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Pedersen SS, Carter N, Barr C, Scholten M, Lambiase PD, Boersma L, Johansen JB, Theuns DAMJ. Quality of life, depression, and anxiety in patients with a subcutaneous versus transvenous defibrillator system. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1541-1551. [PMID: 31677279 DOI: 10.1111/pace.13828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/11/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Use of the subcutaneous implantable defibrillator (S-ICD) has increased because the device received US Food and Drug Administration approval in 2012, but we still know little about whether the quality of life (QoL) of patients with an S-ICD versus a transvenous ICD (TV-ICD) is comparable. We compared S-ICD patients with TV-ICD patients on QoL, depression, and anxiety up to 12 months' follow-up. METHODS A matched cohort of S-ICD (N = 167) and TV-ICD patients (N = 167) completed measures on QoL, depression, anxiety, and personality at baseline, 3, 6, and 12 months post implant. Data were analyzed using multivariable modeling with repeated measures. RESULTS In adjusted analyses, we found no statistically significant differences between cohorts on physical and mental QoL and depression (all Ps > .05), while S-ICD patients reported lower anxiety than TV-ICD patients (P = 0.0007). Both cohorts experienced improvements in physical and mental QoL and symptoms of depression and anxiety over time (all Ps < .001), primarily between implant and 3 months. These improvements were similar for both cohorts with respect to physical and mental QoL and anxiety (Ps > .05), while S-ICD patients experienced greater reductions in depressive symptoms (P = .0317). CONCLUSION The QoL and depression levels were similar in patients with an S-ICD and a TV-ICD up to 12 months' follow-up, while S-ICD patients reported lower anxiety levels and a greater reduction in depression over time as compared to TV-ICD patients. This knowledge may be important for patients and clinicians, if the indication for implantation allows both the S-ICD and the TV-ICD, making a choice possible.
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Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Craig Barr
- Department of Cardiology, Russels Hall Hospital, Dudley, UK
| | - Marcoen Scholten
- Department of Cardiology, Thorax Center Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London & Barts Heart Centre, London, UK
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- Department of Psychology, University of Southern Denmark, Odense, Denmark
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202
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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] [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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203
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Health-related quality of life and exercise-based cardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis. Qual Life Res 2019; 29:579-592. [PMID: 31691204 DOI: 10.1007/s11136-019-02338-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To review the literature on health-related quality of life (HRQoL) outcomes for exercise-based cardiac rehabilitation (EBCR) in contemporary acute coronary syndrome (ACS) patients. METHODS Electronic databases (CENTRAL, MEDLINE, Embase, and CINAHL) were searched from January 2000 to March 2019 for randomised controlled trials (RCTs) comparing EBCR to a no-exercise control in ACS patients recruited after year 2000, follow-up of at least 6 months, and HRQoL as outcome. Potential papers were independently screened by two reviewers. Risks of bias were assessed using the Cochrane Tool. Data analyses were performed using RevMan v5.3, random effects model. RESULTS Fourteen RCTs (1739 participants) were included, with eight studies suitable for meta-analyses. EBCR resulted in statistically significant and clinically important improvements in physical performance (mean difference [MD] 7.09, 95% CI 0.08, 14.11) and general health (MD 5.08, 95% CI 1.03, 9.13) (SF-36) at 6 months, and in physical functioning (MD 9.82, 95% CI 1.46, 18.19) at 12 months. Statistically significant and sustained improvements were also found in social and physical functioning. Meta-analysis of two studies using the MacNew Heart Disease HRQoL instrument did not show any significant benefits. Of the six studies unsuitable for meta-analyses, five reported significant changes in overall HRQoL, general physical activity levels and functional capacity, or quality-adjusted life-years (QALYs). CONCLUSIONS In an era where adherence to clinical practice guidelines has improved survival, EBCR still achieves clinically meaningful improvements in physical performance, general health, and physical functioning in the short and long term in contemporary ACS patients.
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204
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Bouwens E, van Lier F, Rouwet EV, Verhagen HJM, Stolker RJ, Hoeks SE. Type D Personality and Health-Related Quality of Life in Vascular Surgery Patients. Int J Behav Med 2019; 26:343-351. [PMID: 31264102 PMCID: PMC6652784 DOI: 10.1007/s12529-018-09762-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study evaluated the association of type D personality and health-related quality of life (HRQoL) and assessed the stability of type D personality in vascular surgery patients during the year after surgery. METHOD In a prospective cohort study between 2008 and 2014, 294 patients were assessed with validated questionnaires preoperatively and at 1, 6, and 12 months after surgery. Associations between type D personality, depression, and HRQoL were analyzed by generalized estimating equation models. Type D personality was analyzed in its standard dichotomous form as well as continuous (z) scores of its two components, negative affectivity (NA) and social inhibition (SI), and their interaction term. RESULTS Prevalence of type D personality varied between 18% and 25%. However, only 9% of the complete responders were classified as type D personality at all four assessments, whereas one third changed between type D classifications. Continuous scores showed greater stability over time. Dichotomized type D personality measured over time was significantly associated with impaired HRQoL, but this was not the case if measured once at baseline, like in general use. The continuous NA score and depression were also significantly associated with impaired HRQoL over time. CONCLUSION Type D personality was not a stable trait over time. Preoperative assessment of type D personality did not predict improvement in HRQoL after vascular surgery. However, the study revealed associations between the NA component of type D personality, depression, and lower HRQoL. This indicates that measures of overall negative affect should be taken into account when assessing HRQoL patient-reported outcomes in vascular surgery patients.
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Affiliation(s)
- Elke Bouwens
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Erasmus MC, NA-1718, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Felix van Lier
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Erasmus MC, NA-1718, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Ellen V Rouwet
- Department of Vascular Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Erasmus MC, NA-1718, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Sanne E Hoeks
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Erasmus MC, NA-1718, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands.
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205
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Christensen AV, Juel K, Ekholm O, Thrysøe L, Thorup CB, Borregaard B, Mols RE, Rasmussen TB, Berg SK. Significantly increased risk of all-cause mortality among cardiac patients feeling lonely. Heart 2019; 106:140-146. [PMID: 31685646 DOI: 10.1136/heartjnl-2019-315460] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To explore whether living alone and loneliness 1) are associated with poor patient-reported outcomes at hospital discharge and 2) predict cardiac events and mortality 1 year after hospital discharge in women and men with ischaemic heart disease, arrhythmia, heart failure or heart valve disease. METHODS A national cross-sectional survey including patients with known cardiac disease at hospital discharge combined with national register data at baseline and 1-year follow-up. Loneliness was evaluated using one self-reported question, and information on cohabitation was available from national registers. Patient-reported outcomes were Short Form-12, Hospital Anxiety and Depression Scale and HeartQoL. Clinical outcomes were 1-year cardiac events (myocardial infarction, stroke, cardiac arrest, ventricular tachycardia/fibrillation) and all-cause mortality from national registers. RESULTS A total of 13 443 patients (53%) with ischaemic heart disease, arrhythmia, heart failure or heart valve disease completed the survey. Of these, 70% were male, and mean age was 66.1 among women and 64.9 among men. Across cardiac diagnoses, loneliness was associated with significantly poorer patient-reported outcomes in men and women. Loneliness predicted all-cause mortality among women and men (HR 2.92 (95% CI 1.55 to 5.49) and HR 2.14 (95% CI 1.43 to 3.22), respectively). Living alone predicted cardiac events in men only (HR 1.39 (95% CI 1.05 to 1.85)). CONCLUSIONS A strong association between loneliness and poor patient-reported outcomes and 1-year mortality was found in both men and women across cardiac diagnoses. The results suggest that loneliness should be a priority for public health initiatives, and should also be included in clinical risk assessment in cardiac patients.
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Affiliation(s)
- Anne Vinggaard Christensen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Thrysøe
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Borregaard
- Cardiothoracic and Vascular Department, Odense University Hospital, Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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206
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Bouabdallaoui N, O'Meara E, Bernier V, Komajda M, Swedberg K, Tavazzi L, Borer JS, Bohm M, Ford I, Tardif JC. Beneficial effects of ivabradine in patients with heart failure, low ejection fraction, and heart rate above 77 b.p.m. ESC Heart Fail 2019; 6:1199-1207. [PMID: 31591826 PMCID: PMC6989297 DOI: 10.1002/ehf2.12513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
Aims Ivabradine has been approved in heart failure with reduced ejection fraction (HFrEF) and elevated heart rate despite guideline‐directed medical therapy (GDMT) to reduce cardiovascular (CV) death and hospitalization for worsening HF. The median value of 77 b.p.m. is the lower bound selected for the regulatory approval in Canada, South Africa, and Australia. Patient‐reported outcomes (PROs) including symptoms, quality of life, and global assessment are considered of major interest in the global plan of care of patients with HF. However, the specific impact of GDMT, and specifically ivabradine, on PRO remains poorly studied. In the subgroup of patients from the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT) who had heart rate above the median of 77 b.p.m. (pre‐specified analysis) and for whom the potential for improvement was expected to be larger, we aimed (i) to evaluate the effects of ivabradine on PRO (symptoms, quality of life, and global assessment); (ii) to consolidate the effects of ivabradine on the primary composite endpoint of CV death and hospitalization for HF; and (iii) to reassess the effects of ivabradine on left ventricular (LV) remodelling. Methods and results Comparisons were made according to therapy, and proportional hazards models (adjusted for baseline beta‐blocker therapy) were used to estimate the association between ivabradine and various outcomes. In SHIFT, n = 3357 (51.6%) patients had a baseline heart rate > 77 b.p.m. After a median follow‐up of 22.9 months (inter‐quartile range 18–28 months), ivabradine on top of GDMT improved symptoms (28% vs. 23% improvement in New York Heart Association functional class, P = 0.0003), quality of life (5.3 vs. 2.2 improvement in Kansas City Cardiomyopathy Questionnaire overall summary score, P = 0.005), and global assessment [from both patient (improved in 72.3%) and physician (improved in 61.0%) perspectives] significantly more than did placebo (both P < 0.0001). Ivabradine induced a 25% reduction in the combined endpoint of CV death and hospitalization for HF (hazard ratio 0.75; P < 0.0001), which translates into a number of patients needed to be treated for 1 year of 17. Patients under ivabradine treatment demonstrated a significant reduction in LV dimensions when reassessed at 8 months (P < 0.05). Conclusions In patients with chronic HFrEF, sinus rhythm, and a heart rate > 77 b.p.m. while on GDMT, the present analysis brings novel insights into the role of ivabradine in improving the management of HFrEF, particularly with regard to PRO (ISRCTN70429960).
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
| | - Eileen O'Meara
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
| | - Virginie Bernier
- Scientific and Medical Affairs, Servier Canada Inc., Laval, Quebec, Canada
| | - Michel Komajda
- Department of Cardiology, Paris Saint Joseph Hospital, Paris, France
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Jeffrey S Borer
- Howard Gilman and Schiavone Institutes, State University of New York Downstate Medical Center, New York, NY, USA
| | - Michael Bohm
- Internal Medicine Clinic III, Saarland University Clinic, Saarland University, Homburg, Saar, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
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207
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Contribution of the self-regulation model to understanding the health related quality of life of rheumatoid arthritis patients. Qual Life Res 2019; 29:403-412. [PMID: 31576485 DOI: 10.1007/s11136-019-02315-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE This study examined a comprehensive model that integrates the interrelationships among health-related-quality-of-life (HRQoL), disease duration, disease severity, illness representations, and coping resources regarding patients with Rheumatoid arthritis (RA), based on the Self-regulation model. METHOD A convenience sample of 164 patients with RA completed measures of disease's characteristics (disease duration, disease status), illness representations (timeline, consequences, self-control, treatment control, symptom burden, concern about RA, understanding RA, emotional representations), coping resources (resilience, social support), HRQoL, and socio-demographic questionnaires. The research model was assessed through path analysis. RESULTS Perceptions of higher treatment control, lower consequences of RA and lower symptom burden were directly related to HRQoL. The perceptions of higher self-control, higher treatment control, less concern about RA, and lower emotional representations were associated with higher resilience, which in turn was associated with higher HRQoL. The perceptions of higher treatment control, greater understanding of RA, and lower emotional representations were associated with higher perceived social support; however, social support was not associated with HRQoL. CONCLUSIONS This study contributes to a better understanding of the determinants of HRQoL among RA patients. The findings indicate that clinical interventions targeting RA patients' illness representations and resilience may assist patients with RA to improve their HRQoL.
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208
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Khariton Y, Fonarow GC, Arnold SV, Hellkamp A, Nassif ME, Sharma PP, Butler J, Thomas L, Duffy CI, DeVore AD, Albert NM, Patterson JH, Williams FB, McCague K, Spertus JA. Association Between Sacubitril/Valsartan Initiation and Health Status Outcomes in Heart Failure With Reduced Ejection Fraction. JACC-HEART FAILURE 2019; 7:933-941. [PMID: 31521679 DOI: 10.1016/j.jchf.2019.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to describe the short-term health status benefits of angiotensin-neprilysin inhibitor (ARNI) therapy in patients with heart failure and reduced ejection fraction (HFrEF). BACKGROUND Although therapy with sacubitril/valsartan, a neprilysin inhibitor, improved patients' health status (compared with enalapril) at 8 months in the PARADIGM-HF (Prospective Comparison of ARNI with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) study, the early impact of ARNI on patients' symptoms, functions, and quality of life is unknown. METHODS Health status was assessed by using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ) in 3,918 outpatients with HFrEF and left ventricular ejection fraction ≤40% across 140 U.S. centers in the CHAMP-HF (Change the Management of Patients with Heart Failure) registry. ARNI therapy was initiated in 508 patients who were matched 1:2 to 1,016 patients who were not initiated on ARNI (no-ARNI), using a nonparsimonious time-dependent propensity score (6 sociodemographic factors, 23 clinical characteristics), prior KCCQ overall summary (KCCQ-OS) score, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker status. RESULTS Multivariate linear regression demonstrated a greater mean improvement in KCCQ-OS in patients initiated on ARNI therapy (5.3 ± 19 vs. 2.5 ± 17.4, respectively; p < 0.001) over a median (interquartile range [IQR]) of 57 (32 to 104) days. The proportions of ARNI versus no-ARNI groups with ≥10-point (large) and ≥20-point (very large) improvements in KCCQ-OS were 32.7% versus 26.9%, respectively, and 20.5% versus 12.1%, respectively, consistent with numbers needed to treat of 18 and 12, respectively. CONCLUSIONS In routine clinical care, ARNI therapy was associated with early improvements in health status, with 20% experiencing a very large health status benefit compared with 12% who were not started on ARNI therapy. These findings support the use of ARNI to improve patients' symptoms, functions, and quality of life.
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Affiliation(s)
- Yevgeniy Khariton
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri.
| | - Gregg C Fonarow
- Department of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California
| | - Suzanne V Arnold
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Ann Hellkamp
- Duke Clinical Research Institute, Durham, North Carolina
| | - Michael E Nassif
- Department of Cardiology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - Puza P Sharma
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, North Carolina
| | - Carol I Duffy
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - Adam D DeVore
- Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | | | - Kevin McCague
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - John A Spertus
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
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Pool LR, Ning H, Huffman MD, Reis JP, Lloyd-Jones DM, Allen NB. Association of cardiovascular health through early adulthood and health-related quality of life in middle age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Prev Med 2019; 126:105772. [PMID: 31323285 DOI: 10.1016/j.ypmed.2019.105772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/24/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
Previous studies have linked cardiovascular health (CVH) and health-related quality of life (HRQoL), but only in cross-sectional analyses where temporality cannot be established. The aim of this study was to determine trajectories of CVH from early adulthood to middle age, and examine their association with HRQoL in middle age. This analysis, conducted in 2018, included 3275 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study who completed a year 30 follow-up exam in 2015/2016. Group-based trajectory modeling was used to create CVH trajectories, according to American Heart Association definitions, from baseline through follow-up year 20. HRQoL was assessed by the Medical Outcomes Study 12-Item Short Form Health Survey at year 30, which included the physical component summary score (PCS), the mental component summary score (MCS), and overall self-rated health (SRH). The mean (SD) age of the sample was 55.1 (3.6) years, 1868 (57%) were women, and 1541 (47%) were black. Five CVH trajectories were identified, 31% of CARDIA participants maintained ideal CVH during follow-up. Maintaining ideal CVH was associated with higher PCS and MCS, and lower odds of fair/poor SRH as compared to the other trajectory groups. Compared to the consistently low CVH group, those who maintained ideal CVH had on average a 5.9 point higher PCS (95% CI, 4.2-7.7), a 2.5-point higher MCS (95% CI, 0.5-4.4), and 84% lower odds of fair/poor SRH (95% CI, 0.09, 0.31). Our findings suggest that maintaining ideal CVH from early adulthood results in higher health-related quality of life in middle age.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Hongyan Ning
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark D Huffman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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210
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Bradley SM. Deafening Silence: The Lack of Structured Patient Symptoms in Clinical Documentation of Angina. J Am Heart Assoc 2019; 8:e013664. [PMID: 31364491 PMCID: PMC6761635 DOI: 10.1161/jaha.119.013664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
See Article Owlia et al
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Affiliation(s)
- Steven M. Bradley
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis MN
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211
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Adherence to Treatment of Female Patients With Coronary Heart Disease After a Percutaneous Coronary Intervention. J Cardiovasc Nurs 2019; 34:410-417. [PMID: 31365439 DOI: 10.1097/jcn.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients. OBJECTIVE The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention. METHODS A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model. RESULTS Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it. CONCLUSIONS Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.
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Owlia M, Dodson JA, King JB, Derington CG, Herrick JS, Sedlis SP, Crook J, DuVall SL, LaFleur J, Nelson R, Patterson OV, Shah RU, Bress AP. Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina. J Am Heart Assoc 2019; 8:e012811. [PMID: 31362569 PMCID: PMC6761668 DOI: 10.1161/jaha.119.012811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Canadian Cardiovascular Society (CCS) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between CCS class and all‐cause mortality and healthcare utilization, using natural language processing to extract CCS classifications from clinical notes. Methods and Results In this retrospective cohort study of veterans in the United States with stable angina from January 1, 2006, to December 31, 2013, natural language processing extracted CCS classifications. Veterans with a prior diagnosis of coronary artery disease were excluded. Outcomes included all‐cause mortality (primary), all‐cause and cardiovascular‐specific hospitalizations, coronary revascularization, and 1‐year healthcare costs. Of 299 577 veterans identified, 14 216 (4.7%) had ≥1 CCS classification extracted by natural language processing. The mean age was 66.6±9.8 years, 99% of participants were male, and 81% were white. During a median follow‐up of 3.4 years, all‐cause mortality rates were 4.58, 4.60, 6.22, and 6.83 per 100 person‐years for CCS classes I, II, III, and IV, respectively. Multivariable adjusted hazard ratios for all‐cause mortality comparing CCS II, III, and IV with those in class I were 1.05 (95% CI, 0.95–1.15), 1.33 (95% CI, 1.20–1.47), and 1.48 (95% CI, 1.25–1.76), respectively. The multivariable hazard ratio comparing CCS IV with CCS I was 1.20 (95% CI, 1.09–1.33) for all‐cause hospitalization, 1.25 (95% CI, 0.96–1.64) for acute coronary syndrome hospitalizations, 1.00 (95% CI, 0.80–1.26) for heart failure hospitalizations, 1.05 (95% CI, 0.88–1.25) for atrial fibrillation hospitalizations, 1.92 (95% CI, 1.40–2.64) for percutaneous coronary intervention, and 2.51 (95% CI, 1.99–3.16) for coronary artery bypass grafting surgery. Conclusions Natural language processing–extracted CCS classification was positively associated with all‐cause mortality and healthcare utilization, demonstrating the prognostic importance of anginal symptom assessment and documentation. See Editorial Mehta and Bradley
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Affiliation(s)
- Mina Owlia
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY
| | - John A Dodson
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY.,Department of Population Health New York University School of Medicine New York NY
| | - Jordan B King
- Department of Population Health Sciences University of Utah Salt Lake City UT.,Department of Pharmacy Kaiser Permanente Colorado Aurora CO.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Catherine G Derington
- Department of Pharmacy Kaiser Permanente Colorado Aurora CO.,Department of Clinical Pharmacy University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora CO
| | - Jennifer S Herrick
- Department of Population Health Sciences University of Utah Salt Lake City UT
| | - Steven P Sedlis
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY.,Cardiology Section Veterans Affairs Medical Center Manhattan NY
| | - Jacob Crook
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Scott L DuVall
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Joanne LaFleur
- Department of Pharmacotherapy University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Richard Nelson
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Olga V Patterson
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Rashmee U Shah
- Department of Internal Medicine University of Utah Salt Lake City UT
| | - Adam P Bress
- Department of Population Health Sciences University of Utah Salt Lake City UT.,Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
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213
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Association between Type D personality and outcomes in patients with non-ischemic heart failure. Qual Life Res 2019; 28:2901-2908. [DOI: 10.1007/s11136-019-02241-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
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214
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Brinkley DM, Stevenson LW. PROmises to Keep. JACC. HEART FAILURE 2019; 7:626-628. [PMID: 31176673 DOI: 10.1016/j.jchf.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Affiliation(s)
- D Marshall Brinkley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Lynne W Stevenson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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215
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Spertus JV, Hatfield LA, Cohen DJ, Arnold SV, Ho M, Jones PG, Leon M, Zuckerman B, Spertus JA. Integrating Quality of Life and Survival Outcomes in Cardiovascular Clinical Trials. Circ Cardiovasc Qual Outcomes 2019; 12:e005420. [PMID: 31189406 DOI: 10.1161/circoutcomes.118.005420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Survival and health status (eg, symptoms and quality of life) are key outcomes in clinical trials of heart failure treatment. However, health status can only be recorded on survivors, potentially biasing treatment effect estimates when there is differential survival across treatment groups. Joint modeling of survival and health status can address this bias. Methods and Results We analyzed patient-level data from the PARTNER 1B trial (Placement of Aortic Transcatheter Valves) of transcatheter aortic valve replacement versus standard care. Health status was quantified with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at randomization, 1, 6, and 12 months. We compared hazard ratios for survival and mean differences in KCCQ scores at 12 months using several models: the original growth curve model for KCCQ scores (ignoring death), separate Bayesian models for survival and KCCQ scores, and a Bayesian joint longitudinal-survival model fit to either 12 or 30 months of survival follow-up. The benefit of transcatheter aortic valve replacement on 12-month KCCQ scores was greatest in the joint-model fit to all survival data (mean difference, 33.7 points; 95% credible intervals [CrI], 24.2-42.4), followed by the joint-model fit to 12 months of survival follow-up (32.3 points; 95% CrI, 22.5-41.5), a Bayesian model without integrating death (30.4 points; 95% CrI, 21.4-39.3), and the original growth curve model (26.0 points; 95% CI, 18.7-33.3). At 12 months, the survival benefit of transcatheter aortic valve replacement was also greater in the joint model (hazard ratio, 0.50; 95% CrI, 0.32-0.73) than in the nonjoint Bayesian model (0.54; 95% CrI, 0.37-0.75) or the original Kaplan-Meier estimate (0.55; 95% CI, 0.40-0.74). Conclusions In patients with severe symptomatic aortic stenosis and prohibitive surgical risk, the estimated benefits of transcatheter aortic valve replacement on survival and health status compared with standard care were greater in joint Bayesian models than other approaches.
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Affiliation(s)
- Jacob V Spertus
- Department of Statistics, University of California, Berkeley (J.V.S.)
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H.)
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
| | - Martin Ho
- Center for Devices and Radiologic Health, Food and Drug Administration, Bethesda MD (M.H., B.Z.)
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.)
| | - Martin Leon
- Division of Cardiology, Columbia University, New York, NY (M.L.)
| | - Bram Zuckerman
- Center for Devices and Radiologic Health, Food and Drug Administration, Bethesda MD (M.H., B.Z.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
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216
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Ahmad FS, Kallen MA, Schifferdecker KE, Carluzzo KL, Yount SE, Gelow JM, McCullough PA, Kimmel SE, Fisher ES, Cella D. Development and Initial Validation of the PROMIS®-Plus-HF Profile Measure. Circ Heart Fail 2019; 12:e005751. [PMID: 31163985 DOI: 10.1161/circheartfailure.118.005751] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Bringing together generic and heart failure (HF)-specific items in a publicly available, patient-reported outcome measure may facilitate routine health status assessment for improving clinical care and shared decision-making, assessing quality of care, evaluating new interventions, and comparing groups with different conditions. Methods and Results We performed a mixed-methods study to develop and validate the PROMIS®-Plus-HF (Patient-Reported Outcomes Measurement Information System®-Plus-Heart Failure) profile measure-a HF-specific instrument based on the generic PROMIS. We conducted 8 focus groups with 61 patients with HF and phone interviews with 10 HF clinicians. The measure was developed via an iterative process of reviewing existing PROMIS items and developing and testing new HF items. In a 600-patient sample, we estimated reliability (internal consistency; test-retest, with n=100 participants). We conducted validity analyses using Pearson r and Spearman ρ correlations with Kansas City Cardiomyopathy Questionnaire subscores. In a longitudinal sample, we performed responsiveness testing (paired t tests) with 75 patients with HF receiving interventions with expected health status improvement. The PROMIS-Plus-HF measure comprises 86 items (64 existing; 22 new) across 18 domains. Internal consistency reliability (Cronbach α) coefficients ranged from 0.52 to 0.96, with α≥0.70 in 12 of 17 domains. Test-retest intraclass correlation coefficients were ≥0.90. Correlations with Kansas City Cardiomyopathy Questionnaire subscores supported expected convergent ( r/ρ>0.60) and divergent validity ( r/ρ<0.30). In the longitudinal sample, 10 of 18 domains had improved ( P<0.05) scores from baseline to follow-up. Conclusions The PROMIS-Plus-HF profile measure-a complete assessment of physical, mental, and social health-exhibited good psychometric characteristics and may facilitate patient-centered care and research. Subsets of domains and items can be used depending on the clinical or research purpose.
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Affiliation(s)
- Faraz S Ahmad
- Division of Cardiology, Department of Medicine (F.S.A.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Health Information Partnerships, Institute of Public Health and Medicine (F.S.A.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael A Kallen
- Department of Medical Social Sciences (M.A.K., S.E.Y., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Karen E Schifferdecker
- Community and Family Medicine (K.E.S., E.S.F.), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Center for Program Design and Evaluation at Dartmouth (K.E.S., K.L.C.), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice (K.E.S., K.L.C., E.S.F.), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kathleen L Carluzzo
- Center for Program Design and Evaluation at Dartmouth (K.E.S., K.L.C.), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice (K.E.S., K.L.C., E.S.F.), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Susan E Yount
- Department of Medical Social Sciences (M.A.K., S.E.Y., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jill M Gelow
- Oregon Health and Science University Knight Cardiovascular Institute, Portland (J.M.G.).,Providence Heart and Vascular Institute, Portland, Oregon (J.M.G.)
| | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.)
| | - Stephen E Kimmel
- Departments of Medicine (S.E.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia.,Biostatistics, Epidemiology and Informatics (S.E.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Elliot S Fisher
- Community and Family Medicine (K.E.S., E.S.F.), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice (K.E.S., K.L.C., E.S.F.), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - David Cella
- Department of Medical Social Sciences (M.A.K., S.E.Y., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Patient Centered Outcomes, Institute of Public Health and Medicine (D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
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217
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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-E21. [PMID: 31135602 DOI: 10.1097/jcn.0000000000000583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [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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218
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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219
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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220
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Friedrich M, Karoff J, Hinz A. Response shift effects in patients' assessments of their quality of life after cardiac rehabilitation. Qual Life Res 2019; 28:2609-2620. [PMID: 31069601 DOI: 10.1007/s11136-019-02195-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The effect of intervention programs on health-related quality of life (HRQoL) can be underestimated due to response shift effects. This study aims to compare HRQoL between cardiac patients taking part in a rehabilitation program and the general population and to investigate changes in HRQoL in terms of response shift with two approaches. METHODS A sample of 282 cardiac rehabilitation inpatients (response rate: 58.9%) responded to the self-report quality of life questionnaire EORTC QLQ-C30 at baseline (during rehabilitation) and three months later (actual and retrospective judgment). Their HRQoL was compared to that of the general population. Response shift evaluation complemented the thentest with the structural equation modeling approach. RESULTS Compared to the general population, patients showed impaired quality of life on all scales (Hedges' g between 0.31 and 1.57). The complementation of the thentest with the structural equation modeling approach revealed response shift effects in physical, emotional, cognitive, and social functioning. No effects were found in role functioning. CONCLUSIONS The combination of both the thentest and the structural equation modeling approaches proved to be essential for obtaining comprehensive statistical evidence that response shift can distort measurements of change. Our results suggest that studies that use the thentest to evaluate the effectiveness of interventions should complement their analyses with the structural equation modeling approach to avoid biased effects.
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Affiliation(s)
- Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
| | - Jan Karoff
- Institute of Educational Sciences, University of Wuppertal, Wuppertal, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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221
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Ørbo MC, Karlsen SF, Pedersen EP, Hermansen SE, Rønning PB, Nergaard KA, Naesheim T, Myrmel T. Health-related quality of life after extracorporeal membrane oxygenation: a single centre's experience. ESC Heart Fail 2019; 6:701-710. [PMID: 31066213 PMCID: PMC6676289 DOI: 10.1002/ehf2.12433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/22/2019] [Indexed: 12/31/2022] Open
Abstract
Aims The aims of this study were to evaluate health‐related quality of life (HRQL) among patients treated with extracorporeal membrane oxygenation (ECMO) in northern Norway over a period of 27 years (1988–2015) and to identify variables related to HRQL. Methods and results A retrospective inquiry of the ECMO registry at the University Hospital of North Norway identified 74 ECMO‐treated patients (mean age 49 years, 65% males). Acute cardiac failure was the dominant indication (58%), and venoarterial ECMO was the dominant mode of treatment (87%). Mortality for discharged patients was recorded on 20 September 2016. Thirty (41%) survivors were identified. Twenty‐three survivors were eligible for the survey and received a set of questionnaires at home. The main outcome measure was HRQL as measured with the 36‐item Short‐Form health survey (SF‐36) (RAND Short Form‐36 v1.2). Other questionnaires covered demographic information, problems with functioning in usual daily activities (such as hobbies, household chores, family, or work), employment status, and psychological distress. The survey was completed by 20 (87%) survivors (mean age = 49 years, 12 men). Indications for ECMO treatment (VA = 90%) had been respiratory failure (25%), cardiac failure (60%), and extracorporeal cardiopulmonary resuscitation (15%). The average time since ECMO treatment was 6.5 years. Seventy‐five percent reported mental HRQL (SF‐36 Mental Component Summary, mean = 43, SD = 5) or physical HRQL (SF‐36 Physical Component Summary, mean = 43, SD = 4.5) within the normal range (T = 50 ± 10) in comparison with age‐matched population data from national norms. Half of the responders reported problems on the SF‐36 subscales general health and role physical. Seventy percent reported problems on the SF‐36 subscale role emotional. All but one responder lived independently without any organized care, and 90% reported no problems related to basic self‐care. Half of those in working age had returned to work after ECMO treatment. Forty percent of the responders reported some degree of restrictions in usual daily activities, problems with mobility (35%), anxiety/depression (35%), or pain/discomfort (55%). Significant univariate associations were observed for poorer HRQL and higher reports of psychological distress, pain, and experiencing restrictions in usual everyday activities. Improved HRQL was significantly related to an extended time since ECMO treatment. Conclusions Our survey indicates an overall positive long‐term HRQL outcome for our ECMO survivors. A subset reported problems with functioning and HRQL. Future research should focus on identification of the survivors at risk for poor recovery who may benefit from rehabilitation interventions.
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Affiliation(s)
- Marte Christine Ørbo
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Sidsel Fredheim Karlsen
- Department of Cardiology, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Ellinor Phillips Pedersen
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Stig Eggen Hermansen
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Per Bjørnerud Rønning
- Department of Cardiology, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Kathrine Aas Nergaard
- Division of Surgical Medicine and Intensive Care, Clinic of Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway
| | - Torvind Naesheim
- Division of Surgical Medicine and Intensive Care, Clinic of Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Truls Myrmel
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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222
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Zack R, Okunade O, Olson E, Salt M, Amodeo C, Anchala R, Berwanger O, Campbell N, Chia YC, Damasceno A, Phuong Do TN, Tamdja Dzudie A, Fiuza M, Mirza F, Nitsch D, Ogedegbe G, Podpalov V, Schiffrin EL, Vaz Carneiro A, Lamptey P. Improving Hypertension Outcome Measurement in Low- and Middle-Income Countries. Hypertension 2019; 73:990-997. [DOI: 10.1161/hypertensionaha.118.11916] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rachel Zack
- From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.)
| | - Oluwakemi Okunade
- From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.)
| | - Elizabeth Olson
- From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.)
| | - Matthew Salt
- From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.)
| | | | - Raghupathy Anchala
- The Public Health Foundation of India, Indian Institute of Public Health, Hyderabad (R.A.)
| | | | | | - Yook-Chin Chia
- Sunway University; University of Malaya; and Malaysian Society of Hypertension (Y.-C.C.)
| | | | | | | | - Manuela Fiuza
- CCUL, Faculdade de Medicina da Universidade de Lisboa (M.F.)
| | | | | | | | - Vladislav Podpalov
- Belarusian Hypertension Society, Vitebsk State Medical University (V.P.)
| | | | - António Vaz Carneiro
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina da Universidade de Lisboa, Portugal (A.V.C.)
| | - Peter Lamptey
- FHI360, London School of Hygiene & Tropical Medicine (P.L.)
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Ladak LA, Hasan BS, Gullick J, Gallagher R. Health-related quality of life in congenital heart disease surgery in children and young adults: a systematic review and meta-analysis. Arch Dis Child 2019; 104:340-347. [PMID: 29572215 DOI: 10.1136/archdischild-2017-313653] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 01/17/2018] [Accepted: 02/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND As survival improves in the congenital heart disease (CHD) population, health-related quality of life (HRQOL) outcomes become increasingly important. While surgery improves survival, poor HRQOL occurs postoperatively and cardiac-related HRQOL outcomes are rarely reported. OBJECTIVE To conduct a systematic review and meta-analyses of general and cardiac-related HRQOL in CHD surgical children and young adults. METHOD Medline, CINAHL and EMBASE were searched. Quantitative designs with a minimum of 80% CHD surgical patients and mean age ≤18 years compared with healthy controls were included in the review. Data were analysed in RevMan V.5.3 using a random effects model. OUTCOME MEASURES General and cardiac-related HRQOL. RESULTS Studies (n=20) were conducted in high-income countries and included 3808 patients plus 2951 parental reports of patients. HRQOL was worse in postoperative patients with CHD versus healthy controls in all domains with the largest difference seen for physical function (standard mean difference (SMD) of -0.56, 95% CI -0.82 to -0.30). Cardiac-related HRQOL was worse in complex compared with simple CHD with the largest SMD (-0.60, 95% CI -0.80 to -0.40) for symptoms. Heterogeneity ranged from 0% to 90%. CONCLUSIONS CHD surgical patients have substantially worse HRQOL compared with age-matched healthy controls. Strategies should focus on improving HRQOL in this subgroup. Results may not be applicable to low/middle-income countries given the dearth of relevant research.
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Affiliation(s)
- Laila Akbar Ladak
- Charles Perkins Centre, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Babar Sultan Hasan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Janice Gullick
- Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, Sydney Nursing School, The University of Sydney, Sydney, Australia
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224
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Cavanagh CE. Quality of life in heart failure: screening alone is insufficient. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:191-192. [DOI: 10.1093/ehjqcco/qcz009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Casey E Cavanagh
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St., New Haven, CT, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA
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225
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Neilson LM, Swart ECS, Good CB, Shrank WH, Henderson R, Manolis C, Parekh N. Identifying Outcome Measures for Coronary Artery Disease Value-Based Contracting Using the Delphi Method. Cardiol Ther 2019; 8:135-143. [PMID: 30825093 PMCID: PMC6525225 DOI: 10.1007/s40119-019-0132-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Value-based contracts (VBCs) that link drug payments to disease-related performance metrics aim to increase the value and lower the cost of medications by aligning incentives and sharing risk between payers and pharmaceutical manufacturers. This study sought to identify outcome measures that are meaningful to key stakeholders to inform VBCs for coronary artery disease (CAD) medications. Methods We administered a modified Delphi survey to gather expert opinion from a diverse panel of patients (n = 9), cardiologists (n = 4), primary care physicians (n = 5), payers (n = 2), pharmacy benefits managers (n = 3), and pharmaceutical company representatives (n = 2). A list of 16 CAD-associated clinical indicators was generated from the literature and expert consultation. Delphi participants rated the importance of each outcome on a five-point Likert scale, and selected the three most meaningful outcomes. We defined consensus as ≥ 75% agreement on the importance of an outcome (Likert scores 4 or 5 or selection of an outcome as most meaningful). Results Eleven of 13 outcomes reached consensus for importance on the Likert scale. “Preventing heart attacks” was selected as the most meaningful outcome (80%) while “preventing death” ranked second (76%). Conclusions Our study results verify the utility of a widely used clinical CAD outcome measure, myocardial infarction events, for the purpose of pharmaceutical value-based contracting. Electronic supplementary material The online version of this article (10.1007/s40119-019-0132-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lynn M Neilson
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA.
| | - Elizabeth C S Swart
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
| | - Chester B Good
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - William H Shrank
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
| | | | - Chronis Manolis
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
- Pharmacy Division, UPMC Health Plan, Pittsburgh, PA, USA
| | - Natasha Parekh
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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226
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Van Bulck L, Luyckx K, Goossens E, Apers S, Kovacs AH, Thomet C, Budts W, Sluman MA, Eriksen K, Dellborg M, Berghammer M, Johansson B, Caruana M, Soufi A, Callus E, Moons P. Patient-reported outcomes of adults with congenital heart disease from eight European countries: scrutinising the association with healthcare system performance. Eur J Cardiovasc Nurs 2019; 18:465-473. [DOI: 10.1177/1474515119834484] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Inter-country variation in patient-reported outcomes of adults with congenital heart disease has been observed. Country-specific characteristics may play a role. A previous study found an association between healthcare system performance and patient-reported outcomes. However, it remains unknown which specific components of the countries’ healthcare system performance are of importance for patient-reported outcomes. Aims: The aim of this study was to investigate the relationship between components of healthcare system performance and patient-reported outcomes in a large sample of adults with congenital heart disease. Methods: A total of 1591 adults with congenital heart disease (median age 34 years; 51% men; 32% simple, 48% moderate and 20% complex defects) from eight European countries were included in this cross-sectional study. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviours and quality of life. The Euro Health Consumer Index 2015 and the Euro Heart Index 2016 were used as measures of healthcare system performance. General linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. Results: Health risk behaviours were associated with the Euro Health Consumer Index subdomains about patient rights and information, health outcomes and financing and access to pharmaceuticals. Perceived physical health was associated with the Euro Health Consumer Index subdomain about prevention of chronic diseases. Subscales of the Euro Heart Index were not associated with patient-reported outcomes. Conclusion: Several features of healthcare system performance are associated with perceived physical health and health risk behaviour in adults with congenital heart disease. Before recommendations for policy-makers and clinicians can be conducted, future research ought to investigate the impact of the healthcare system performance on outcomes further.
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Affiliation(s)
- Liesbet Van Bulck
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven – University of Leuven, Belgium
- UNIBS, University of the Free State, South Africa
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Research Foundation Flanders (FWO), Belgium
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
| | - Silke Apers
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
| | - Adrienne H Kovacs
- Peter Munk Cardiac Centre, University of Toronto, Canada
- Knight Cardiovascular Institute, Oregon Health & Science University, USA
| | - Corina Thomet
- Center for Congenital Heart Disease, Bern University Hospital, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
| | - Maayke A Sluman
- Department of Cardiology, Academic Medical Center, The Netherlands
- Department of Cardiology, Jeroen Bosch Hospital, The Netherlands
- Coronel Institute for Occupational Health, Academic Medical Centre, The Netherlands
| | - Katrine Eriksen
- Department of Cardiology, Oslo University Hospital – Rikshospitalet, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Adult Congenital Heart Unit, Sahlgrenska University Hospital, Sweden
- Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Department of Health Sciences, University West, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | | | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, France
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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227
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Cacciata M, Stromberg A, Lee JA, Sorkin D, Lombardo D, Clancy S, Nyamathi A, Evangelista LS. Effect of exergaming on health-related quality of life in older adults: A systematic review. Int J Nurs Stud 2019; 93:30-40. [PMID: 30861452 DOI: 10.1016/j.ijnurstu.2019.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Exercise through video or virtual reality games (i.e. exergames) has grown in popularity among older adults; however, there is limited evidence on efficacy of exergaming on well-being related to health in this population. This systematic review examined the effectiveness of exergaming on health-related quality of life in older adults. METHODS PRISMA guidelines for this systematic review. Several databases were searched using keywords to identify peer-reviewed journal articles in English. Randomized control trials that evaluated the effect of exergaming on health-related quality of life in older adults when compared to a control group and published between January 2007 to May 2017 were included. RESULTS Nine articles that in total included 614 older adults with varying levels of disability, mean age 73.6 + 7.9 years old, and 67% female were analyzed. Significant improvements in health-related quality of life of older adults engaged in exergaming were reported in three studies. Sample sizes were small in 7 of the studies (N < 60). The study participants, exergaming platforms, health-related quality of life instruments, study settings and length, duration and frequency of exergaming varied across studies. CONCLUSION Exergaming is a new emerging form of exercise that is popular among older adults. However, findings from this analysis were not strong enough to warrant recommendation due to the small sample sizes and heterogeneity in the study participants, exergaming platforms, health-related quality of life instruments, length, duration and frequency of the intervention and study settings. Further research is needed with larger sample sizes and less heterogeneity to adequately explore the true effects of exergaming on health-related quality of life of older adults.
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Affiliation(s)
- Marysol Cacciata
- Sue and Bill Gross School of Nursing, University of California, Irvine, CA, 92697, USA.
| | - Anna Stromberg
- Department of Medical and Health Services, Linkoping University, Sweden
| | - Jung-Ah Lee
- Sue and Bill Gross School of Nursing, University of California, Irvine, CA, 92697, USA
| | - Dara Sorkin
- Division of General Internal Medicine, University of California, Irvine, USA
| | - Dawn Lombardo
- Heart Failure Program, University of California Irvine Health, USA
| | - Steve Clancy
- Health Sciences and Nursing Science, University of California, Irvine, USA
| | - Adeline Nyamathi
- Sue and Bill Gross School of Nursing, University of California, Irvine, CA, 92697, USA
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228
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Myles PS, Smith JA, Kasza J, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussières JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S, Forbes A, Myles P, Smith J, Cooper DJ, Silbert B, McNeil J, Marasco S, Esmore D, Krum H, Tonkin A, Buxton B, Heritier S, Merry A, Liew D, McNeil J, Forbes A, Cooper D, Wallace S, Meehan A, Myles P, Wallace S, Galagher W, Farrington C, Ditoro A, Wutzlhofer L, Story D, Peyton P, Baulch S, Sidiropoulos S, Potgieter D, Baker R, Pesudovs B, O'Loughlin J Wells E, Coutts P, Bolsin S, Osborne C, Ives K, Smith J, Hulley A, Christie-Taylor G, Painter T, Lang S, Mackay H, Cokis C, March S, Bannon P, Wong C, Turner L, Scott D, Silbert B, Said S, Corcoran P, Painter T, de Prinse L, Bussières J, Gagné N, Lamy A, Semelhago L, Chan M, Underwood M, Choi G, Fung B, Landoni G, Lembo R, Monaco F, Simeone F, Marianello D, Alvaro G, De Vuono G, van Dijk D, Dieleman J, Numan S, McGuinness S, Parke R, Raudkivi P, Gilder E, Byrne K, Dunning J, Termaat J, Mans G, Jayarajah M, Alderton J, Waugh D, Platt M, Pai A, Sevillano A, Lal A, Sinclair C, Kunst G, Knighton A, Cubas G, Saravanan P, Millner R, Vasudevan V, Patteril M, Lopez E, Basu R, Lu J. Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. J Thorac Cardiovasc Surg 2019; 157:644-652.e9. [DOI: 10.1016/j.jtcvs.2018.09.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
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229
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Grønset CN, Thygesen LC, Berg SK, Zangger G, Kristensen MS, Sibilitz KL, Pedersen SS, Oldridge NB, Zwisler AD. Measuring HRQoL following heart valve surgery: the HeartQoL questionnaire is a valid and reliable core heart disease instrument. Qual Life Res 2019; 28:1245-1253. [PMID: 30610503 DOI: 10.1007/s11136-018-02098-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Patient-reported health-related quality of life is a complementary healthcare outcome and important when assessing treatment efficacy. Using COSMIN methodological recommendations, this study evaluates the validity and reliability of a core heart disease-specific health-related quality of life questionnaire, the HeartQoL questionnaire (Danish version) in a sample of patients following heart valve surgery. DESIGN This project involved a cross-sectional validity study and a test-retest reliability study. METHODS Eligible patients completed the HeartQoL, the SF-36 health survey questionnaire, and the Hospital Anxiety and Depression Scale following heart valve surgery. Construct validity was tested using a priori hypotheses. Internal consistency reliability was assessed with Cronbach's alpha. An independent sample of patients participated in the test-retest study and reproducibility was determined with relative [intra-class correlation coefficient (ICC)] and absolute reliability [standard error of measurement (SEM) and smallest detectable change (SDC)]. RESULTS Internal consistency was high with Cronbach's alpha ≥ 0.87. ICC was 0.86-0.92. SEM ranged from 0.17 to 0.26 points and SDC ranged from 0.5 to 0.7 points. Construct validity was confirmed with 87% of all a priori hypotheses for predicted variables. CONCLUSIONS The HeartQoL questionnaire demonstrates acceptable construct validity, internal consistency, and test-retest reproducibility in patients following heart valve surgery. Future studies should focus on assessing the responsiveness of the HeartQoL questionnaire over time and following heart valve surgery.
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Affiliation(s)
- Charlotte N Grønset
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Graziella Zangger
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirstine L Sibilitz
- Department of Internal Medicine, Section of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Neil B Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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230
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Lapin B, Thompson NR, Schuster A, Katzan IL. Clinical Utility of Patient-Reported Outcome Measurement Information System Domain Scales. Circ Cardiovasc Qual Outcomes 2019; 12:e004753. [DOI: 10.1161/circoutcomes.118.004753] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brittany Lapin
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH (B.L., N.R.T.)
- Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (B.L., N.R.T., A.S., I.L.K.)
| | - Nicolas R. Thompson
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH (B.L., N.R.T.)
- Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (B.L., N.R.T., A.S., I.L.K.)
| | - Andrew Schuster
- Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (B.L., N.R.T., A.S., I.L.K.)
| | - Irene L. Katzan
- Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (B.L., N.R.T., A.S., I.L.K.)
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231
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Unlocking the potential of value-based health care by defining global standard sets of outcome measures that matter to patients with cardiovascular diseases. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 5:92-95. [DOI: 10.1093/ehjqcco/qcy056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/29/2018] [Accepted: 12/01/2018] [Indexed: 11/15/2022]
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232
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Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. Long-term health-related quality of life and survival after cardiac surgery: A prospective study. J Thorac Cardiovasc Surg 2018; 156:2183-2190.e2. [DOI: 10.1016/j.jtcvs.2018.05.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/04/2018] [Accepted: 05/12/2018] [Indexed: 01/14/2023]
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233
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The role of illness uncertainty in the relationship between disease knowledge and patient-reported outcomes among adolescents and adults with congenital heart disease. Heart Lung 2018; 48:325-330. [PMID: 30471879 DOI: 10.1016/j.hrtlng.2018.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Greater general disease knowledge predicts better patient-reported outcomes (PROs) among congenital heart disease (CHD) survivors, but higher illness uncertainty is associated with elevated emotional distress and poorer well-being among patients with chronic disease. OBJECTIVES This study explored the relationship of illness uncertainty and disease knowledge with emotional distress and health-related quality of life (HRQoL) among patients with CHD. METHODS Individuals with CHD (N = 169, ages 15-39) completed self-report measures of disease knowledge (general and risk-related), illness uncertainty, depressive and anxiety symptoms, and HRQoL. Pearson correlations and regressions analyses were utilized. RESULTS Greater risk-related knowledge was associated with greater anxiety (b = .41, p = .03, 95% CI = [.04, .77]) and poorer emotional HRQoL (b = -.53, p = .03, 95% CI = [-1.02, -.05]) when illness uncertainty was higher. CONCLUSION When individuals with CHD feel uncertain about their disease course and outcomes, knowledge about future cardiovascular risks may result in higher levels of distress.
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234
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Verwijmeren L, Noordzij PG, Daeter EJ, van Zaane B, Peelen LM, van Dongen EPA. Preoperative determinants of quality of life a year after coronary artery bypass grafting: a historical cohort study. J Cardiothorac Surg 2018; 13:118. [PMID: 30453989 PMCID: PMC6245532 DOI: 10.1186/s13019-018-0798-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/26/2018] [Indexed: 01/02/2023] Open
Abstract
Background Health related quality of life (HRQL) is an important patient related outcome measure after cardiac surgery. Preoperative determinants for postoperative HRQL have not yet been identified, but could aid in preoperative decision making. The aim of this article is to identify associations between preoperative determinants and change in HRQL 1 year after coronary artery bypass grafting (CABG). Methods Single centre retrospective cohort study in 658 patients. Change in HRQL was defined as a decrease or increase of ≥5 points on the physical or mental domain of the Short Form 12 (SF-12) questionnaire. Patients were stratified in three groups according to worse, unchanged, or better HRQL. Multinomial logistic regression analysis was used to investigate the association between preoperative risk factors and postoperative change in HRQL. Results Physical HRQL improved in 22.8% of patients, did not change in 61.2% of patients and worsened in 16.0% of patients. Comorbidities associated with change in physical HRQL were a history of stroke, atrial fibrillation, vascular disease or pulmonary disease. Most important risk factor for change in physical HRQL was preoperative HRQL. Higher preoperative SF-12 score decreased the odds for worse physical HRQL and increased the odds for better physical HRQL. Mental HRQL improved in 49.8% of patients, remained unchanged in 34.5% of patients and worsened in 15.7% of patients. Preoperative HRQL was an important risk factor for a change in mental HRQL. Higher preoperative physical HRQL increased the odds for improved mental HRQL. Lower preoperative mental HRQL increased the odds for better mental HRQL. Conclusions One year after CABG the majority of patients experiences equal or improved HRQL compared to before surgery. Most important preoperative risk factor for change in HRQL is preoperative HRQL. Electronic supplementary material The online version of this article (10.1186/s13019-018-0798-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa Verwijmeren
- Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands
| | - Peter Gerben Noordzij
- Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands.
| | - Edgar Jozeph Daeter
- Cardiac Surgery, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands
| | - Bas van Zaane
- Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Linda Margaretha Peelen
- Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.,Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Eric Paulus Adrianus van Dongen
- Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands
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235
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Hypertension Status and Associations with Self-Rated Health and General Practitioner Health Seeking in a Rural Australian Cohort. J Cardiovasc Dev Dis 2018; 5:jcdd5040053. [PMID: 30404200 PMCID: PMC6306829 DOI: 10.3390/jcdd5040053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 12/18/2022] Open
Abstract
Hypertension is the most frequently managed condition by Australian general practitioners (GP). Knowledge of hypertension and blood pressure (BP) values may motivate individuals to seek GP management. Our study aims to determine the associations of knowledge of BP values, BP perception, GP health seeking, and self-rated health (SRH) in a rural population. Two-hundred and seventy-eight (278) residents responded to the health survey on socio-demographic profile, medical history, BP knowledge and perception, SRH, and GP visit frequency. Associations were evaluated using Chi-squared test and multivariate logistic regression. Cohort mean age was 63.6 (12.4) years with 63.3% females. Hypertension (37.8%) was the most common condition. GP visits were made at least once every month (19.1%), every 2–6 months (35.6%), >6 months (11.5%), or only when needed (29.5%). Univariate analyses showed age, education, alcohol consumption, comorbidities, hypertension status, and SRH were significantly associated with visit frequency. After adjustments, hypertension status (OR = 3.6, 95% CI [1.7, 7.9]) and poor SRH (OR = 3.1, 95% CI [1.4, 7.0]) were significantly associated with frequent monthly visits. Our cohort demonstrated that having hypertension and poor self-rated health were associated with frequent monthly GP visits. The perception of high blood pressure does not drive seeking additional GP input.
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236
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Rathod KS, Wragg A. Do patient-reported outcome measures speak for all patient subgroups: is everyone included? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 4:79-80. [PMID: 29385436 DOI: 10.1093/ehjqcco/qcy004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
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Katzan IL, Schuster A, Newey C, Uchino K, Lapin B. Patient-reported outcomes across cerebrovascular event types: More similar than different. Neurology 2018; 91:e2182-e2191. [PMID: 30381370 DOI: 10.1212/wnl.0000000000006626] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the degrees to which 8 domains of health are affected across types of cerebrovascular events and to identify factors associated with domain scores in different event types. METHODS This was an observational cohort study of 2,181 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or TIA in a cerebrovascular clinic from February 17, 2015, to June 2, 2017 who completed Quality of Life in Neurologic Disorders executive function and the following Patient-Reported Outcomes Measurement Information System scales as part of routine care: physical function, satisfaction with social roles, fatigue, anxiety, depression, pain interference, and sleep disturbance. RESULTS All health domains were affected to similar degrees in patients with ICH, SAH, and ischemic stroke after adjustment for disability and other clinical factors, whereas patients with TIA had worse adjusted scores for 5 of the 8 domains of health. Female sex, younger age, lower income, and event <90 days were associated with worse scores in multiple domains. Factors associated with health domain scores were similar for all cerebrovascular events. Most affected domains for all were physical function, satisfaction with social roles, and executive function. CONCLUSIONS The subtype of stroke (ischemic stroke, ICH, and SAH) had similar effects in multiple health domains, while patients with TIA had worse adjusted outcomes, suggesting that the mechanisms for outcomes after TIA may differ from those of other cerebrovascular events. The most affected domains across all event types were physical function, satisfaction with social roles, and executive function, highlighting the need to develop effective interventions to improve these health domains in survivors of these cerebrovascular events.
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Affiliation(s)
- Irene L Katzan
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH.
| | - Andrew Schuster
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Christopher Newey
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Ken Uchino
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Brittany Lapin
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
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Barker AL, Peeters G, Morello RT, Norman R, Ayton D, Lefkovits J, Brennan A, Evans SM, Zalcberg J, Reid C, Ahern S, Soh SE, Stoelwinder J, McNeil JJ. Symptoms and feelings valued by patients after a percutaneous coronary intervention: a discrete-choice experiment to inform development of a new patient-reported outcome. BMJ Open 2018; 8:e023141. [PMID: 30341131 PMCID: PMC6196865 DOI: 10.1136/bmjopen-2018-023141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To inform the development of a patient-reported outcome measure, the aim of this study was to identify which symptoms and feelings following percutaneous coronary intervention (PCI) are most important to patients. DESIGN Discrete-choice experiment consisting of two hypothetical scenarios of 10 symptoms and feelings (pain or discomfort; shortness of breath; concern/worry about heart problems; tiredness; confidence to do usual activities; ability to do usual activities; happiness; sleep disturbance; dizziness or light-headedness and bruising) experienced after PCI, described by three levels (never, some of the time, most of the time). Preference weights were estimated using a conditional logit model. SETTING Four Australian public hospitals that contribute to the Victorian Cardiac Outcomes Registry (VCOR) and a private insurer's claim database. PARTICIPANTS 138 people aged >18 years who had undergone a PCI in the previous 6 months. MAIN OUTCOME MEASURES Patient preferences via trade-offs between 10 feelings and symptoms. RESULTS Of the 138 individuals recruited, 129 (93%) completed all 16 choice sets. Conditional logit parameter estimates were mostly monotonic (eg, moving to worse levels for each individual symptom and feeling made the option less attractive). When comparing the magnitude of the coefficients (based on the coefficient of the worst level relative to best level in each item), feeling unhappy was the symptom or feeling that most influenced perception of a least-preferred PCI outcome (OR 0.42, 95% CI 0.34 to 0.51, p<0.0001) and the least influential was bruising (OR 0.81, 95% CI 0.67 to 0.99, p=0.04). CONCLUSION This study provides new insights into how patients value symptoms and feelings they experience following a PCI.
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Affiliation(s)
- Anna L Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Geeske Peeters
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Global Brain Health Institute, University of California, San Francisco | Trinity College Dublin, Trinity College Institute of Neuroscience, Dublin, Ireland
| | - Renata T Morello
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue M Evans
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- NHMRC Centre for Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Bentley, Western Australia, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johannes Stoelwinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Baniak LM, Chasens ER, Luyster FS, Strollo PJ, Thunström E, Peker Y. Obstructive sleep apnea and self-reported functional impairment in revascularized patients with coronary artery disease in the RICCADSA trial. Sleep Breath 2018; 22:1169-1177. [PMID: 30324547 DOI: 10.1007/s11325-018-1733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/11/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Daytime sleepiness, a frequent symptom of obstructive sleep apnea (OSA), can impact functional status. In patients with coronary artery disease (CAD) and concomitant OSA, the distinction between sleep-related functional impairment from underlying CAD versus OSA is unclear. This study evaluated the impact of OSA on sleep-related functional impairment in patients with CAD and compared the effect of 1-year continuous positive airway pressure (CPAP) use on change in impairment between those with and without excessive daytime sleepiness (EDS) and OSA. We hypothesized that sleep-related functional impairment is impacted by EDS independent of OSA in patients with CAD. METHODS One hundred five CAD patients without OSA and 105 with moderate-to-severe OSA from the RICCADSA trial were matched on disease severity and included in the current substudy. Of those with OSA, 80 were allocated to CPAP. Functional Outcomes of Sleep Questionnaire (FOSQ) score < 17.9 corresponded to sleep-related functional impairment. RESULTS Following revascularization, CAD patients with and without OSA frequently report sleep-related functional impairment (35% and 27.3%, respectively; p = .29). Moderate-to-severe OSA was not related to baseline FOSQ scores < 17.9 in regression analyses; EDS was (OR 4.82, 95% CI 2.12-11.0; p < .001). CPAP use significantly improved FOSQ scores from baseline to 1-year follow-up in OSA patients with EDS (17.2 ± 2.0 to 18.15 ± 1.7, p = .002) despite suboptimal adherence. CONCLUSIONS Sleep-related functional impairment may be reflective of persistent EDS, independent of OSA. Diagnosing OSA and initiating treatment are worthwhile in individuals with CAD and EDS, as both are important to guide appropriate therapy in patients with CAD.
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Affiliation(s)
- Lynn M Baniak
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA.
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA
| | - Faith S Luyster
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Erik Thunström
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - Yüksel Peker
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul, Turkey.,Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
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240
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Gallagher AM, Lucas R, Cowie MR. Assessing health-related quality of life in heart failure patients attending an outpatient clinic: a pragmatic approach. ESC Heart Fail 2018; 6:3-9. [PMID: 30311454 PMCID: PMC6352889 DOI: 10.1002/ehf2.12363] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/13/2018] [Accepted: 08/30/2018] [Indexed: 12/28/2022] Open
Abstract
Aims Improving quality of life (QoL) in heart failure patients is a key management objective. Validated health‐related QoL (HR‐QoL) measurement tools have been incorporated into clinical trials but not routinely into daily practice. The aims of this study were to investigate the acceptability and feasibility of implementing validated HR‐QoL instruments into heart failure clinics and to examine the impact of patient characteristics on HR‐QoL. Methods and results One hundred and sixty‐three patients attending heart failure clinics at a UK tertiary centre were invited to complete three HR‐QoL assessments: the Minnesota Living with Heart Failure Questionnaire (MLHFQ); the EuroQoL 5D‐3L (EQ‐5D‐3L); and the Kansas City Cardiomyopathy Questionnaire (KCCQ) in that order. Data on patient demographics, co‐morbidities, New York Heart Association (NYHA) class, plasma B‐type natriuretic peptide (BNP), renal function, and left ventricular ejection fraction were recorded. 94% of patients attending clinic were willing to participate. The EQ‐5D‐3L had all questions answered by 92% of patients, compared with 86% and 51% for the MLHFQ and KCCQ, respectively. HR‐QoL significantly correlated with NYHA class using each tool (MLHFQ, r = 0.59; KCCQ, r = −0.61; EQ‐5D‐3L, r = −0.44, all P < 0.01). However, within each NYHA class, there was a widespread of HR‐QoL scores. There was no association between patient demographics, left ventricular ejection fraction, plasma B‐type natriuretic peptide, or renal function with HR‐QoL using any tool. Conclusions Health‐related QoL assessment by validated questionnaire was acceptable to patients and feasible to perform in routine practice. Although NYHA class correlated significantly with HR‐QoL scores, there was high variability in HR‐QoL within each NYHA class, highlighting its limitation as the sole assessment of HR‐QoL. Clinicians should encourage the assessment of HR‐QoL to facilitate patient‐centred care and make more specific use of HR‐QoL measurement tools.
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Affiliation(s)
| | | | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), London, UK
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241
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Barriers to Healthcare Access and to Improvements in Health-Related Quality of Life After an Acute Coronary Syndrome (From TRACE-CORE). Am J Cardiol 2018; 122:1121-1127. [PMID: 30107903 DOI: 10.1016/j.amjcard.2018.06.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 01/22/2023]
Abstract
Little is known about how barriers to healthcare access affect health-related quality of life (HRQOL) after an acute coronary syndrome (ACS). In a large cohort of ACS survivors from 6 medical centers in Massachusetts and Georgia enrolled from 2011 to 2013, patients were classified as having any financial barriers, no usual source of care (USOC), or transportation barriers to healthcare based on their questionnaire survey responses. The principal study outcomes included clinically meaningful declines in generic physical and mental HRQOL and in disease-specific HRQOL from 1 to 6 months posthospital discharge. Adjusted relative risks (aRRs) for declines in HRQOL were calculated using Poisson regression models, controlling for several sociodemographic and clinical factors of prognostic importance. In 1,053 ACS survivors, 29.0% had a financial barrier, 14.2% had no USOC, and 8.7% had a transportation barrier. Patients with a financial barrier had greater risks of experiencing a decline in generic physical (aRR 1.48, 95% confidence interval [CI] 1.17, 1.86) and mental (aRR 1.36, 95% CI 1.07, 1.75) HRQOL at 6 months. Patients with 2 or more access barriers had greater risks of decline in generic physical (aRR 1.53, 95% CI 1.20, 1.93) and mental (aRR 1.50, 95% CI 1.17, 1.93) HRQOL compared with those without any healthcare barriers. There was a modest association between lacking a USOC and experiencing a decline in disease-specific HRQOL (aRR 1.46, 95% CI 0.96, 2.22). Financial and other barriers to healthcare access may be associated with clinically meaningful declines in HRQOL after hospital discharge for an ACS.
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242
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Dawson AJ, Krastev Y, Parsonage WA, Peek M, Lust K, Sullivan EA. Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis. BMJ Open 2018; 8:e022755. [PMID: 30269070 PMCID: PMC6169742 DOI: 10.1136/bmjopen-2018-022755] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services. METHOD We conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women's experiences extracted from each publication to inform new healthcare practices and communication. RESULTS Eleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences. CONCLUSIONS There is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decision-making must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care.
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Affiliation(s)
- Angela J Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Yordanka Krastev
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - William A Parsonage
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Service Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Peek
- Department of Obstetrics and Gynaecology, Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Obstetrics, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Karin Lust
- Department of Obstetrics and Gynaecology, Women's and Newborn Services, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Osibogun O, Ogunmoroti O, Spatz ES, Burke GL, Michos ED. Is self-rated health associated with ideal cardiovascular health? The Multi-Ethnic Study of Atherosclerosis. Clin Cardiol 2018; 41:1154-1163. [PMID: 29896874 DOI: 10.1002/clc.22995] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Self-rated health (SRH) is an indicator of health status-a determinant of health-promoting behaviors and a predictor of morbidity/mortality. Little is known about the association between SRH and ideal cardiovascular health (CVH), as measured by the AHA Life's Simple 7 (LS7) metrics, or whether the relationship between SRH and CVH differs by race/ethnicity. HYPOTHESIS Favorable SRH is associated with better CVH. METHODS We conducted a cross-sectional analysis of 6457 men and women (4 race/ethnicities) who participated in the Multi-Ethnic Study of Atherosclerosis. SRH was measured on a 5-point Likert scale (excellent, very good, good, fair, and poor). CVH was assessed using the LS7 metrics, each scored from 0 to 2, with a total score of 0 to 14. Scores of 0 to 8 indicate inadequate, 9 to 10, average, and 11 to 14, optimal CVH. ORs and 95% CIs were calculated for associations between SRH and CVH scores using multinomial logistic regression, adjusted for age, sex, race/ethnicity, education, income, marital status, health insurance, and chronic diseases. RESULTS Mean age of participants was 62 ± 10 years; 53% were female. Odds of ideal CVH increased as SRH improved. Compared with poor-fair SRH, adjusted ORs and 95% CIs for optimal CVH by SRH status were excellent, 4.9 (3.4-7.0); very good, 2.2 (1.6-3.1); and good, 1.5 (1.1-2.1). Results were similar by race/ethnicity, sex, and age groups. CONCLUSIONS More favorable SRH was associated with better CVH, irrespective of sex, race/ethnicity, or age. Further research could explore whether optimization of SRH predicts CVH.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Oluseye Ogunmoroti
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin D Michos
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
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Berg SK, Rasmussen TB, Mols RE, Thorup CB, Borregaard B, Christensen AV, Cromhout PF, Ekholm O, Juel K, Thrysoee L. Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators: findings from the national DenHeart study. Eur J Cardiovasc Nurs 2018; 18:96-105. [DOI: 10.1177/1474515118794598] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, 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
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
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Telephone-based mindfulness training to reduce stress in women with myocardial infarction: Rationale and design of a multicenter randomized controlled trial. Am Heart J 2018; 202:61-67. [PMID: 29864732 PMCID: PMC7432959 DOI: 10.1016/j.ahj.2018.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Elevated stress is associated with adverse cardiovascular disease outcomes and accounts in part for the poorer recovery experienced by women compared with men after myocardial infarction (MI). Psychosocial interventions improve outcomes overall but are less effective for women than for men with MI, suggesting the need for different approaches. Mindfulness-based cognitive therapy (MBCT) is an evidence-based intervention that targets key psychosocial vulnerabilities in women including rumination (i.e., repetitive negative thinking) and low social support. This article describes the rationale and design of a multicenter randomized controlled trial to test the effects of telephone-delivered MBCT (MBCT-T) in women with MI. METHODS We plan to randomize 144 women reporting elevated perceived stress at least two months after MI to MBCT-T or enhanced usual care (EUC), which each involve eight weekly telephone sessions. Perceived stress and a set of patient-centered health outcomes and potential mediators will be assessed before and after the 8-week telephone programs and at 6-month follow-up. We will test the hypothesis that MBCT-T will be associated with greater 6-month improvements in perceived stress (primary outcome), disease-specific health status, quality of life, depression and anxiety symptoms, and actigraphy-based sleep quality (secondary outcomes) compared with EUC. Changes in mindfulness, rumination and perceived social support will be evaluated as potential mediators in exploratory analyses. CONCLUSIONS If found to be effective, this innovative, scalable intervention may be a promising secondary prevention strategy for women with MI experiencing elevated perceived stress.
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Cohen MI, Frias PA. Challenges of healthcare administration: optimizing quality and value at an affordable cost in pediatric cardiology. Curr Opin Cardiol 2018; 33:117-120. [PMID: 29049043 DOI: 10.1097/hco.0000000000000478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore the paradigm shift in healthcare delivery that will need to take place over the next few years away from an emphasis on supply-driven health care to better quality transparent-driven health care whose focus is on the consumer's best interest. RECENT FINDINGS The current healthcare system is fragmented and costs continue to rise. The best way to contain costs is to improve quality to the consumer, the patient. Physicians and hospitals need to align in a team-based approach that allows physicians to understand current costs and how to strive toward a focus on healthcare outcomes. Pediatric cardiology is a unique discipline that cares for patients with complex congenital conditions that will span their lifetime and also involves not just cardiology but surgery, intensive care, anesthesia, nursing, and a host of inpatient and ambulatory services. Understanding what matters to the patient and his/her family and presenting quality outcomes in a transparent fashion will gradually allow a shift to take place away from physician visits, tests ordered, and procedures performed. This can only be achieved with physicians, given the appropriate tools to understand costs, value, and outcomes and models where the hospitals and physicians are aligned. SUMMARY The transformation to a value-based healthcare system is beginning and pediatric cardiologists need to be educated, given the appropriate resources, receive appropriate feedback, and patients need to be part of the solution so that care providers can understand what matters most to them.
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Affiliation(s)
- Mitchell I Cohen
- Inova Children's Hospital, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Patricio A Frias
- Sibley Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
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Pedersen SS, Skovbakke SJ, Wiil UK, Schmidt T, dePont Christensen R, Brandt CJ, Sørensen J, Vinther M, Larroudé CE, Melchior TM, Riahi S, Smolderen KGE, Spertus JA, Johansen JB, Nielsen JC. Effectiveness of a comprehensive interactive eHealth intervention on patient-reported and clinical outcomes in patients with an implantable cardioverter defibrillator [ACQUIRE-ICD trial]: study protocol of a national Danish randomised controlled trial. BMC Cardiovasc Disord 2018; 18:136. [PMID: 29969990 PMCID: PMC6029360 DOI: 10.1186/s12872-018-0872-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Denmark and other countries, there has been a shift in the management of patients with an implantable cardioverter defibrillator (ICD) with remote device monitoring largely replacing in-hospital visits. Less patient-nurse and patient-physician interaction may lead to gaps in patients' quality of care and impede patients' adaptation to living successfully with the ICD. A comprehensive eHealth intervention that include goal-setting, monitoring of symptoms of depression, anxiety, and quality of life, psychological treatment, information provision, supportive tools, online dialogues with nursing staff and access to an online community network, may help fill these gaps and be particularly beneficial to patients who suffer from anxiety and depression. This study will evaluate the effectiveness of the ACQUIRE-ICD care innovation, a comprehensive and interactive eHealth intervention, on patient-reported and clinical outcomes. METHODS The ACQUIRE-ICD study is a multicenter, prospective, two-arm, unblinded randomised controlled superiority trial that will enroll 478 patients implanted with a first-time ICD or ICD with cardiac synchronisation therapy (CRT-D) from the six implanting centers in Denmark. The trial will evaluate the clinical effectiveness and cost-effectiveness of the ACQUIRE-ICD care innovation, as add-on to usual care compared with usual care alone. The primary endpoint, device acceptance, assessed with the Florida Patient Acceptance Survey, is evaluated at 12 months' post implant. Secondary endpoints, evaluated at 12 and 24 months' post implant, include patient-reported outcomes, return to work, time to first ICD therapy and first hospitalisation, mortality and cost-effectiveness. DISCUSSION The effectiveness of a comprehensive and interactive eHealth intervention that relies on patient-centred and personalised tools offered via a web-based platform targeted to patients with an ICD has not been assessed so far. The ACQUIRE-ICD care innovation promotes and facilitates that patients become active participants in the management of their disease, and as such addresses the need for a more patient-centered disease-management approach. If the care innovation proves to be beneficial to patients, it may not only increase patient empowerment and quality of life but also free up time for clinicians to care for more patients. TRIAL REGISTRATION The trial has been registered on https://clinicaltrials.gov/ct2/show/NCT02976961 on November 30, 2016 with registration number [ NCT02976961 ].
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Affiliation(s)
- Susanne S. Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient data Explorative Networ, Odense University Hospital, Odense, Denmark
| | - Søren J. Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Uffe K. Wiil
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Thomas Schmidt
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | | | - Jan Sørensen
- Danish Center for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Michael Vinther
- Department of Cardiology B, Rigshospitalet, Copenhagen, Denmark
| | | | - Thomas M. Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kim G. E. Smolderen
- Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO USA
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO USA
| | - Jens B. Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens C. Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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249
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Patel KK, Arnold SV, Chan PS, Tang Y, Jones PG, Guo J, Buchanan DM, Qintar M, Decker C, Morrow DA, Spertus JA. Validation of the Seattle angina questionnaire in women with ischemic heart disease. Am Heart J 2018; 201:117-123. [PMID: 29772387 DOI: 10.1016/j.ahj.2018.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/16/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although the Seattle Angina Questionnaire (SAQ) has been widely used to assess disease-specific health status in patients with ischemic heart disease, it was originally developed in a predominantly male population and its validity in women has been questioned. METHODS Using data from 8892 men and 4013 women across 2 multicenter trials and 5 registries, we assessed the construct validity, test-retest reliability, responsiveness to clinical change, and predictive validity of the SAQ Summary Score (SS) and its 5 subdomains (Physical Limitation (PL), Anginal Stability (AS), Angina Frequency (AF), Treatment Satisfaction (TS), and Quality of Life (QoL)) separately in men and women. RESULTS Comparable correlations of the SAQ SS with Canadian Cardiovascular Society class was demonstrated in both men and women (-0.48 for men, -0.46 for women). Similar correlations between the SAQ PL scale with treadmill exercise duration and Short Form-12 (SF-12) Physical Component Summary were observed in women and men (0.34-0.63 and 0.40-0.63, respectively). SAQ AS scores were significantly lower for both men and women with acute syndromes compared with 1 month later. The SAQ AF scale was strongly correlated with daily angina diaries (0.62 for men and 0.66 for women). The SAQ QoL scores were moderately correlated with the EQ5D visual analog scale and SF-12 general health question in men (0.43-0.50) and women (0.33-0.39). All SAQ scales demonstrated excellent reliability (intraclass correlation ≥0.78) in both men and women with stable CAD and were very sensitive to change after percutaneous coronary intervention (≥15-point difference in scores, standardized response mean ≥ 0.67). The SAQ SS was similarly predictive of 1-year mortality and cardiac re-hospitalizations for both men and women. CONCLUSION The SAQ demonstrates similar psychometric properties in men and women with CAD. These findings provide evidence for validity of the SAQ in assessing women with IHD.
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250
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Jackson JL, Gerardo GM, Daniels CJ, Vannatta K. Perceptions of Disease-Related Stress: A Key to Better Understanding Patient-Reported Outcomes Among Survivors of Congenital Heart Disease. J Cardiovasc Nurs 2018; 32:587-593. [PMID: 27685861 PMCID: PMC5373923 DOI: 10.1097/jcn.0000000000000371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disease-related stressors for survivors of congenital heart disease (CHD) have been qualitatively described but not quantified nor examined in relationship to important patient-reported outcomes (PROs). OBJECTIVE The aims of this study are to (1) identify the types and degree of disease-related stress experienced by CHD survivors based on age, functional status, and sex, (2) examine differences in stress and PROs by age, functional status, and sex, and (3) determine the unique contribution of perceived stress to variability in PROs. METHODS A cross-sectional study of 173 adolescents and emerging and young adults who were recruited from both pediatric and adult CHD clinics was conducted. Participants rated the degree to which they found various aspects of CHD stressful and completed PROs of health-related quality of life and emotional distress. Differences in perceptions of stress across predictors were determined using analyses of variance and χ analyses. The relative contribution of perceived stress predicting PROs was examined using stepwise linear regression. RESULTS Two items emerged as being stressful for almost half of the sample, including concerns about future health and having scars or other signs of medical procedures. Adolescents reported less perceived stress than emerging or young adults, and survivors with even mild functional limitations reported higher perceived stress than did those without any symptoms. Perceptions of stress significantly contributed to variability in PROs above and beyond other predictors and was the only variable to explain unique variance in emotional distress. CONCLUSIONS Having even mild functional impairment may have significant deleterious consequences on PROs via increased perceptions of stress. Stress may be modifiable using cognitive behavioral therapy.
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Affiliation(s)
- Jamie L. Jackson
- Center for Biobehavioral Health, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Gina M. Gerardo
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Curt J. Daniels
- Columbus Ohio Adult Congenital Heart Disease Program, Heart Center, Nationwide Children’s Hospital, Columbus, OH
- Departments of Internal Medicine and Pediatrics, The Ohio State University, Columbus, OH
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
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