methods. RESULTS The average age of the 154 respondents was 68.5 years (SD 7.01), with a majority males (n = 118, 86.6%). Adherence to a healthy lifestyle, good perceived results of care, support from nurses, high sense of normality, low fear of complications, motivation, older age, and duration of coronary artery disease were associated with better general perceived health as well as its dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). CONCLUSION Support from nurses is a key factor to ensuring high perceived health among post-percutaneous coronary intervention patients. This support must be continuous and motivate the patient to adhere to a healthy lifestyle. Patients should feel comfortable sharing their problems and fears. This type of relationship will allow health care professionals to assess the patient's current situation and address potential problems about mobility, pain and discomfort, as well as anxiety and depression to strengthen the patient's sense of normality and enable them to confidently lead a normal life. IMPACT The research aimed to gain knowledge about how perceived health is associated with treatment adherence six years after percutaneous coronary intervention. The results emphasise that a nurse's support of patients is crucial to the care process, as adherence to treatment showed a clear positive association with perceived health in the analysed sample of post-PCI patients.
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Affiliation(s)
- Outi Kähkönen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure of Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Zinckernagel L, Holmberg T, Zwisler AD, Pedersen SS, Graversen CB, Ersbøll AK. Association of patient-reported psychosocial healthcare and risk of readmissions and mortality in patients with ischemic heart disease: A population-based cohort study. J Psychosom Res 2022; 156:110776. [PMID: 35276588 DOI: 10.1016/j.jpsychores.2022.110776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Psychosocial risk factors are common in patients with ischemic heart disease (IHD) and linked to poor prognosis. Psychosocial healthcare is recommended in international guidelines and has demonstrated positive effects, primarily on psychosocial symptoms. We examined the association between patient-reported psychosocial healthcare and hospital readmissions and mortality in patients with IHD. METHODS A population-based cohort study with register-based follow-up. Patient-reported psychosocial healthcare was measured by seven items in a survey sent to a random sample of patients with incident IHD in Denmark in 2014. We used multivariable Cox proportional hazards models and Poisson regression to examine the association between psychosocial healthcare and readmissions and all-cause mortality. RESULTS In total, 1083 (57%) patients were followed up to 4½ years. Low psychosocial support was reported by 53.4%, medium by 26.2% and high by 20.4% patients. The hazard of acute cardiac readmission for patients reporting low psychosocial healthcare was 2.08 higher than for patients reporting high psychosocial healthcare (95%CI:1.01-4.30). No association was found with time to first all-cause readmission. The acute cardiac readmission rate was 3.24 (95%CI:1.66-6.29) and 4.23 (95%CI:2.15-8.33) times higher among patients reporting low and medium psychosocial healthcare compared to high, and the all-cause readmission rate was 1.30 (95%CI:1.16-1.46) and 1.32 (95%CI:1.17-1.49) times higher. The hazard of death was 2.86 (95%CI:1.23-6.69) and 2.88 (95%CI:1.18-7.04) times higher among patients reporting low and medium psychosocial healthcare compared to high. CONCLUSION In patients with IHD, a high level of patient-reported psychosocial healthcare was significantly associated with reduced hospital readmissions and all-cause mortality.
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Koopman MY, Reijnders JJW, Willemsen RTA, van Bruggen R, Doggen CJM, Kietselaer B, Oude Wolcherink MJ, van Ooijen PMA, Gratama JWC, Braam R, Oudkerk M, van der Harst P, Dinant GJ, Vliegenthart R. Coronary calcium scoring as first-line test to detect and exclude coronary artery disease in patients presenting to the general practitioner with stable chest pain: protocol of the cluster-randomised CONCRETE trial. BMJ Open 2022; 12:e055123. [PMID: 35440450 PMCID: PMC9020291 DOI: 10.1136/bmjopen-2021-055123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Identifying and excluding coronary artery disease (CAD) in patients with atypical angina pectoris (AP) and non-specific thoracic complaints is a challenge for general practitioners (GPs). A diagnostic and prognostic tool could help GPs in determining the likelihood of CAD and guide patient management. Studies in outpatient settings have shown that the CT-based coronary calcium score (CCS) has high accuracy for diagnosis and exclusion of CAD. However, the CT CCS test has not been tested in a primary care setting. In the COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GPs patients with stable chest pain (CONCRETE) study, the impact of direct access of GPs to CT CCS will be investigated. We hypothesise that this will allow for early diagnosis of CAD and treatment, more efficient referral to the cardiologist and a reduction of healthcare-related costs. METHODS AND ANALYSIS CONCRETE is a pragmatic multicentre trial with a cluster randomised design, in which direct GP access to the CT CCS test is compared with standard of care. In both arms, at least 40 GP offices, and circa 800 patients with atypical AP and non-specific thoracic complaints will be included. To determine the increase in detection and treatment rate of CAD in GP offices, the CVRM registration rate is derived from the GPs electronic registration system. Individual patients' data regarding cardiovascular risk factors, expressed chest pain complaints, quality of life, downstream testing and CAD diagnosis will be collected through questionnaires and the electronic GP dossier. ETHICS AND DISSEMINATION CONCRETE has been approved by the Medical Ethical Committee of the University Medical Center of Groningen. TRIAL REGISTRATION NUMBER NTR 7475; Pre-results.
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Affiliation(s)
- Moniek Y Koopman
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorn J W Reijnders
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Robert T A Willemsen
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rykel van Bruggen
- Multicenter General Practitioners Organisation 'HuisartsenOrganisatie Oost-Gelderland', Apeldoorn, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Bas Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Martijn J Oude Wolcherink
- Department of Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Peter M A van Ooijen
- Department of Data Science Center in Health, University of Groniningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Richard Braam
- Department of Cardiology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Matthijs Oudkerk
- Department of Medical Science, University of Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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Ning H, Kershaw KN, Allen NB, Wilkins J, Lloyd-Jones DM. Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling Project. Am J Prev Cardiol 2021; 7:100222. [PMID: 34611648 DOI: 10.1016/j.ajpc.2021.100222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Objective The Pooled Cohort Equations (PCE) serve as the platform for quantitative risk assessment for atherosclerotic cardiovascular disease (ASCVD). Data are sparse regarding the benefit of adding health-related quality of life (HRQoL) measures to the PCE. We sought to estimate the association of HRQoL with ASCVD events and evaluate the potential utility of adding HRQoL to the PCE in refining quantitative risk assessment for primary prevention decisions. Methods Three multi-ethnic longitudinal cohorts were included in the study. HRQoL was measured using the SF-12 physical component summary (PCS) and mental component summary (MCS); higher PCS or MCS scores indicate better HRQoL. We constructed a four-level HRQoL status variable: MCS <50 and PCS <50; MCS <50 and PCS ≥50; MCS ≥50 and PCS <50; MCS ≥50 and PCS ≥50. Harrell's C statistics and net reclassification improvement (NRI) analyses were used to assess the added predictive ability of HRQoL for incident ASCVD. Results A total of 9,904 individuals were included in the analysis, of whom 4,743 were in the low risk subgroup (<5% predicted 10-year risk). HRQoL status, PCS and its subscale scores were independent predictors of ASCVD events. HRQoL improved both discrimination (delta C: 0.004, p = 0.05) and reclassification (cNRI: 0.15, p<0.01) modestly when added to PCE; 3% and 6% of individuals with events were correctly reclassified to higher risk in the overall sample and low risk subgroup, respectively. Conclusion HRQoL is an independent predictor of ASCVD events, and improves ASCVD risk prediction significantly, though modestly, overall and in low-risk individuals. HRQoL may be a cost-effective risk-enhancing factor for refining quantitative risk assessment for primary prevention decisions.
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Al Sayah F, McAlister FA, Ohinmaa A, Majumdar SR, Johnson JA. The predictive ability of EQ-5D-3L compared to the LACE index and its association with 30-day post-hospitalization outcomes. Qual Life Res 2021; 30:2583-2590. [PMID: 33974221 DOI: 10.1007/s11136-021-02835-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine whether the EQ-5D-3L at the time of discharge from hospital provides additional prognostic information above the LACE index for 30-day post-discharge hospital readmission and to explore the association of EQ-5D-3L with readmissions, emergency department (ED) visits, and death within the same period. METHODS Using data (n = 495; mean age 62.9 years (SD 18.6), 50.5% female) from a prospective cohort study of patients discharged from medical wards at two university hospitals, the prognostic ability of EQ-5D-3L was examined using C-statistic, Integrated Discrimination Improvement (IDI) Index, and Akaike's Information Criterion (AIC). The associations between EQ-5D-3L dimensions, total sum, index and VAS scores at the time of discharge and 30-day post-discharge ED visits, readmission, and readmission/death were examined using multivariate logistic regression. RESULTS At the time of discharge, 58.6% of participants reported problems in mobility, 28.3% in self-care, 62.1% in usual activities, 62.7% in pain/discomfort, and 42.4% in anxiety/depression. Mean (SD) total sum score was 7.9 (2.0), index score was 0.69 (0.21), and VAS score was 63.7 (18.4). In adjusted analyses, mobility, self-care, usual activities, and the total sum score were significantly associated with 30-day readmission and readmission/death. Differences in C-statistic for LACE readmission prediction models with and without EQ-5D-3L were small. AIC analysis suggests that readmission prediction models containing EQ-5D-3L dimensions or scores were more often preferred to those with the LACE index only. IDI analysis indicates that the discrimination slope of readmission prediction models is significantly improved with the addition of mobility, self-care, or the total sum score of the EQ-5D-3L. CONCLUSION The EQ-5D-3L, especially the mobility and self-care dimensions as well as the total sum score, improves 30-day readmission prediction of the LACE index and is associated with 30-day readmissions or readmissions/death.
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Affiliation(s)
- Fatima Al Sayah
- 2-040 Li Ka Shing Centre for Health Research Innovation, Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, EdmontonAlberta, AB, T6G 2E1, Canada.
| | - Finlay A McAlister
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Arto Ohinmaa
- 2-040 Li Ka Shing Centre for Health Research Innovation, Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, EdmontonAlberta, AB, T6G 2E1, Canada
| | - Sumit R Majumdar
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey A Johnson
- 2-040 Li Ka Shing Centre for Health Research Innovation, Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, EdmontonAlberta, AB, T6G 2E1, Canada
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Aburub AS, Phillips SP, Aldughmi M, Curcio CL, Guerra RO, Auais M. Fear of Falling Among Community-Dwelling Older Adults with Heart Disease: Findings from an International Mobility in Aging Study (IMIAS). Physiother Theory Pract 2021; 38:2038-2051. [PMID: 33726620 DOI: 10.1080/09593985.2021.1901327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Older adults with heart disease (HD) are more likely to report a higher prevalence of falls compared to those without HD. A knowledge gap currently exists regarding the factors associated with fear of falling (FOF) among older adults with HD. Therefore, this study aimed to estimate FOF and identify factors associated with FOF among older adults with HD. Methods: Data came from a secondary analysis of the International Mobility in Aging Study (IMIAS) baseline (2012) data. FOF was measured using the Falls Efficacy Scale-International (FES-I). Stepwise linear regression was used to identify factors associated with FOF. Results: A total of 429 participants identified themselves as having heart disease diagnosed by their physician (mean age 69.5 ± 2.9). Older adults with HD reported on average (25.6) higher FOF than those without HD. For older adults with HD, FES-I increased significantly by 1.3, 1.0, and 0.6 points, when the Short Physical Performance Battery, the Leganes Cognitive Test, and QOL total scores decreased by one point. FES-I also significantly increased by 3.2 when income was insufficient compared to sufficient or very sufficient income. Discussion: FOF is multifactorial, and our findings provide a base for developing future management rehabilitation intervention programs aimed at decreasing FOF among older adults with HD.
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Affiliation(s)
- Ala' S Aburub
- Physical Therapy Department, Faculty of Allied Medical Sciences, Isra University, Amman, Jordan
| | - Susan P Phillips
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Mayis Aldughmi
- School of Rehabilitation Sciences, Department of Physical Therapy, University of Jordan, Amman, Jordan
| | - Carmen-Lucia Curcio
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad De Caldas, Manizales, Colombia
| | | | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Wang G, Yang Q. Factors associated with health-related quality of life in Chinese patients with heart failure: a cross-sectional study. Collegian 2020; 27:512-520. [DOI: 10.1016/j.colegn.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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17
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Wang G, Liu X, Yang Q. Symptom clusters and quality of life in Chinese patients with heart failure. Collegian 2020. [DOI: 10.1016/j.colegn.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Tew M, Dalziel K, Clarke P, Smith A, Choong PF, Dowsey M. Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement? Qual Life Res 2020; 29:3273-3283. [PMID: 32651804 DOI: 10.1007/s11136-020-02577-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE As patient-reported outcome measures (PROMs) are increasingly integrated into clinical practice, there is a need to translate collected data into valuable information to guide and improve the quality and value of patient care. The purpose of this study was to investigate health-related quality-of-life (QoL) trajectories in the 5 years following total knee replacement (TKR) and the patient characteristics associated with these trajectories. The feasibility of translating QoL trajectories into valuable information for guiding patient-centered care was also explored. METHODS Data on patients who underwent TKR between 2006 and 2011 from a single-institution registry were extracted including patient-reported QoL (captured using the Short Form Survey (SF-12) instrument) up to 5 years post-surgery. QoL trajectories were modelled using latent class growth analysis. Quality-adjusted life-years (QALYs) were calculated to illustrate longer term health benefit. Multinomial logistic regression analyses were performed to examine the association between trajectory groups and baseline patient characteristics. RESULTS After exclusions, 1553 patients out of 1892 were included in the analysis. Six unique QoL trajectories were identified; with differing levels at baseline and improvement patterns post-surgery. Only 18.4% of patients were identified to be in the most positive QoL trajectory (low baseline, large sustainable improvement after surgery) associated with the greatest gain in QALY. These patients were likely to be younger, have no co-morbidities and report greater pain at pre-surgery than most in other QoL trajectories. CONCLUSIONS Our findings demonstrate the importance of underlying heterogeneity in QoL trajectories, resulting in variable QALY gains. There is scope in translating routinely collected PROMs to improve shared decision-making allowing for more patient engagement. However, further research is required to identify suitable approaches of its implementation into practice to guide clinical care and maximize patient outcomes.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia.
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia
| | - Philip Clarke
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter F Choong
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia
| | - Michelle Dowsey
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia
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Höfer S. Health-related quality of life in heart disease. Revista Portuguesa de Cardiologia (English Edition) 2020. [DOI: 10.1016/j.repce.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Höfer S. Health-related quality of life in heart disease. Rev Port Cardiol 2020; 39:375-376. [DOI: 10.1016/j.repc.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kok B, Whitlock R, Ferguson T, James Bailey R, Warren Burak K, Kowalczewski J, Tangri N, Tandon P. Health-Related Quality of Life: A Rapid Predictor of Hospitalization in Patients With Cirrhosis. Am J Gastroenterol 2020; 115:575-83. [PMID: 32079859 DOI: 10.14309/ajg.0000000000000545] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients with cirrhosis experience a worsened quality of life; this may be quantified by the use of health-related QoL (HRQoL) constructs, such as the chronic liver disease questionnaire (CLDQ) and EuroQoL Group-visual analog scale (EQ-VAS). In this multicenter prospective study, we aimed to evaluate HRQoL as a predictor of unplanned hospital admission/early mortality, identify HRQoL domains most affected in cirrhosis, and identify predictors of low HRQoL in patients with cirrhosis. METHODS Multivariable logistic regression was used to determine independent association of HRQoL with primary outcome and identify predictors of low HRQoL. HRQoL was also compared with population norms. RESULTS In this cohort of 402 patients with cirrhosis, mean model for end-stage liver disease was 12.5 (4.9). More than 50% of the cohort had low HRQoL, considerably lower than population norms. HRQoL (measured by either CLDQ or EQ-VAS) was independently associated with the primary outcome of short-term unplanned hospitalization/mortality. Every 1-point increase in the CLDQ and every 10-point increase in the EQ-VAS reduced the risk of reaching this outcome by 30% and 13%, respectively. Patients with cirrhosis had lower HRQoL scores than population norms across all domains of the CLDQ. Younger age, female sex, current smoker, lower serum albumin, frailty, and ascites were independently associated with low CLDQ. DISCUSSION Patients with cirrhosis experience poor HRQoL. HRQoL is independently associated with increased mortality/unplanned hospitalizations in patients with cirrhosis and could be an easy-to-use prognostic screen that patients could complete in the waiting room before their appointment.
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Tew M, Dalziel K, Dowsey M, Choong PF, Clarke P. Exploring the Impact of Quality of Life on Survival: A Case Study in Total Knee Replacement Surgery. Med Decis Making 2020; 40:302-313. [PMID: 32297839 DOI: 10.1177/0272989x20913266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. There is growing evidence that quality of life (QoL) has a strong association with mortality. However, incorporation of QoL is uncommon in standard survival modeling. Methods. Using data extracted from a registry of patients undergoing total knee replacement (TKR), the impact of incorporating QoL in survival modeling was explored using 4 parametric survival models. QoL was incorporated and tested in 2 forms, which are baseline and change in QoL due to intervention. Life expectancy and quality-adjusted life years (QALYs) were calculated and comparisons made to a reference model (no QoL) to translate the findings in the context of modeled economic evaluations. Results. A total of 2858 TKR cases (2309 patients) who had TKR between 2006 and 2015 were included in this analysis. Increases in baseline and change in QoL were associated with a reduction in mortality. Compared to the reference model, differences of up to 0.32 life years and 0.53 QALYs were observed, and these translated into a 9.5% change in incremental effectiveness. These differences were much larger as the strength of the association between QoL and mortality increased. Conclusions. This work has demonstrated that the inclusion of QoL measures (at baseline and change from baseline) when extrapolating survival does matter. It can influence health outcomes such as life expectancy and QALYs, which are relevant in cost-effectiveness analysis. This is important because neglecting the correlation between QoL and mortality can lead to imprecise extrapolations and thus risk misleading results affecting subsequent decisions made by policy makers.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Philip Clarke
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Rasmussen AA, Larsen SH, Jensen M, Berg SK, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Wiggers H, Johnsen SP. Prognostic impact of self-reported health on clinical outcomes in patients with heart failure. Eur Heart J Qual Care Clin Outcomes 2020; 7:397-406. [PMID: 32232437 DOI: 10.1093/ehjqcco/qcaa026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/28/2022]
Abstract
AIMS An in-depth understanding of the prognostic value of patient-reported outcomes (PRO) is essential to facilitate person-centred care in heart failure (HF). This study aimed to clarify the prognostic role of subjective mental and physical health status in patients with HF. METHODS AND RESULTS Patients with HF were identified from the DenHeart Survey (n = 1499) and PRO data were obtained at hospital discharge, including the EuroQol five-dimensional questionnaire (EQ-5D), the HeartQoL, and the Hospital Anxiety and Depression Scale (HADS). Clinical baseline data were obtained from medical records and linked to nationwide registries with patient-level data on sociodemographics and healthcare contacts. Outcomes were all-cause and cardiovascular (CV) mortality, CV events, and HF hospitalization with 1- and 3-year follow-up. Analysing the PRO data on a continuous scale, a worse score in the following were associated with risk of all-cause and CV mortality after 1 year: the HeartQoL (adjusted hazard ratios (HRs) 1.91, 95% confidence interval (CI) 1.42-2.57 and 2.17, 95% CI 1.50-3.15, respectively), the EQ-5D (adjusted HRs 1.26, 95% CI 1.15-1.38 and 1.27, 95% CI 1.13-1.42, respectively), the HADS depression subscale (adjusted HRs 1.12, 95% CI 1.07-1.17 and 1.11, 95% CI 1.05-1.17, respectively), and the HADS anxiety subscale (adjusted HRs 1.08, 95% CI 1.03-1.13 and 1.09, 95% CI 1.04-1.15, respectively). Three-year results were overall in concordance with the 1-year results. A similar pattern was also observed for non-fatal outcomes. CONCLUSION Health-related quality of life and symptoms of anxiety and depression at discharge were associated with all-cause and CV mortality at 1- and 3-year follow-up.
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Affiliation(s)
- Anne Ankerstjerne Rasmussen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Signe Holm Larsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Martin Jensen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Cardiology, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B Winsløvs Vej 19,3, 5000 Odense C, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B Winsløvs Vej 19,3, 5000 Odense C, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
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Perez JM, Alessi C, Kittleson MD, Linares-Villalba S, Engel-Manchado J. Psychometric Properties of the Spanish Version of the Functional Evaluation of Cardiac Health Questionnaire "FETCH-Q™" for Assessing Health-related Quality of Life in Dogs with Cardiac Disease. Top Companion Anim Med 2020; 39:100431. [PMID: 32482290 DOI: 10.1016/j.tcam.2020.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
To evaluate the psychometric properties of the Spanish version of the "FETCH-Q™", 228 dogs with cardiovascular diseases were included. After forward and back translation of the original questionnaire, nonexperts, ethologists and veterinary colleagues evaluated the content's validity through feedback. For criteria validity, the total score was correlated with the heart disease/failure class. For construct validity, the overall quality of life of the dog and the results obtained in each question was correlated. The reliability of the questionnaire was assessed using the Cronbach's alpha coefficient. To evaluate the test-retest validity the intra-class correlation coefficient and Wilcoxon signed-rank test were used. A good agreement with the original questionnaire was evident. For construct validity, the questionnaire obtained r > 0.09 to < 0.82. The criterion validity was appropriate and the correlation was rho = 0.82, with an effect size of 0.55 (P < 0.05). Cronbach's alpha coefficient was (α = 0.89). The test-retest assessment revealed adequate repeatability (correlation coefficient = 0.87; P < .001). There was no difference in the owner responses to the questionnaire at baseline and 2 weeks later in dogs with stable cardiac disease (P > .05). This study supports the validity of psychometric properties of the Spanish version of the functional evaluation of cardiac health questionnaire "FETCHSV2-Q™" to assess Health-related Quality of Life in dogs with cardiovascular disease in clinical settings and research.
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Affiliation(s)
- Jeff M Perez
- Advanced Veterinary Centre - المستوصف البيطرى المتقدمة, Doha Expy, Doha, Qatar.
| | - Chiara Alessi
- Department of Animal health, University of Caldas, Manizales, Colombia
| | - Mark D Kittleson
- Department of Medicine and Epidemiology, University of California, Davis, Davis, CA, USA
| | | | - Javier Engel-Manchado
- Cardiology service, Veterinary Clinic-Teaching Hospital, CEU Cardenal Herrera University, Valencia, España
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Lee MK, Basford JR, Heinemann AW, Cheville A. Assessing whether ad hoc clinician-generated patient questionnaires provide psychometrically valid information. Health Qual Life Outcomes 2020; 18:50. [PMID: 32127015 PMCID: PMC7055149 DOI: 10.1186/s12955-020-01287-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background The provision of psychometrically valid patient reported outcomes (PROs) improves patient outcomes and reflects their quality of life. Consequently, ad hoc clinician-generated questionnaires of the past are being replaced by more rigorous instruments. This change, while beneficial, risks the loss/orphaning of decades-long information on difficult to capture/chronically ill populations. The goal of this study was to assess to the quality of data retrieved from these legacy questionnaires. Methods Participants included 8563 patients who generated a total of 12,626 hospital admissions over the 2004–2014 study period. Items used to screen for issues related to function, mood, symptoms, and social support among patients with chronic disease were identified in our medical center’s patient information questionnaire. Cluster and exploratory factor analyses (EFA) followed by multidimensional item response theory (MIRT) analyses were used to select items that defined factors. Scores were derived with summation and MIRT approaches; inter-factor relationships and relationships of factor scores to assigned diagnostic codes were assessed. Rasch analyses assessed the constructs’ measurement properties. Results Literature review and clinician interviews yielded four hypothesized constructs: psychological distress/wellbeing, symptom burden, social support, and physical function. Rasch analyses showed that, while all had good measurement properties, only one, function, separated individuals well. In exploratory factor analyses (EFA), 11 factors representing depression, respiratory symptoms, musculoskeletal pain, family support, mobility, activities of daily living, alcohol consumption, weight loss, fatigue, neurological disorders, and fear at home were identified. Based on the agreement between EFA and cluster analyses as well as Cronbach’s alpha, six domains were retained for analyses. Correlations were strong between activities of daily living and mobility (.84), and moderate between pain and mobility (.37) and psychological distress (.59) Known-group validity was supported from the relationships between factor scores and the relevant diagnostic code assignments (.12 to .20). Conclusions and discussion Items from ad hoc clinician-generated patient information questionnaires can be aggregated into valid factors that assess supportive care domains among chronically ill patients. However, the binary response options offered by many screening items limit their information content and consequently, as highlighted by Rasch analyses, their ability to meaningfully discriminate trait levels in these populations.
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Affiliation(s)
- Minji K Lee
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, and the Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Andrea Cheville
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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26
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Zhang Y, Yan F, Jiang W. Relationship between self-management behaviors and health-related quality of life among Chinese patients with coronary heart disease: A cross-sectional study. Contemp Nurse 2020; 55:554-564. [PMID: 32063155 DOI: 10.1080/10376178.2020.1731316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Coronary heart disease (CHD) has become one of the leading cause of death and physical disability in China. However, the relationship between self-management behaviors and health-related quality of life (HrQoL) among CHD patients in Chinese community settings is unclear.Aim: To explore the relationship between self-management behaviors and HrQoL among CHD patients in Chinese community settings.Methods: 220 participants were recruited from a community setting in Xi'an city, China. A cross-sectional study was conducted by using the Coronary Artery Disease Self-Management Scale (CSMS) and Chinese Mandarin version of the Short-Form 36 Health Survey (SF-36) on HrQoL.Results: Compared with Chinese norms, the CHD patients reported poorer HrQoL (P < 0.05). Pearson correlation analyses identified positive correlations (r = 0.117-0.328, P < 0.05) between self-management behaviors and HrQoL among the CHD patients in Chinese community settings.Conclusion: It is critical to improve self-management behaviors and HrQoL of CHD patients in Chinese communities.
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Affiliation(s)
- Yanan Zhang
- School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Fanghong Yan
- Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China.,School of Nursing, Lanzhou University, Lanzhou, 730000, Gansu Province, People's Republic of China
| | - Wenhui Jiang
- Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
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27
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Vámosi M, Lauberg A, Borregaard B, Christensen AV, Thrysoee L, Rasmussen TB, Ekholm O, Juel K, Berg SK. Patient-reported outcomes predict high readmission rates among patients with cardiac diagnoses. Findings from the DenHeart study. Int J Cardiol 2020; 300:268-275. [DOI: 10.1016/j.ijcard.2019.09.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022]
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28
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Mehaffey JH, Hawkins RB, Charles EJ, Kron IL, Ailawadi G, Kern JA, Roeser ME, Kozower B, Teman NR. Impact of Complications After Cardiac Operation on One-Year Patient-Reported Outcomes. Ann Thorac Surg 2020; 109:43-48. [DOI: 10.1016/j.athoracsur.2019.05.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
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29
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Borregaard B, Pedersen SS, Berg SK, Dahl J, Ekholm O, Sibilitz K, Zwisler ADO, Lauck SB, Kyte D, Calvert M, Riber LPS, Møller JE. What to expect after open heart valve surgery? Changes in health-related quality of life. Qual Life Res 2020; 29:1247-58. [DOI: 10.1007/s11136-019-02400-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 11/27/2022]
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Abstract
Abstract
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Affiliation(s)
- Lotte C A Stiekema
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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31
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Jarab AS, Almousa A, Rababa'h AM, Mukattash TL, Farha RA. Health-related quality of life and its associated factors among patients with angina in Jordan. Qual Life Res 2019; 29:1027-1035. [PMID: 31823184 DOI: 10.1007/s11136-019-02383-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the negative impact of angina and its worsening symptoms on the quality of life of the affected patients, little research has evaluated the factors associated with poor health-related quality of life (HRQOL) among patients with angina. OBJECTIVE The study aim was to evaluate HRQOL and to explore factors associated with poor HRQOL in patients with angina in Jordan. SETTING The present study used data collected for patients attending the cardiology clinic at the Royal Medical Services (RMS) Hospital in Amman. METHODS In addition to collecting sociodemographic and clinical data, the EQ-5D questionnaire was used to assess HRQOL in outpatients with angina in the present study. Multiple linear regression analysis was conducted to build a model with variables that are significantly and independently associated with poor HRQOL. MAIN OUTCOME MEASURE HRQOL quantified using the EQ-5D. RESULTS The mean of the total EQ-5D score of the 500 participants was 0.392. Most of the patients reported 'some problems' through the five dimensions, with the highest percentage (66.6%) related to mobility domain. Regression analysis identified female gender (B = - 0.232; P < 0.05) elevated fasting blood sugar (FBS) (P < 0.05; B = - 0.219), and low high density lipoprotein (HDL) (B = - 0.183; P < 0.05) as being significantly associated with poor HRQOL. CONCLUSIONS The HRQOL has considerable scope for improvement for patients with angina in Jordan. Female gender, elevated FBS, and decreased HDL levels were significantly associated with poor HRQoL in the present study.
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Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | - Abdullah Almousa
- Department of Clinical Pharmacy, Jordanian Royal Medical Services, P.O. Box 855122, Amman, 11855, Jordan
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Rana Abu Farha
- Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences Private University, P.O. Box 166, Amman, 11931, Jordan
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Christensen AV, Bjorner JB, Ekholm O, Juel K, Thrysoee L, Borregaard B, Rasmussen TB, Mols RE, Thorup CB, Berg SK. Increased risk of mortality and readmission associated with lower SF-12 scores in cardiac patients: Results from the national DenHeart study. Eur J Cardiovasc Nurs 2019; 19:330-338. [PMID: 31696734 DOI: 10.1177/1474515119885480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The SF-12v2 health survey (SF-12) is widely used as a generic measure of health-related quality of life. However, interpretation of score differences can be difficult. AIM To estimate benchmarks for interpretation of score differences on the SF-12 for readmission and all-cause mortality in cardiac patients. METHODS Data from the DenHeart study, a national cross-sectional survey including one year follow-up register data, were used. Patients with ischaemic heart disease, arrhythmia, heart failure and heart valve disease answered the survey at hospital discharge. Cox proportional hazards models were used to regress readmission and all-cause mortality. RESULTS A total of 10,813 cardiac patients completed the SF-12. For patients with ischaemic heart disease and arrhythmia, a one point lower physical component summary score was associated with a 2% increase in risk in readmission (hazard ratio (HR) 1.022 (95% confidence interval 1.017;1.027) and HR 1.024 (1.018; 1.029), respectively) and a 3% increase in risk for patients with heart failure (HR 1.027 (1.015; 1.038)). A one point lower mental component summary score was associated with a 2% increase in the risk of readmission (HR 1.017 (1.013; 1.022)) across diagnoses. For both the physical and mental component summary score, a one point lower score meant a 5% increase in the risk of all-cause mortality (HR 1.046 (1.031; 1.060) and HR 1.046 (1.029; 1.065), respectively) across diagnoses. CONCLUSION In a large group of cardiac patients, a one point lower physical or mental component summary score was associated with an up to 3% increased risk of readmission and a 5% increased risk of mortality in the first year after discharge.
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Affiliation(s)
| | - Jakob Bue Bjorner
- Optum Patient Insights, USA.,Section of Social Medicine, University of Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
| | - Britt Borregaard
- Cardiothoracic and Vascular Department, Odense University Hospital, Denmark
| | | | | | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,National Institute of Public Health, University of Southern Denmark, Denmark
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Huber A, Höfer S, Saner H, Oldridge N. East-West divide in health-related quality of life across Europe: Results from the HeartQoL sub-study. Eur J Prev Cardiol 2019; 27:1112-1115. [PMID: 31630541 DOI: 10.1177/2047487319876042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandra Huber
- Department of Medical Psychology, Medical University Innsbruck, Austria
| | - Stefan Höfer
- Department of Medical Psychology, Medical University Innsbruck, Austria
| | - Hugo Saner
- Preventive Cardiology and Sports Medicine, University Hospital Bern, Inselspital Bern, Switzerland
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, USA
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Rasmussen TB, Palm P, Herning M, Christensen AV, Borregaard B, Nielsen KSG, Thrysoee L, Thorup CB, Mols R, Juel K, Ekholm O, Berg SK. Subgroup Differences and Determinants of Patient-Reported Mental and Physical Health in Patients With Ischemic Heart Disease: Results From the DenHeart Study. J Cardiovasc Nurs 2019; 34:E11-21. [PMID: 31135602 DOI: 10.1097/JCN.0000000000000583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A growing population is living with ischemic heart disease (IHD). Patient-reported outcomes (PROs) are reliable prognostic tools. Studies exploring PROs are needed to identify vulnerable patients and guide targeted healthcare strategies. OBJECTIVES The aims of this study were to (i) describe PROs at hospital discharge across 3 diagnostic subgroups: (1) chronic IHD/stable angina, (2) non-ST-elevation myocardial infarction (non-STEMI)/unstable angina, and (3) ST-elevation myocardial infarction (STEMI), and (ii) examine determinants for PROs at hospital discharge in patients with IHD. METHODS This study included a national cohort with register-data linkage including 14 115 adults with IHD discharged from Danish heart centers. Eligible patients (n = 13 476) were invited to complete a questionnaire, and 7 167 (53%) responded. Questionnaires included the Medical Outcome Study Short-Form 12, the Hospital Anxiety and Depression Scale, EuroQoL, HeartQoL, the Edmonton Symptom Assessment Scale, and ancillary questions. Sociodemographic and clinical characteristics were obtained from national registers. Student t test, χ test, and adjusted linear and logistic regression analyses were conducted to investigate subgroup differences, and adjusted linear and logistic regression analyses were conducted to explore determinants for PROs. RESULTS Statistically significant subgroup differences were found, with groups reporting worst to best scores for most of PROs being as follows: chronic IHD/stable angina, non-STEMI/unstable angina, and STEMI. Symptoms of anxiety were highly prevalent in the non-STEMI/unstable angina group, with 33.8% exceeding a Hospital Anxiety and Depression Scale-Anxiety cutoff score indicating a possible anxiety disorder. Determinants for worse PROs included female sex, lower educational level, obesity, and poor physical fitness. CONCLUSIONS Significant differences in PROs across IHD subgroups were observed and determinants for poor outcomes suggested. Results may guide differentiated care initiatives and resource allocation for preventative strategies.
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Ek A, Ekblom Ö, Hambraeus K, Cider Å, Kallings LV, Börjesson M. Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival: results from the SWEDEHEART-registry. Clin Res Cardiol 2019; 108:324-32. [PMID: 30167806 DOI: 10.1007/s00392-018-1360-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
Background Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6–10 weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality. Methods A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004–2014. PA was expressed as the number of exercise sessions of ≥ 30 min in the last 7 days: 0–1 (low), 2–4 (medium) and 5–7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions. Results During follow-up (M = 3.58 years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission. Conclusions The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines. Electronic supplementary material The online version of this article (10.1007/s00392-018-1360-x) contains supplementary material, which is available to authorized users.
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36
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Lee YM, Kim RB, Lee HJ, Kim K, Shin MH, Park HK, Ahn SK, Kim SY, Lee YH, Kim BG, Lee H, Lee WK, Lee KS, Kim MJ, Park KS. Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study. Health Qual Life Outcomes 2018; 16:100. [PMID: 29788961 PMCID: PMC5964665 DOI: 10.1186/s12955-018-0921-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients. Methods A cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview. Results In the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5–91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4–93.3). Conclusions Adherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes. Electronic supplementary material The online version of this article (10.1186/s12955-018-0921-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Mi Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Rock Bum Kim
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, South Korea.,Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, 15 Jinju-daero, 816 Beon-gil, Jinju, 52727, South Korea
| | - Hey Jean Lee
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Chuncheon, South Korea
| | - Keonyeop Kim
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyeung-Keun Park
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, South Korea
| | - Soon-Ki Ahn
- Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, South Korea
| | - So Young Kim
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University Hospital, Cheongju, South Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine &Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, South Korea
| | - Byoung-Gwon Kim
- Busan-Ulsan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, South Korea
| | - Heeyoung Lee
- Center for preventive medicine and public health, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Won Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, South Korea
| | - Mi-Ji Kim
- Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, 15 Jinju-daero, 816 Beon-gil, Jinju, 52727, South Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, 15 Jinju-daero, 816 Beon-gil, Jinju, 52727, South Korea.
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Berg SK, Thorup CB, Borregaard B, Christensen AV, Thrysoee L, Rasmussen TB, Ekholm O, Juel K, Vamosi M. Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey. Eur J Prev Cardiol 2018; 26:624-637. [DOI: 10.1177/2047487318769766] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient-reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design A cross-sectional survey with register follow-up. Methods Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes Patient-reported outcomes: anxiety and depression (Hospital Anxiety and Depression Scale); perceived health (Short Form-12); quality of life (HeartQoL and EQ-5D); symptom burden (Edmonton Symptom Assessment Scale). Register data: mortality and cardiac events within one year following discharge. Results There were 471 deaths among the 16,689 respondents in the first year after discharge. Across diagnostic groups, patients reporting symptoms of anxiety had a two-fold greater mortality risk when adjusted for age, sex, marital status, educational level, comorbidity, smoking, body mass index and alcohol intake (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.52–2.42). Similar increased mortality risks were found for patients reporting symptoms of depression (HR 2.29, 95% CI 1.81–2.90), poor quality of life (HR 0.46, 95% CI 0.39–0.54) and severe symptom distress (HR 2.47, 95% CI 1.92–3.19). Cardiac events were predicted by poor quality of life (HR 0.71, 95% CI 0.65–0.77) and severe symptom distress (HR 1.58, 95% CI 1.35–1.85). Conclusions Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses.
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Affiliation(s)
- Selina K Berg
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Charlotte B Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | - Anne V Christensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
| | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Marianne Vamosi
- Aarhus University, Institute of Public Health, Section of Nursing Science. Department of Cardiology, Aarhus University Hospital, Denmark
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Bonaccio M, Di Castelnuovo A, Costanzo S, Persichillo M, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Health-related quality of life and risk of composite coronary heart disease and cerebrovascular events in the Moli-sani study cohort. Eur J Prev Cardiol 2017; 25:287-297. [PMID: 29243510 DOI: 10.1177/2047487317748452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background To assess the association between health-related quality of life (HRQL) and a composite outcome including incident coronary heart disease (CHD) and cerebrovascular events in a large general population-based cohort. Design Prospective analysis on 17,102 men and women (mean age 53 ± 11) free from cardiovascular disease at time of enrolment in the Moli-sani cohort (2005-2010). Methods HRQL was assessed by the 36-Item Short Form Health Survey. Hazard ratios with 95% confidence intervals (95% CIs) were calculated using multivariable Cox-proportional hazard models. Results At the end of follow-up (median 4.2 years), 237 new events occurred (coronary heart disease n = 197, cerebrovascular disease n = 42). In a multivariable model adjusted for socioeconomic factors, chronic disease and health-related behaviours, both mental and physical HRQL were inversely associated with the risk of the composite outcome (hazard ratio = 0.57; 0.39-0.84 and hazard ratio = 0.62; 0.40-0.94, respectively; highest vs. lowest quartile). Further adjustment for C-reactive protein marginally modified the association with physical HRQL (hazard ratio = 0.67; 0.43-1.02). Similar findings were obtained when only CHD events were analysed (hazard ratio = 0.63; 0.41-0.96 for highest versus lowest mental HRQL) although results with physical HRQL were no longer significant (hazard ratio = 0.65; 0.40-1.04 for highest versus lowest quartile). Associations with incident cerebrovascular disease showed a trend toward protection (hazard ratio = 0.50; 0.22-1.17 and hazard ratio = 0.51; 0.22-1.23 for highest versus lowest tertile of mental and physical HRQL, respectively). Conclusions HRQL is an independent predictor of composite CHD/cerebrovascular outcomes in an adult population. The magnitude of the association was not affected either by socioeconomic factors, health conditions or health-related behaviours. Improvement of quality of life may be a major factor in targeting appropriate prevention strategies for cardiovascular health.
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Affiliation(s)
- Marialaura Bonaccio
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Augusto Di Castelnuovo
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Simona Costanzo
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Mariarosaria Persichillo
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Amalia De Curtis
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Chiara Cerletti
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Maria Benedetta Donati
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Giovanni de Gaetano
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Licia Iacoviello
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy.,2 Department of Medicine and Surgery, Research Centre in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
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Bjørnnes AK, Parry M, Falk R, Watt-Watson J, Lie I, Leegaard M. Impact of marital status and comorbid disorders on health-related quality of life after cardiac surgery. Qual Life Res 2017; 26:2421-34. [PMID: 28484915 DOI: 10.1007/s11136-017-1589-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To explore associations between HRQL, marital status, and comorbid disorders in men and women following cardiac surgery. METHOD A secondary analysis was completed using data from a randomized controlled trial in which 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery were recruited between March 2012 and September 2013. HRQL was assessed using the Health State Descriptive System (15D) preoperatively, then at 2 weeks, and at 3, 6, and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations between HRQL, social support, and comorbid disorders. RESULTS The overall 15D scores for the total sample improved significantly from 2 weeks to 3 months post surgery, with only a gradual change observed from 3 to 12 months. Thirty percent (n = 92) of the total sample reported a lower 15D total score at 12 months compared to preoperative status, of whom 78% (n = 71) had a negative minimum important differences (MID), indicating a worse HRQL status. When adjusted for age and marital status, women had statistically significant lower 15D total scores compared to men at 3, 6, and 12 months post surgery. Compared to pre-surgery, improvement was demonstrated in 4 out of 15 dimensions of HRQL for women, and in 6 out of 15 dimensions for men at 12 months post surgery. Both men and women associated back/neck problems, depression, and persistent pain intensity with lower HRQL; for women, not living with a partner/spouse was associated with lower HRQL up to 12 months. CONCLUSION Women experienced decreased HRQL and a slower first-year recovery following cardiac surgery compared to men. This study demonstrates a need for follow-up and support to help women manage their symptoms and improve their function within the first year after cardiac surgery. This was particularly pronounced for those women living alone.
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Liang JW, Cheung YK, Willey JZ, Moon YP, Sacco RL, Elkind MSV, Dhamoon MS. Quality of life independently predicts long-term mortality but not vascular events: the Northern Manhattan Study. Qual Life Res 2017; 26:2219-28. [PMID: 28357682 DOI: 10.1007/s11136-017-1567-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE Cardiovascular disease is a major contributor to morbidity and mortality, and prevention relies on accurate identification of those at risk. Studies of the association between quality of life (QOL) and mortality and vascular events incompletely accounted for depression, cognitive status, social support, and functional status, all of which have an impact on vascular outcomes. We hypothesized that baseline QOL is independently associated with long-term mortality in a large, multi-ethnic urban cohort. METHODS In the prospective, population-based Northern Manhattan Study, Spitzer QOL index (SQI, range 0-10, with ten signifying the highest QOL) was assessed at baseline. Participants were followed over a median 11 years for stroke, myocardial infarction (MI), and vascular and non-vascular death. Multivariable Cox proportional hazards regression estimated hazard ratio and 95% confidence interval (HR, 95% CI) for each outcome, with SQI as the main predictor, dichotomized at 10, adjusting for baseline demographics, vascular risk factors, history of cancer, social support, cognitive status, depression, and functional status. RESULTS Among 3298 participants, mean age was 69.7 + 10.3 years; 1795 (54.5%) had SQI of 10. In fully adjusted models, SQI of 10 (compared to SQI <10) was associated with reduced risk of all-cause mortality (HR 0.80, 95% CI 0.72-0.90), vascular death (0.81, 0.69-0.97), non-vascular death (0.78, 0.67-0.91), and stroke or MI or death (0.82, 0.74-0.91). In fully adjusted competing risk models, there was no association with stroke (0.93, 0.74-1.17), MI (0.98, 0.75-1.28), and stroke or MI (1.03, 0.86-1.24). Results were consistent when SQI was analyzed continuously. CONCLUSION In this large population-based cohort, highest QOL was inversely associated with long-term mortality, vascular and non-vascular, independently of baseline primary vascular risk factors, social support, cognition, depression, and functional status. QOL was not associated with non-fatal vascular events.
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Benzer W, Philippi A, Hoefer S, Friedrich O, Oldridge N. Health-related quality of life predicts unplanned rehospitalization following coronary revascularization. Herz 2015; 41:138-43. [PMID: 26394779 DOI: 10.1007/s00059-015-4351-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/06/2015] [Accepted: 08/08/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is an increasingly well-recognized measure of health outcome in cardiology. We examined HRQL as a predictor of unplanned rehospitalization for cardiac reasons in patients after coronary revascularization over a period of 3 years. PATIENTS AND METHODS Out of 791 patients enrolled in the study, 743 completed the MacNew HRQL questionnaire after coronary revascularization. MacNew HRQL scores were used as predictors of unplanned rehospitalization. RESULTS Within the 3-year follow-up period, 125 patients (16.8 %) were rehospitalized. After adjustment for age, gender, and myocardial infarction as the initiating event, there were significant differences in unplanned rehospitalization rates between patients with low or moderate vs. high MacNew HRQL global scores (HR: 1.8, 95 % CI: 1.2-2.7) and both physical (HR: 2.2, 95 % CI: 1.4-3.5) and social (HR: 1.8, 95 % CI: 1.2-2.7) subscale scores. CONCLUSION Poor HRQL assessed after coronary revascularization appears to be a powerful predictor of rehospitalization over a 3-year period.
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Affiliation(s)
- W Benzer
- Department of Interventional Cardiology, Cardiac Disease Management Centre, Academic Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria. .,Reha Sports Institute, Feldkirch, Austria.
| | - A Philippi
- Reha Sports Institute, Feldkirch, Austria
| | - S Hoefer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | - O Friedrich
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria
| | - N Oldridge
- College of Health Sciences, University of Wisconsin, Milwaukee, WI, USA
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Soley-Bori M, Soria-Saucedo R, Ryan CM, Schneider JC, Haynes AB, Gerrard P, Cabral HJ, Lillemoe KD, Kazis LE. Functional Status and Hospital Readmissions Using the Medical Expenditure Panel Survey. J Gen Intern Med 2015; 30:965-72. [PMID: 25691236 DOI: 10.1007/s11606-014-3170-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hospital readmissions are expensive and they may signal poor quality of care. Whether functional status is related to hospital readmissions using a representative U.S sample remains unexplored . OBJECTIVE We aimed to assess the relationship between functional status and all-cause 30-day hospital readmissions using a representative sample of the US population. DESIGN This was a retrospective observational study (2003-2011). PATIENTS The study included 3,772 patients who completed the SF-12 before being hospitalized. Three hundred and eighteen (8.4%) were readmitted within 30 days after being discharged. MEASUREMENTS The Medical Expenditure Panel Survey (MEPS) was employed. Functional status was measured with the Short-Form 12-Item Health Survey Version 2® (SF-12). The probability of being readmitted was estimated using a logistic model controlling for demographic characteristics, comorbid conditions, insurance coverage, physical (PCS) and mental (MCS) summaries of the SF-12, reason for hospitalization, length of hospital stay, region, and residential area. RESULTS A one-unit difference in PCS reduced the odds of readmission by 2% (odds ratio 0.98 [95% CI, 0.97 to 0.99]; p < 0.001), which implies an 18% reduction in the odds of readmissions for a ten-unit difference (one standard deviation) in PCS. The c-statistic of the model was 0.72. CONCLUSION Baseline physical function is associated with hospital readmissions. The SF-12 improves the ability to identify patients at high risk of hospital readmission.
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