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Flynn KE, Lin L, Moe GW, Howlett JG, Fine LJ, Spertus JA, McConnell TR, Piña IL, Weinfurt KP. Relationships between changes in patient-reported health status and functional capacity in outpatients with heart failure. Am Heart J 2012; 163:88-94.e3. [PMID: 22172441 DOI: 10.1016/j.ahj.2011.09.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 09/29/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure trials use a variety of measures of functional capacity and quality of life. Lack of formal assessments of the relationships between changes in multiple aspects of patient-reported health status and measures of functional capacity over time limits the ability to compare results across studies. METHODS Using data from HF-ACTION (N = 2331), we used the Pearson correlation coefficients and predicted change scores from linear mixed-effects modeling to demonstrate the associations between changes in patient-reported health status measured with the EQ-5D visual analog scale and the Kansas City Cardiomyopathy Questionnaire (KCCQ) and changes in peak VO(2) and 6-minute walk distance at 3 and 12 months. We examined a 5-point change in KCCQ within individuals to provide a framework for interpreting changes in these measures. RESULTS After adjustment for baseline characteristics, correlations between changes in the visual analog scale and changes in peak VO(2) and 6-minute walk distance ranged from 0.13 to 0.28, and correlations between changes in the KCCQ overall and subscale scores and changes in peak VO(2) and 6-minute walk distance ranged from 0.18 to 0.34. A 5-point change in KCCQ was associated with a 2.50-mL kg(-1) min(-1) change in peak VO(2) (95% CI 2.21-2.86) and a 112-m change in 6-minute walk distance (95% CI 96-134). CONCLUSIONS Changes in patient-reported health status are not highly correlated with changes in functional capacity. Our findings generally support the current practice of considering a 5-point change in the KCCQ within individuals to be clinically meaningful.
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Affiliation(s)
- Kathryn E Flynn
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
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102
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Brouwers C, Denollet J, de Jonge N, Caliskan K, Kealy J, Pedersen SS. Patient-Reported Outcomes in Left Ventricular Assist Device Therapy. Circ Heart Fail 2011; 4:714-23. [DOI: 10.1161/circheartfailure.111.962472] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Corline Brouwers
- From the Department of Medical Psychology and Neuropsychology (C.B., J.D., S.S.P.), CoRPS (Center of Research on Psychology in Somatic diseases), Tilburg University, Tilburg, The Netherlands; Division Heart and Lung (N.d.J.), University Medical Center Utrecht, Utrecht, The Netherlands; Thoraxcenter, Erasmus Medical Center (K.C., S.S.P.), Rotterdam, The Netherlands; Heart Center (J.K.), St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Johan Denollet
- From the Department of Medical Psychology and Neuropsychology (C.B., J.D., S.S.P.), CoRPS (Center of Research on Psychology in Somatic diseases), Tilburg University, Tilburg, The Netherlands; Division Heart and Lung (N.d.J.), University Medical Center Utrecht, Utrecht, The Netherlands; Thoraxcenter, Erasmus Medical Center (K.C., S.S.P.), Rotterdam, The Netherlands; Heart Center (J.K.), St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Nicolaas de Jonge
- From the Department of Medical Psychology and Neuropsychology (C.B., J.D., S.S.P.), CoRPS (Center of Research on Psychology in Somatic diseases), Tilburg University, Tilburg, The Netherlands; Division Heart and Lung (N.d.J.), University Medical Center Utrecht, Utrecht, The Netherlands; Thoraxcenter, Erasmus Medical Center (K.C., S.S.P.), Rotterdam, The Netherlands; Heart Center (J.K.), St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kadir Caliskan
- From the Department of Medical Psychology and Neuropsychology (C.B., J.D., S.S.P.), CoRPS (Center of Research on Psychology in Somatic diseases), Tilburg University, Tilburg, The Netherlands; Division Heart and Lung (N.d.J.), University Medical Center Utrecht, Utrecht, The Netherlands; Thoraxcenter, Erasmus Medical Center (K.C., S.S.P.), Rotterdam, The Netherlands; Heart Center (J.K.), St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Kealy
- From the Department of Medical Psychology and Neuropsychology (C.B., J.D., S.S.P.), CoRPS (Center of Research on Psychology in Somatic diseases), Tilburg University, Tilburg, The Netherlands; Division Heart and Lung (N.d.J.), University Medical Center Utrecht, Utrecht, The Netherlands; Thoraxcenter, Erasmus Medical Center (K.C., S.S.P.), Rotterdam, The Netherlands; Heart Center (J.K.), St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Susanne S. Pedersen
- From the Department of Medical Psychology and Neuropsychology (C.B., J.D., S.S.P.), CoRPS (Center of Research on Psychology in Somatic diseases), Tilburg University, Tilburg, The Netherlands; Division Heart and Lung (N.d.J.), University Medical Center Utrecht, Utrecht, The Netherlands; Thoraxcenter, Erasmus Medical Center (K.C., S.S.P.), Rotterdam, The Netherlands; Heart Center (J.K.), St Paul's Hospital, Vancouver, British Columbia, Canada
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103
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Erdman RAM, Pedersen SS. Clinical and scientific progress related to the interface between cardiology and psychology: lessons learned from 35 years of experience at the Thoraxcenter of the Erasmus Medical Center in Rotterdam. Neth Heart J 2011; 19:470-6. [PMID: 21882002 PMCID: PMC3203984 DOI: 10.1007/s12471-011-0190-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In November 1975, as the first in the Netherlands, a full-time psychologist was employed at the Department of Cardiology of the Thoraxcenter of the Erasmus Medical Center. This innovative decision was consistent with a view to treat the patient as a whole rather than the heart as a single body part in need of repair, combined with the understanding that the heart and mind interact to affect health. The present selective review addresses the broad range of contributions of 35 years of psychology to clinical cardiology and cardiovascular research with a focus on research, teaching, psychological screening and patient care. The review ends with lessons to be learned and challenges for the future with respect to improving the care and management of patients with heart disease in order to enhance secondary prevention and the role of behavioural and psychological factors in this endeavour.
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Affiliation(s)
- R A M Erdman
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands,
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104
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Versteeg H, Spek V, Pedersen SS, Denollet J. Type D personality and health status in cardiovascular disease populations: a meta-analysis of prospective studies. Eur J Prev Cardiol 2011; 19:1373-80. [PMID: 21965518 DOI: 10.1177/1741826711425338] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Knowledge of the factors associated with individual differences in patient-reported outcomes is essential to identify high-risk patients and improve secondary prevention. DESIGN In this meta-analysis, we examined the association between Type D personality and the individual differences in patient-reported physical and mental health status among cardiovascular patients. METHODS A computerized search of the literature through PUBMED and PsychINFO (from 1995 to May 2011) was performed and prospective studies were selected that analysed the association between Type D personality and health status in cardiovascular patients. Two separate meta-analyses were performed for the association of Type D personality with physical and mental health status, respectively. RESULTS Of all identified studies, ten studies met the selection criteria. The meta-analyses showed that Type D was associated with a two-fold increased odds for impaired physical health status (3035 patients, OR 1.94, 95% CI 1.49-2.52) and a 2.5-fold increased odds for impaired mental health status (2213 patients, OR 2.55, 95% CI 1.57-4.16). There was no significant heterogeneity between the studies on physical health status (Q = 12.78; p = 0.17; I(2 )= 29.59), but there was between those on mental health status (Q = 21.91; p = 0.003; I(2 )= 68.04). Subgroup analyses showed that the association between Type D and mental health status decreased yet remained significant when adjusting for baseline health status. CONCLUSION Type D personality was shown to be an independent correlate of impaired patient-reported physical and mental health status in various cardiovascular patient groups. Clinicians should be aware of the association between chronic psychological distress and poor patient-reported outcomes.
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Affiliation(s)
- Henneke Versteeg
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands
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105
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Allen LA. End-point selection for acute heart failure trials. Heart Fail Clin 2011; 7:481-95. [PMID: 21925431 DOI: 10.1016/j.hfc.2011.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The appropriate selection of response variables for clinical trials of new therapies for acute heart failure (AHF) is a complex process with major trade-offs. For one therapeutic approach to be considered superior to another, it must produce clinically significant improvements in making patients live longer, making patients feel better, or saving resources without adversely affecting these two goals. This review outlines factors that complicate AHF end-point selection, discusses a variety of end points used in recently completed and ongoing AHF studies, and suggests directions for future design and standardization of end points across AHF trials.
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Affiliation(s)
- Larry A Allen
- Colorado Cardiovascular Outcomes Research Consortium and the Section of Advanced Heart Failure, Division of Cardiology, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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106
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Shaw LJ, Mieres JH, Hendel RH, Boden WE, Gulati M, Veledar E, Hachamovitch R, Arrighi JA, Bairey Merz CN, Gibbons RJ, Wenger NK, Heller GV. Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease. Circulation 2011; 124:1239-49. [DOI: 10.1161/circulationaha.111.029660] [Citation(s) in RCA: 207] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There is a paucity of randomized trials regarding diagnostic testing in women with suspected coronary artery disease (CAD). It remains unclear whether the addition of myocardial perfusion imaging (MPI) to the standard ECG exercise treadmill test (ETT) provides incremental information to improve clinical decision making in women with suspected CAD.
Methods and Results—
We randomized symptomatic women with suspected CAD, an interpretable ECG, and ≥5 metabolic equivalents on the Duke Activity Status Index to 1 of 2 diagnostic strategies: ETT or exercise MPI. The primary end point was 2-year incidence of major adverse cardiac events, defined as CAD death or hospitalization for an acute coronary syndrome or heart failure. A total of 824 women were randomized to ETT or exercise MPI. For women randomized to ETT, ECG results were normal in 64%, indeterminate in 16%, and abnormal in 20%. By comparison, the exercise MPI results were normal in 91%, mildly abnormal in 3%, and moderate to severely abnormal in 6%. At 2 years, there was no difference in major adverse cardiac events (98.0% for ETT and 97.7% for MPI;
P
=0.59). Compared with ETT, index testing costs were higher for exercise MPI (
P
<0.001), whereas downstream procedural costs were slightly lower (
P
=0.0008). Overall, the cumulative diagnostic cost savings was 48% for ETT compared with exercise MPI (
P
<0.001).
Conclusions—
In low-risk, exercising women, a diagnostic strategy that uses ETT versus exercise MPI yields similar 2-year posttest outcomes while providing significant diagnostic cost savings. The ETT with selective follow-up testing should be considered as the initial diagnostic strategy in symptomatic women with suspected CAD.
Clinical Trial Registration—
http://www.clinicaltrials.gov
. Unique identifier: NCT00282711.
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Affiliation(s)
- Leslee J. Shaw
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - Jennifer H. Mieres
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - Robert H. Hendel
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - William E. Boden
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - Martha Gulati
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - Emir Veledar
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - Rory Hachamovitch
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - James A. Arrighi
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - C. Noel Bairey Merz
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - Raymond J. Gibbons
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - Nanette K. Wenger
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
| | - Gary V. Heller
- From Emory University, Atlanta, GA (L.J.S., E.V., N.K.W.); North Shore–Long Island Jewish Hospital, Manhasset, NY (J.H.M.); University of Miami, Miami, FL (R.H.H.); University of Buffalo, Buffalo, NY (W.E.B.); Ohio State University, Columbus (M.G.); Cleveland Clinic Foundation, Cleveland, OH (R.H.); Brown University, Providence, RI (J.A.A.); Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Mayo Clinic, Rochester, MN (R.J.G.); and Hartford Hospital, Hartford, CT (G.V.H.)
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107
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Singh M, Rihal CS, Lennon RJ, Spertus JA, Nair KS, Roger VL. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes 2011; 4:496-502. [PMID: 21878670 DOI: 10.1161/circoutcomes.111.961375] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND- Although older patients frequently undergo percutaneous coronary interventions (PCI), frailty, comorbidity, and quality of life are seldom part of risk prediction approaches. We assessed their incremental prognostic value over and above the risk factors in the Mayo Clinic risk score. METHODS AND RESULTS- Patients ≥65 years who underwent PCI were assessed for frailty (Fried criteria), comorbidity (Charlson index), and quality of life [SF-36]. Of the 628 discharged [median follow-up of 35.0 months (interquartile range, 22.7 to 42.9)], 78 died and 72 had a myocardial infarction (MI). Three-year mortality was 28% for frail patients, 6% for nonfrail patients. The respective 3-year rates of death or MI were 41% and 17%. After adjustment, frailty [hazard ratio (HR), 4.19 [95% confidence interval (CI), 1.85, 9.51], physical component score of the SF-36 (HR, 1.59; 95% CI, 1.24 to 2.02), and comorbidity, (HR, 1.10; 95% CI, 1.05, 1.16) were associated with mortality. Frailty was associated with mortality/MI (HR, 2.61, 1.52, 4.50). Models with conventional Mayo Clinic risk score had C-statistics of 0.628, 0.573 for mortality and mortality/MI, respectively. Adding frailty, quality of life, and comorbidity, the C-statistic was (0.675, 0.694, 0.671) for mortality and (0.607, 0.587, 0.576) for mortality/MI, respectively. Including frailty, comorbidities and SF-36, conferred a discernible improvement to predict death and death/MI (integrated discrimination improvement, 0.027 and 0.016, and net reclassification improvement of 43% and 18%, respectively). CONCLUSIONS- After PCI, frailty, comorbidity and poor quality of life are prevalent and are associated with adverse long-term outcomes. Their inclusion improves the discriminatory ability of the Mayo Clinic risk score derived from the routine cardiovascular risk factors.
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Affiliation(s)
- Mandeep Singh
- Divisions of Cardiovascular Diseases and Department of Health Sciences Research, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, and the Mayo Clinic and Mid America Heart Institute, Rochester, MN 55905, USA.
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108
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Drozda J, Messer JV, Spertus J, Abramowitz B, Alexander K, Beam CT, Bonow RO, Burkiewicz JS, Crouch M, Goff DC, Hellman R, James T, King ML, Machado EA, Ortiz E, O'Toole M, Persell SD, Pines JM, Rybicki FJ, Sadwin LB, Sikkema JD, Smith PK, Torcson PJ, Wong JB. ACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and Hypertension. Circulation 2011; 124:248-70. [DOI: 10.1161/cir.0b013e31821d9ef2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Joseph Drozda
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Joseph V. Messer
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - John Spertus
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Karen Alexander
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Craig T. Beam
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Robert O. Bonow
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Jill S. Burkiewicz
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Michael Crouch
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - David C. Goff
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Richard Hellman
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Marjorie L. King
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Edison A. Machado
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | | | | | - Jesse M. Pines
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Frank J. Rybicki
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Joanna D. Sikkema
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Peter K. Smith
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Patrick J. Torcson
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
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Allen LA, Gheorghiade M, Reid KJ, Dunlay SM, Chan PS, Hauptman PJ, Zannad F, Konstam MA, Spertus JA. Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life. Circ Cardiovasc Qual Outcomes 2011; 4:389-98. [PMID: 21693723 DOI: 10.1161/circoutcomes.110.958009] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Communicating prognosis to enable shared decision-making is strongly endorsed by heart failure (HF) guidelines. Patients are concerned with both their quantity and quality of life (QoL). To facilitate the recognition of patients at high risk for unfavorable future QoL or death, we created a simple prognostic tool to estimate this combined outcome. METHODS AND RESULTS We identified factors associated with 6-month mortality or persistently unfavorable QoL, defined by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores <45 at 1 and 24 weeks after hospital discharge, among 1458 patients from the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST). Within 24 weeks of discharge, 478 (32.8%) patients had died and 192 (13.2%) patients had serial KCCQ scores <45. After adjusting for 23 predischarge covariates, independent predictors of the combined end point included low admission KCCQ score, high B-type natriuretic peptide, hyponatremia, tachycardia, hypotension, absence of β-blocker therapy, and history of diabetes mellitus and arrhythmia. A simplified predischarge HF score for subsequent death or unfavorable QoL had moderate discrimination (c-statistic 0.72). Predischarge clinical covariates were substantially different in predicting the QoL end point as compared with traditional death or rehospitalization end points. CONCLUSIONS At the time of hospital discharge, readily available clinical characteristics are associated with HF patients at high risk for persistently unfavorable QoL or death over the next 6 months. Such information can target patients for whom aggressive treatment options (eg, devices or transplantation) and/or end-of-life discussions should be strongly considered before hospital discharge.
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Affiliation(s)
- Larry A Allen
- Colorado Cardiovascular Outcomes Research Group, University of Colorado-Denver, Aurora, CO 80045, USA.
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Drozda J, Messer JV, Spertus J, Abramowitz B, Alexander K, Beam CT, Bonow RO, Burkiewicz JS, Crouch M, Goff DC, Hellman R, James T, King ML, Machado EA, Ortiz E, O'Toole M, Persell SD, Pines JM, Rybicki FJ, Sadwin LB, Sikkema JD, Smith PK, Torcson PJ, Wong JB. ACCF/AHA/AMA-PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association-Physician Consortium for Performance Improvement. J Am Coll Cardiol 2011; 58:316-36. [PMID: 21676572 DOI: 10.1016/j.jacc.2011.05.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
The etiology, predictive value, and biobehavioral aspects of depression in heart failure (HF) are described in this article. Clinically elevated levels of depressive symptoms are present in approximately 1 out of 5 patients with HF. Depression is associated with poor quality of life and a greater than 2-fold risk of clinical HF progression and mortality. The biobehavioral mechanisms accounting for these adverse outcomes include biological processes (elevated neurohormones, autonomic nervous system dysregulation, and inflammation) and adverse health behaviors (physical inactivity, medication nonadherence, poor dietary control, and smoking). Depression often remains undetected because of its partial overlap with HF-related symptoms and lack of systematic screening. Behavioral and pharmacologic antidepressive interventions commonly result in statistically significant but clinically modest improvements in depression and quality of life in HF, but not consistently better clinical HF or cardiovascular disease outcomes. Documentation of the biobehavioral pathways by which depression affects HF progression will be important to identify potential targets for novel integrative behavioral and pharmacologic interventions.
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Affiliation(s)
- Willem J Kop
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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RAWLINGS DEB, HENDRY KATHY, MYLNE SUSAN, BANFIELD MAREE, YATES PATSY. Using Palliative Care Assessment Tools to Influence and Enhance Clinical Practice. ACTA ACUST UNITED AC 2011; 29:139-45; quiz 146-7. [DOI: 10.1097/nhh.0b013e31820ba808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Spertus J, Dorian P, Bubien R, Lewis S, Godejohn D, Reynolds MR, Lakkireddy DR, Wimmer AP, Bhandari A, Burk C. Development and Validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in Patients With Atrial Fibrillation. Circ Arrhythm Electrophysiol 2011; 4:15-25. [DOI: 10.1161/circep.110.958033] [Citation(s) in RCA: 259] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Atrial fibrillation (AF) has a deleterious impact on health-related quality-of-life (HRQoL), but measuring this outcome is difficult. A comprehensive, validated, disease-specific questionnaire to measure the spectrum of QoL domains affected by AF and its treatment is not available. We developed and validated a 20-item questionnaire, Atrial Fibrillation Effect on QualiTy-of-life (AFEQT), in a 6-center, prospective, observational study.
Methods and Results—
Factor analyses established 4 conceptual domains (Symptoms, Daily Activities, Treatment Concern, and Treatment Satisfaction) from which individual domain and global scores were calculated. Participants from 6 centers completed the AFEQT at baseline, at month 1, and at month 3. Psychometric analyses included internal consistency and known-group validity. Test-retest reliability was assessed by comparing 1-month changes in scores among those with no change in therapy. Effect size was used to assess responsiveness after intervention. Among 219 patients age 62±11.9 years, 94% completed the AFEQT at baseline and 3 months; 66% had paroxysmal, 24% persistent, 5% longstanding persistent, and 5% permanent AF. Internal consistency was >0.88 for all scales. Lower AFEQT scores were observed with increased AF severity, categorized as asymptomatic, mild, moderate and severe, respectively: 71.2±20.6, 71.3±19.2, 57.9±19.0, and 42.0±21.2. Intraclass correlations for Overall, Symptoms, Daily Activities, Treatment Concern, and Satisfaction scores were 0.8, 0.5, 0.8, 0.7, and 0.7, respectively. Changes in 3-month scores were larger after ablation than with pharmacological adjustments, and both were greater than those observed in stable patients.
Conclusions—
This initial validation of AFEQT supports its use as an outcome in studies and a means to clinically follow patients with AF.
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Affiliation(s)
- John Spertus
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Paul Dorian
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Rosemary Bubien
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Steve Lewis
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Donna Godejohn
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Matthew R. Reynolds
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Dhanunjaya R. Lakkireddy
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Alan P. Wimmer
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Anil Bhandari
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
| | - Caroline Burk
- From the Mid America Heart Institute (J.S., A.P.W.), Kansas City, MO; St Michael's Hospital (P.D.), Toronto, Ontario, Canada; the University of Alabama at Birmingham (R.B.), Birmingham, AL; St Jude Medical (S.L., D.G., C.B.), Atrial Fibrillation Division, St Paul, MN; the Division of Cardiology (M.R.R.), Beth Israel Deaconess Medical Center, Boston, MA; the University of Kansas Hospital (D.R.L.), Kansas City, KS; MDCC (S.L.), San Diego, CA; Outcomes Research Consultant (C.B.), Laguna Beach, CA; and
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Spertus JA, Bonow RO, Chan P, Diamond GA, Drozda JP, Kaul S, Krumholz HM, Masoudi FA, Normand SLT, Peterson ED, Radford MJ, Rumsfeld JS. ACCF/AHA new insights into the methodology of performance measurement: a report of the American College of Cardiology Foundation/American Heart Association Task Force on performance measures. Circulation 2010; 122:2091-106. [PMID: 21060078 DOI: 10.1161/cir.0b013e3181f7d78c] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Rahimi K, Malhotra A, Banning AP, Jenkinson C. Outcome selection and role of patient reported outcomes in contemporary cardiovascular trials: systematic review. BMJ 2010; 341:c5707. [PMID: 21041324 PMCID: PMC2967478 DOI: 10.1136/bmj.c5707] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To systematically assess the type of outcomes selected and the prevalence of patient reported outcomes in contemporary cardiovascular trials and to quantify any misuse or underuse of patient reported outcomes using a specially developed tool that would allow estimation of the relevance of such outcomes to clinical decision making. DESIGN Systematic review. DATA SOURCES Medline and Embase. STUDY SELECTION Randomised controlled trials of the treatment for or prevention of cardiovascular disease published in 10 leading general medical and cardiology journals from January 2005 to December 2008. RESULTS Primary outcomes were patient important (death, morbidity, or patient reported outcomes) in only 93 of 413 trials (23%, SE 2%), whereas another 92 (22%, SE 2%) combined these outcomes with other less important ones into a composite. Sixty five trials (16%; SE 2%) used at least one instrument to measure patient reported outcomes, mostly in trials where such information would have been important or crucial for clinical decision making (52 trials). Patient reported outcomes were judged to be of little incremental value to a large number of, mostly explanatory, cardiovascular trials (152 trials). However, many trials in which patient reported outcomes would have been important or crucial for clinical decision making did not report such outcomes (122 of 174 trials, 70%). These included several trials that primarily aimed to improve symptoms or functional status, trials that tested interventions with a considerable potential for causing harm (mainly bleeding) that were not meaningfully measured, and trials with composite outcomes that were dominated by outcomes of questionable importance to patients. CONCLUSIONS Despite a continued rise in the reporting of patient reported outcomes with no evidence for their misuse in more recent cardiovascular trials, they seem to be still underused once their relevance to clinical decision making has been taken into account. This was largely explained by inappropriate use of composite outcomes and inadequate measurement of harms.
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Affiliation(s)
- Kazem Rahimi
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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Landman GWD, van Hateren KJJ, Kleefstra N, Groenier KH, Gans ROB, Bilo HJG. Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18). Diabetes Care 2010; 33:2378-82. [PMID: 20805257 PMCID: PMC2963498 DOI: 10.2337/dc10-0979] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes negatively impacts the health-related quality of life (HRQOL) of patients with type 2 diabetes. An earlier analysis showed HRQOL to be associated with mortality, which suggests that measuring HRQOL could have clinical implications. We studied the association between HRQOL and total and cardiovascular mortality in patients with type 2 diabetes during long-term follow-up and specifically focused on old age and sex differences. RESEARCH DESIGN AND METHODS HRQOL was measured in a prospectively followed cohort of 1,353 patients with type 2 diabetes using the RAND-36. Cox proportional hazard models were used to measure the independent effect of baseline HRQOL on mortality. RESULTS During a mean follow-up of 9.6 years, 570 (42%) patients died, 280 of whom died of cardiovascular disease (49%). The Physical Component Score (PCS) and the Mental Component Score (MCS) were inversely associated with total mortality, with hazard ratios of 0.988 (95% CI 0.983-0.993) and 0.990 (95% CI 0.985-0.995), respectively. A 10-point-higher score on the PCS and MCS decreased the risk for total mortality by 11 and 10%, respectively. An inverse relationship with mortality was also seen for men, women, and for patients aged>75 years. Mental health was significantly related to mortality in men but not in women. CONCLUSIONS Lower physical and mental HRQOL was associated with a higher total mortality and cardiovascular mortality in patients with type 2 diabetes; this is also the case when studying men and women and the elderly separately. The dimension mental health, related to depression and anxiety, was only associated with mortality in men, not in women.
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Affiliation(s)
- Gijs W D Landman
- Diabetes Centre, Department of Internal Medicine, Isala Clinics, Zwolle, Overijssel, the Netherlands.
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Pedersen SS, Versteeg H, Denollet J, Cheng JM, Serruys PW, van Domburg RT. Patient-rated health status predicts prognosis following percutaneous coronary intervention with drug-eluting stenting. Qual Life Res 2010; 20:559-67. [PMID: 20978857 PMCID: PMC3075391 DOI: 10.1007/s11136-010-9775-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2010] [Indexed: 01/25/2023]
Abstract
Purpose In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events. Methods Consecutive PCI patients treated with drug-eluting stenting (N = 870; 72.2% men; mean age = 62.6 ± 11.5) completed the EQ-5D post-PCI. The EQ-5D levels were dichotomized into ‘no problems’ (level 1) versus ‘problems’ (levels 2, 3); the visual analogue scale (VAS) was dichotomized using the 25th percentile (cut-off ≤60) indicating poor health status. Patients were followed up for 1-year clinical events (death or non-fatal myocardial infarction (MI)). Results There were 53 deaths/MIs at follow-up. The EQ-5D health status dimensions mobility (HR:2.23; 95% CI:1.25–3.97), self-care (HR:3.09; 95% CI:1.54–6.20), and self-reported health status as measured with the EQ-VAS (HR:2.94; 95% CI:1.65–5.25) were independent predictors of death/MI and added to the predictive value of a model comprised of demographic and clinical characteristics. The EQ-5D dimensions usual activities, pain/discomfort, and anxiety/depression were not associated with adverse clinical events in adjusted analysis. Conclusions Patient-rated health status predicted adverse clinical events at 1-year follow-up in PCI patients treated with drug-eluting stenting, with the risk being more than 2-fold independent of disease severity and other demographic and clinical characteristics. It may be timely to adopt standard assessment of health status in clinical practice.
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Affiliation(s)
- Susanne S Pedersen
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Room P506, PO Box 90153, 5000, Tilburg, LE, The Netherlands.
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Denollet J, Schiffer AA, Spek V. A General Propensity to Psychological Distress Affects Cardiovascular Outcomes. Circ Cardiovasc Qual Outcomes 2010; 3:546-57. [DOI: 10.1161/circoutcomes.109.934406] [Citation(s) in RCA: 251] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Johan Denollet
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
| | - Angélique A. Schiffer
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
| | - Viola Spek
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
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Issa SM, Hoeks SE, Scholte op Reimer WJM, Van Gestel YRBM, Lenzen MJ, Verhagen HJM, Pedersen SS, Poldermans D. Health-related quality of life predicts long-term survival in patients with peripheral artery disease. Vasc Med 2010; 15:163-9. [DOI: 10.1177/1358863x10364208] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined whether health-related quality of life (HRQoL) predicts long-term survival in patients with peripheral artery disease (PAD) independent of established prognostic risk factors. In 2004, data on 711 consecutive patients with PAD undergoing vascular surgery were collected from 11 hospitals in The Netherlands. After 1 year, patients were contacted to complete the EuroQol Questionnaire (EQ-5D), of which 503 complied. HRQoL assessed by the EQ-5D was divided into tertiles (i.e. poor, intermediate and good HRQoL). Mortality was subsequently assessed 3 years after surgery. Of the 503 patients, 55 (11%) patients died during follow-up. Mortality was 21% in patients with poor HRQoL, 8% in patients with intermediate HRQoL, and 5% in patients with good HRQoL. Patients with poor HRQoL (HR = 5.4; 95% CI 2.3—12.5) had a worse survival compared to patients with a good HRQoL, after adjusting for established prognostic factors. In conclusion, the study indicates that poor HRQoL predicts long-term survival in patients with PAD, and provides prognostic value above established risk factors.
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Affiliation(s)
- Samson M Issa
- CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands, Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sanne E Hoeks
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - Mattie J Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hence JM Verhagen
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Susanne S Pedersen
- CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands, Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Don Poldermans
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands,
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Health-related quality of life is related to cytokine levels at 12 months in patients with chronic heart failure. Brain Behav Immun 2010; 24:615-22. [PMID: 20074634 DOI: 10.1016/j.bbi.2010.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 01/05/2010] [Accepted: 01/07/2010] [Indexed: 11/22/2022] Open
Abstract
Chronic heart failure (CHF) is a condition with a high mortality risk. Besides traditional risk factors, poor health-related quality of life (HRQoL) is also associated with poor prognosis in CHF. Immunological functioning might serve as a biological pathway underlying this association, since pro and anti-inflammatory cytokines are independent predictors of prognosis. The aim of this study was to examine the association between HRQoL at inclusion (baseline) and pro and anti-inflammatory cytokine levels both at baseline and 12months, using a prospective study design. CHF outpatients completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short Form Health Survey 36 (SF-36). Blood samples were drawn at baseline (n=111) and 12months (n=127) to measure pro (IL-6, TNFalpha, sTNFR1, sTNFR2) and anti- (IL1ra, IL-10) inflammatory markers. Linear regression analysis were run for the MLHFQ, the SF-36 mental component summary (MCS) and the physical component summary (PCS), controlling for age, sex, BMI, smoking, co morbidity, NYHA-class and 6min walk test. Baseline MLHFQ was associated with increased levels of baseline sTNFR2, and 12-month sTNFR1 12month sTNFR2. Baseline MCS and change in MCS were related to increased 12-month sTNFR1 levels. All significant findings relate a worse HRQoL at baseline or a deterioration over time to increased sTNFR1/2 levels. These findings suggest that immune activation may be one of the pathways underlying the relationship between poor HRQoL and mortality and morbidity in CHF patients. Future studies are warranted to replicate these findings in larger samples.
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Pedersen SS, Herrmann-Lingen C, de Jonge P, Scherer M. Type D personality is a predictor of poor emotional quality of life in primary care heart failure patients independent of depressive symptoms and New York Heart Association functional class. J Behav Med 2010; 33:72-80. [PMID: 19937107 PMCID: PMC2813529 DOI: 10.1007/s10865-009-9236-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 11/07/2009] [Indexed: 12/22/2022]
Abstract
Quality of life is an important patient-centered outcome and predictor of mortality in heart failure, but little is known about the role of personality as a determinant of quality of life in this patient group. We examined the influence of Type D personality (i.e., increased negative emotions paired with emotional non-expression) on quality of life in primary care heart failure patients, using a prospective study design. Heart failure patients (n = 251) recruited from 44 primary care practices in Germany completed standardized questionnaires at baseline and 9 months. The prevalence of Type D was 31.9%. Type D patients experienced poorer emotional (P < .001) and physical quality of life (P = .01) at baseline and 9 months compared to non-Type D patients. There was no significant change in emotional (P = .78) nor physical quality of life (P = .74) over time; neither the interaction for time by Type D for emotional (P = .31) nor physical quality of life (P = .91) was significant, indicating that Type D exerted a stable effect on quality of life over time. Adjusting for demographics, New York Heart Association functional class, and depressive symptoms, Type D remained an independent determinant of emotional (P = .03) but not physical quality of life (P = .29). Primary care heart failure patients with a Type D personality experienced poorer emotional but not physical quality of life compared to non-Type D patients. Patients with this personality profile should be identified in primary care to see if their treatment is optimal, as both Type D and poor quality of life have been associated with increased morbidity and mortality.
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Affiliation(s)
- Susanne S Pedersen
- CoRPS, Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands.
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A comparison of the health status after percutaneous coronary intervention at a hospital with and without on-site cardiac surgical backup: a randomized trial in nonemergent patients. ACTA ACUST UNITED AC 2010; 17:235-43. [DOI: 10.1097/hjr.0b013e3283378880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Karsai S, Raulin C. Comparison of clinical outcome parameters, the Patient Benefit Index (PBI-k) and patient satisfaction after ablative fractional laser treatment of peri-orbital rhytides. Lasers Surg Med 2010; 42:215-23. [DOI: 10.1002/lsm.20904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Schenkeveld L, Pedersen SS, van Nierop JW, Lenzen MJ, de Jaegere PP, Serruys PW, van Domburg RT. Health-related quality of life and long-term mortality in patients treated with percutaneous coronary intervention. Am Heart J 2010; 159:471-6. [PMID: 20211311 DOI: 10.1016/j.ahj.2009.12.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 12/19/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Health status has become increasingly important as an outcome measure in patients with cardiovascular disease. Poor patient-rated health status has been shown to predict mortality in patients with coronary artery disease and heart failure. In patients treated with percutaneous coronary intervention (PCI), we examined whether poor health status predicts 6-year mortality and whether a decline in health status is associated with adverse clinical outcome. METHODS Consecutive patients (N = 872) treated with PCI as part of the RESEARCH registry, completed the 36-item Short-Form Health Survey (SF-36) at 1 and 12 months post-PCI. RESULTS The SF-36 domains physical functioning (hazard ratio [HR] 2.59, 95% CI 1.61-4.16), social functioning (HR 2.76, 95% CI 1.74-4.37), role limitations due to physical functioning (HR 2.45, CI 1.52-3.92), mental health (HR 2.12, 95% CI 1.35-3.31), vitality (HR 1.73, 95% CI 1.09-2.74), bodily pain (HR 2.25, 95% CI 1.43-3.54), and general health (HR 2.46, 95% CI 1.57-3.87) were associated with 6-year mortality. A decline in health status was not related with higher 6-year mortality. CONCLUSIONS Health status domains as measured with the SF-36 predicted death at 6-year follow-up in PCI patients treated with drug-eluting stenting, independent of demographic and clinical characteristics. In contrast, a decline in health status between 1 and 12 months post index procedure, as measured with the SF-36, was not associated with 6-year mortality in PCI patients treated with drug-eluting stenting.
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Pedersen SS, Kupper N. Representing the patient perspective in the treatment of atrial fibrillation. Europace 2010; 12:305-6. [DOI: 10.1093/europace/euq012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pelle AJ, Pedersen SS, Schiffer AA, Szabó B, Widdershoven JW, Denollet J. Psychological distress and mortality in systolic heart failure. Circ Heart Fail 2010; 3:261-7. [PMID: 20071656 DOI: 10.1161/circheartfailure.109.871483] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression, anxiety, and type D ("distressed") personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but little is known about their role in chronic heart failure. Therefore, we investigated whether these indicators of psychological distress are associated with mortality in chronic heart failure. METHOD AND RESULTS Consecutive outpatients with chronic heart failure (n=641; 74.3% men; mean age, 66.6+/-10.0 years) filled out a 4-item questionnaire to assess mixed symptoms of anxiety and depression and the 14-item type D scale. End points were defined as all-cause and cardiac mortality. After a mean follow-up of 37.6+/-15.6 months, 123 deaths (76 due to cardiac cause) were recorded. Cumulative hazard functions for elevated anxiety/depression symptoms differed marginally for all-cause (P=0.06), but not cardiac, mortality (P=0.43); type D personality was associated with neither all-cause mortality (P=0.63) nor cardiac mortality (P=0.87). In multivariable analyses, neither elevated anxiety/depression symptoms nor type D personality was associated with all-cause mortality (hazard ratio [HR]=1.18; 95% CI, 0.76 to 1.84; P=0.45 and HR=1.09; 95% CI, 0.67 to 1.77; P=0.73, respectively) or cardiac mortality (HR=1.13; 95% CI, 0.63 to 2.04; P=0.65 and HR=1.16; 95% CI, 0.62 to 2.18; P=0.67). In secondary analyses, a 1-point increase in anxiety/depression (range, 0 to 16) was associated with an 8% increase in risk for all-cause mortality (HR=1.08; 95% CI, 1.01 to 1.15; P=0.02). CONCLUSIONS Neither elevated anxiety/depression symptoms nor type D personality was associated with an increased risk for all-cause or cardiac mortality. Future studies with adequate power and a longer follow-up duration are needed to further elucidate the role of psychological distress in chronic heart failure.
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Affiliation(s)
- Aline J Pelle
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
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Nishijima DK, Zehtabchi S. The Efficacy of Recombinant Activated Factor VII in Severe Trauma. Ann Emerg Med 2009; 54:737-744.e1. [DOI: 10.1016/j.annemergmed.2009.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 01/22/2009] [Accepted: 01/26/2009] [Indexed: 10/21/2022]
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ANDERSON KELLEYP. Health Status Assessment Tools: Natural Components of Cardiac Resynchronization Therapy? Pacing Clin Electrophysiol 2009; 32:1257-8. [DOI: 10.1111/j.1540-8159.2009.02504.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Clinical interpretation of computerized adaptive test outcome measures in patients with foot/ankle impairments. J Orthop Sports Phys Ther 2009; 39:753-64. [PMID: 19801815 DOI: 10.2519/jospt.2009.3122] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Prospective cohort study of 10 287 patients with foot/ankle impairments receiving outpatient physical therapy. OBJECTIVES To describe meaningful interpretations of functional status (FS) outcomes measures, estimated using a body-part-specific computerized adaptive test (CAT). BACKGROUND Increased use of CATs to generate outcome measures in rehabilitation has stimulated questions concerning score interpretation. Identifying meaningful intra-individual change and reporting clinical interpretation of those generated outcomes are essential to advance the quality of rehabilitation practice. METHODS We performed 4 approaches to clinically interpret outcomes data. First, we used the standard error of the estimate to construct a 90% confidence interval for each CAT estimated score. Second, we presented the percentile rank of FS scores. Third, we used 2 threshold approaches to define individual-patient-level change: statistically reliable change and clinically important change. Last, we illustrated a functional staging method. RESULTS Precision of a single score was estimated by an FS score of +/-4. Based on score distribution, percentile ranks at 25th, 50th, and 75th percentiles corresponded to intake FS scores of 38, 47, and 57, and discharge FS scores of 52, 64, and 77, respectively. Minimal detectable change supported 7 or more FS change units out of 100 represented statistically reliable change, and ROC analyses supported 8 or more FS change units represented minimal clinically important improvement. Using a functional staging system, we established 5 hierarchical functional status levels. CONCLUSION CAT-generated outcome measures can be interpreted to improve clinical interpretation and to assist clinicians in using patient-reported outcomes during therapy practice.
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Versteeg H, Schiffer AA, Widdershoven JW, Meine MM, Doevendans PA, Pedersen SS. Response to cardiac resynchronization therapy: is it time to expand the criteria? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1247-56. [PMID: 19702599 DOI: 10.1111/j.1540-8159.2009.02505.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is a promising treatment for a subgroup of patients with advanced congestive heart failure and a prolonged QRS interval. Despite the majority of patients benefiting from CRT, 10-40% of patients do not respond to this treatment and are labeled as nonresponders. Given that there is a lack of consensus on how to define response to CRT, the purpose of this viewpoint is to discuss currently used definitions and their shortcomings, and to provide recommendations as to how an expansion of the criteria for CRT response may be useful to clinicians. METHODS AND RESULTS Analysis of the literature and case reports indicates that the majority of established measures of CRT response, including New York Heart Association functional class and echocardiographic, hemodynamic, and neurohormonal parameters, are poor associates of patient-reported symptoms and quality of life. Moreover, the potential moderating role of psychological factors in determining health outcomes after CRT has largely been neglected. CONCLUSIONS It is recommended to routinely assess health status after CRT with a disease-specific questionnaire in standard clinical practice and to examine its determinants, including psychological factors such as personality traits and depression. This may lead to improved (secondary) treatment and prognosis in CHF patients treated with CRT.
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Affiliation(s)
- Henneke Versteeg
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, The Netherlands
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Knudtson ML, Norris CM, Galbraith PD, Hubacek J, Ghali WA. Explicit risk in acute coronary syndrome management. Can J Cardiol 2009; 25 Suppl A:29A-36A. [PMID: 19521571 DOI: 10.1016/s0828-282x(09)71051-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
At least implicitly, most clinical decisions represent an integration of disease and treatment-based risk assessments. Often, as is the case with acute coronary syndrome (ACS), these decisions need to be made quickly at a time when data elements are limited, and published risk models are very useful in clarifying time-dependent determinants of risk. The present review emphasizes the value of explicit risk assessment and reinforces the fact that patients at highest risk are often those most likely to benefit from newer and more invasive therapies. Suggested ways to incorporate published ACS risk models into clinical practice are included. In addition, the need to adopt a longer-term view of risk in ACS patients is stressed, with particular regard to the important role of heart failure prediction and treatment.
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Affiliation(s)
- Merril L Knudtson
- Department of Cardiovascular Sciences, University of Calgary, Alberta, Canada.
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