Quality of life and symptoms of depression in advanced heart failure patients and their partners

Quality of life and survival in patients with heart failure

AIMS

To examine whether self-rated disease-specific and generic quality of life predicts long-term mortality, independent of brain natriuretic peptide (BNP) levels, and to explore factors related to low quality of life in a well-defined heart failure (HF) population.

METHODS AND RESULTS

A cohort of 661 patients (62% male; age 71 years; left ventricular ejection fraction 34%) was followed prospectively for 3 years. Quality of life questionnaires (Ladder of Life, RAND36, and Minnesota Living with Heart Failure Questionnaire) and BNP levels were assessed at discharge after a hospital admission for HF. Three-year mortality was 42%. After adjustment for demographic variables, clinical variables, and BNP levels, poor quality of life scores predicted higher mortality; per 10 units on the physical functioning [hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.02-1.14] and general health (HR 1.08, 95% CI 1.01-1.16) dimensions of the RAND36. Patients with low scores on these dimensions were more likely to be in New York Heart Association class III-IV, diagnosed with co-morbidities, have suffered longer from HF, have lower estimated glomerular filtration rates, and have fewer beta-blocker prescriptions.

CONCLUSION

Quality of life was independently related to survival in a cohort of hospitalized patients with HF.

TRIAL REGISTRATION

NCT 98675639.

The comorbidity conundrum: a focus on the role of noncardiovascular chronic conditions in the heart failure patient

The rapid aging of the US population combined with improvements in modern medicine has created a new public health concern of comorbidity, a chronic condition that co-exists with a primary illness. Over 141 million Americans suffer from one or more comorbid conditions. In the heart failure (HF) patient, this comorbidity burden is particularly high, with over 40% of patients having five or more chronic conditions. These comorbidities can vary from being a risk factor to a cause of HF progression or even a precipitating factor for decompensation. Comorbidities, particularly the noncardiovascular conditions, have been associated with greater health resource utilization, poor health outcomes, and increased mortality. To minimize the negative impact that these comorbidities have on patient outcomes, appropriate attention should be paid to identifying, prioritizing, and managing each condition; minimizing medication complexity and polypharmacy; and improving overall coordination of care between providers and patients.

Reporting of "quality of life": a systematic review and quantitative analysis of research publications in palliative care journals

CONTEXT

Palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. One of the most important goals in clinical palliative care is to improve patients' quality of life (QoL).

AIM

This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on QoL.

SETTINGS AND DESIGN

This was a systematic review of palliative care journals.

MATERIALS AND METHODS

Twelve palliative care journals were searched for articles with "QoL" in the title of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original article category was further classified according to study designs.

STATISTICAL ANALYSIS USED

Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5.

RESULTS

The overall reporting rate among all journals was 1.95% (71/3634), and Indian Journal of Palliative Care (IJPC) had the highest reporting rate of 5.08% (3/59), followed by Palliative Medicine (PM) with 3.71% (20/538), and Palliative and Supportive Care (PSC) with 3.64% (9/247) reporting.

CONCLUSIONS

The overall reporting rate for QoL articles in palliative care journals was 1.95% and there were very few randomized clinical trials and systematic reviews found. The study findings indicate further high-quality research to establish an adequate evidence base for QoL.

The effects of perceived social support on quality of life in patients awaiting coronary artery bypass grafting and their partners: testing dyadic dynamics using the Actor-Partner Interdependence Model

Patients awaiting coronary artery bypass grafting (CABG) need support from their partners or family caregivers to manage their self care successfully and to maximise quality of life. Partners need social support to help overcome the stressful tasks of an unexpected caregiving role. It is not known whether the individual's perceived social support contributes to their own, as well as their partner's quality of life. The aims of this study were to assess differences in social support and quality of life in patients and partners awaiting CABG, and to examine whether patients' and partners' perceived social support predicted their own, as well as their partner's quality of life before CABG. This cross-sectional study recruited 84 dyads (patients 84% males, aged 64.5 years and partners 94% females, aged 61.05 years). Perceived social support was assessed using the Medical Outcomes Study Social Support survey, with sub-scales for informational/emotional support, affectionate support, tangible support and positive social interaction. Quality of life was assessed using the Short-Form 12 Health Survey. Dyadic data were analysed using the Actor-Partner Interdependence Model, with distinguishable dyad regression. Results revealed the patients' informational/emotional support exhibited an actor effect on their own mental health (ß = 0.19, p = 0.001); indicating those with low informational/emotional support had poorer mental health. There was a partner effect of the patients' informational/emotional support on their partner's mental health (ß = 0.14, p = 0.024), indicating the patients' informational/emotional support was associated with the partner's mental health. None of the other types of social support exhibited an actor effect or a partner effect on the patient's or the partner's mental or physical health. More research into the relationship between social support and mental health is needed to help inform the design of interventions that target the dyad.