1
|
Stocker TJ, Sommer S, Cohen DJ, Spertus JA, Stolz L, Doldi PM, Weckbach LT, Nabauer M, Massberg S, Hausleiter J. Burden of Heart Failure in Patients With Tricuspid Regurgitation and Effect of Transcatheter Repair on Different Subdimensions of Quality of Life. J Am Heart Assoc 2024; 13:e034112. [PMID: 39136306 DOI: 10.1161/jaha.124.034112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/22/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Right-sided heart failure (HF) due to severe tricuspid regurgitation (TR) is associated with reduced quality of life (QoL). Here, we analyzed the impact of TR on specific QoL dimensions and the effect of transcatheter tricuspid valve intervention (TTVI) on individual QoL items. METHODS AND RESULTS In this study, we included 174 patients with HF (49% women; median age, 79 years; 97% New York Heart Association ≥3) with baseline QoL assessment undergoing TTVI by transcatheter edge-to-edge-repair at our center between April 2016 and March 2022. QoL was assessed by the standardized Minnesota Living With HF Questionnaire. QoL change after TTVI and correlation to functional end points were analyzed. In addition, all QoL domains and the 21 individual items of the Minnesota Living With HF Questionnaire were analyzed. TTVI significantly reduced TR (TR ≥3: baseline 95%, 1-year-follow-up 7%; P<0.001). Total Minnesota Living with HF Questionnaire score improved from 37 (interquartile range, 26-50) points to 31 (interquartile range, 17-42) points (median follow-up-interval, 355 days; P<0.001). QoL improvement was associated with positive New York Heart Association class, 6-minute walking distance, and actigraphy changes (all P<0.05). The detailed analysis revealed that all items of the physical-related QoL dimension were impaired at baseline and strongly improved after TTVI. In contrast, the emotional and "social" Minnesota Living With HF Questionnaire dimensions were largely unaffected at baseline, yet specific items improved with TTVI. CONCLUSIONS In this single-center study, we delineate the QoL-associated disease burden of TR and identify specific QoL items that improved after TTVI. Our findings support TTVI in patients with reduced QoL and may add to the development of specific tools assessing the functional status of an increasing patient population undergoing TTVI.
Collapse
Affiliation(s)
- Thomas J Stocker
- Department of Cardiology, Department of Medicine I LMU University Hospital, LMU Munich Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich Germany
| | - Saskia Sommer
- Department of Cardiology, Department of Medicine I LMU University Hospital, LMU Munich Munich Germany
| | - David J Cohen
- Cardiovascular Research Foundation New York NY USA
- St. Francis Hospital and Heart Center Roslyn NY USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City MO USA
| | - Lukas Stolz
- Department of Cardiology, Department of Medicine I LMU University Hospital, LMU Munich Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich Germany
| | - Philipp M Doldi
- Department of Cardiology, Department of Medicine I LMU University Hospital, LMU Munich Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich Germany
| | - Ludwig T Weckbach
- Department of Cardiology, Department of Medicine I LMU University Hospital, LMU Munich Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich Germany
| | - Michael Nabauer
- Department of Cardiology, Department of Medicine I LMU University Hospital, LMU Munich Munich Germany
| | - Steffen Massberg
- Department of Cardiology, Department of Medicine I LMU University Hospital, LMU Munich Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich Germany
| | - Jörg Hausleiter
- Department of Cardiology, Department of Medicine I LMU University Hospital, LMU Munich Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich Germany
| |
Collapse
|
2
|
Gecaite-Stonciene J, Burkauskas J, Bunevicius A, Steibliene V, Macijauskiene J, Brozaitiene J, Mickuviene N, Kazukauskiene N. Validation and Psychometric Properties of the Minnesota Living With Heart Failure Questionnaire in Individuals With Coronary Artery Disease in Lithuania. Front Psychol 2022; 12:771095. [PMID: 35185680 PMCID: PMC8855069 DOI: 10.3389/fpsyg.2021.771095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is known to be impaired in individuals with coronary artery disease (CAD), especially in those after a recent acute coronary syndrome (ACS). Heart failure (HF) is a common burden in this population that significantly contributes to worsening HRQoL. To accurately measure the level of HRQoL in individuals with CAD after ACS, disease-specific scales, such as the Minnesota living with heart failure questionnaire (MLHFQ), are recommended. Nevertheless, to date, there has not been a study that would comprehensively evaluate the psychometric properties of the MLHFQ in a large sample of individuals with CAD after ACS. The debate regarding the internal structure of MLHFQ is also still present. Hence, this study aimed to translate the MLHFQ and evaluate its internal structure, reliability/precision, and validity in individuals with CAD following ACS in Lithuania. METHODS In the cross-sectional study, 1,083 participants (70% men, age M = 58, SD = 9) were evaluated for sociodemographic and clinical characteristics. HRQoL was measured using the MLHFQ and the Short Form-36 health survey (SF-36). In addition, exercise capacity (EC) was also evaluated in the study patients, using a standardized computer-driven bicycle ergometer. RESULTS The internal consistency of the MLHFQ subscales (0.79-0.88) was found to be good. Confirmatory factor analysis (CFA) provided the support for the three-factor model ("physical domain," "social domain," and "emotional domain") of the MLHFQ and showed acceptable fit [comparative fit indices (CFI) = 0.894; goodness-of-fit (GFI) = 0.898; non-normal fit index (NFI) = 0.879, and root mean square error of approximation (RMSEA) = 0.073]. Regarding convergent evidence, significant associations were found between the MLHFQ domains and the SF-36 domains and EC (r's range 0.11-0.58). CONCLUSION The current study completed cultural validation and provided further information on the psychometric characteristics of the MLHFQ in Lithuania, suggesting MLHFQ as a valid and reliable instrument to measure HRQoL. The Lithuanian version of MLHFQ is best described by a three-factor solution, measuring physical, social, and emotional dimensions of HRQoL among individuals with CAD following ACS.
Collapse
Affiliation(s)
- Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Adomas Bunevicius
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Vesta Steibliene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | | | - Julija Brozaitiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Narseta Mickuviene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Nijole Kazukauskiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| |
Collapse
|
3
|
Mwansisya T, Mbekenga C, Isangula K, Mwasha L, Pallangyo E, Edwards G, Orwa J, Mantel M, Mugerwa M, Subi L, Mrema S, Siso D, Selestine E, Temmerman M. Translation and validation of Training Needs Analysis Questionnaire among reproductive, maternal and newborn health workers in Tanzania. BMC Health Serv Res 2021; 21:735. [PMID: 34303368 PMCID: PMC8310585 DOI: 10.1186/s12913-021-06686-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs. Methods A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ). Results In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1. Conclusions The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.
Collapse
Affiliation(s)
- Tumbwene Mwansisya
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Loveluck Mwasha
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Eunice Pallangyo
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Grace Edwards
- School of Nursing and Midwifery, the Aga Khan University, Kampala, Uganda
| | - James Orwa
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
| | - Michaela Mantel
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
| | | | - Leonard Subi
- Community Development, Ministry of Health, Gender, Elderly and Children, Dodoma, Tanzania
| | - Secilia Mrema
- Regional Reproductive and Child Health Coordinator, Mwanza, Tanzania
| | - David Siso
- Aga Khan Foundation, Dar es Salaam, Tanzania
| | | | - Marleen Temmerman
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
| |
Collapse
|
4
|
Lauck SB, Lewis KB, Borregaard B, de Sousa I. "What Is the Right Decision for Me?" Integrating Patient Perspectives Through Shared Decision-Making for Valvular Heart Disease Therapy. Can J Cardiol 2021; 37:1054-1063. [PMID: 33711478 DOI: 10.1016/j.cjca.2021.02.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Innovations in the treatment of valvular heart disease have transformed treatment options for people with valvular heart disease. In this rapidly evolving environment, the integration of patients' perspectives is essential to close the potential gap between what can be done and what patients want. Shared decision-making (SDM) and the measurement of patient-reported outcomes (PROs) are two strategies that are in keeping with this aim and gaining significant momentum in clinical practice, research, and health policy. SDM is a process that involves an individualised, intentional, and bidirectional exchange among patients, family, and health care providers that integrates patients' preferences, values, and priorities to reach a high-quality consensus treatment decision. SDM is widely endorsed by international valvular heart disease guidelines and increasingly integrated in health policy. Patient decision aids are evidence-based tools that facilitate SDM. The measurement of PROs-an umbrella term that refers to the standardised reporting of symptoms, health status, and other domains of health-related quality of life-provides unique data that come directly from patients to inform clinical practice and augment the reporting of quality of care. Sensitive and validated instruments are available to capture generic, dimensional, and disease-specific PROs in patients with valvular heart disease. The integration of PROs in clinical care presents significant opportunities to help guide treatment decision and monitor health status. The integration of patients' perspectives promotes the shift to patient-centred care and optimal outcomes, and contributes to transforming the way we care for patients with valvular heart disease.
Collapse
Affiliation(s)
- Sandra B Lauck
- St Paul's Hospital, Vancouver, British Columbia, Canada; School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Krystina B Lewis
- Faculty of Health Sciences, University of Ottawa, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ismalia de Sousa
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|