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Mulugeta H, Sinclair PM, Wilson A. Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis. Qual Life Res 2024; 33:1175-1189. [PMID: 38070032 DOI: 10.1007/s11136-023-03563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 04/26/2024]
Abstract
PURPOSE Heart failure is a global health concern and associated with poor health-related quality of life and increased mortality. There is a disproportionate burden on patients and health systems in low- and middle-income countries. This systematic review and meta-analysis estimates the health-related quality of life of people with heart failure in low- and middle-income countries. METHODS A systematic literature search was conducted to identify relevant studies from January 2012 to November 2022 using the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Scopus and JBI EBP database. Study screening, quality appraisal and data extraction were conducted using JBI methodology. A random-effects model was used to perform the meta-analysis. Heterogeneity was assessed using the I2 statistic. All statistical analyses were done in STATA version 17. RESULTS A total of 33 studies with 5612 participants were included in this review. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short-Form-36 questionnaire (SF-36) were the most used instruments across 19 and 8 studies, respectively. The pooled mean MLHFQ and SF-36 scores using the random-effects model were 46.08 (95% CI 35.06, 57.10) and 41.23 (95% CI 36.63, 45.83), respectively. In a subgroup analysis using both instruments, the highest health-related quality-of-life scores occurred in studies with inpatient participants. CONCLUSION The overall health-related quality of life of people with heart failure in low- and middle-income countries is poor. Strategies should be strategically developed to improve the health-related quality of life of people with heart failure in these countries. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022377781.
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Affiliation(s)
- Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Amhara Region, Ethiopia.
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.
| | - Peter M Sinclair
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
| | - Amanda Wilson
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
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Searchinger C, Nalubwama H, Pulle J, Mehta R, Tumwbaze H, Kyarimpa R, Mwima R, Atukunda E, Bua B, Sarnacki R, Sherman MG, Oketcho M, Zimmerman M, Nakitto M, Longenecker CT, Webel A, Scheel A, Lwabi PS, Sable CA. Quality of Life in Ugandan Children and Young Adults After Surgery for Congenital Heart Disease: Mixed Methods Approach. Glob Heart 2024; 19:36. [PMID: 38638125 PMCID: PMC11025577 DOI: 10.5334/gh.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
Background Health-related quality of life (HRQOL) is a critical issue for patients undergoing surgery for congenital heart disease (CHD) but has never been assessed in a low-income country. We conducted a cross-sectional mixed methods study with age-matched healthy siblings serving as controls at the Uganda Heart Institute. Methods One-hundred fifteen CHD pediatric and young adult patients and sibling control participants were recruited. Health-related quality of life was assessed using the Pediatric Quality of Life Inventory Version 4.0 in participants ages 5-17 and 36-Item Short Form Survey for young adults aged 18-25. A subset of 27 participants completed face-to-face interviews to supplement quantitative findings. Results Eighty-six pediatric (age 5-17) sibling and parent pairs completed Peds QOL surveys, and 29 young adult (age 18-25) sibling pairs completed SF-36 surveys. One third of patients had surgery in Uganda. Ventricular septal defects and tetralogy of Fallot were the most common diagnoses. Health-related quality of life scores in patients were lower across all domains compared to control participants in children. Reductions in physical and emotional domains of HRQOL were also statistically significant for young adults. Variables associated with lower HRQOL score on multivariate analysis in pediatric patients were younger age in the physical and emotional domains, greater number of surgeries in the physical domain and surgery outside Uganda in the school domain. The only predictor of lower HRQOL score in young adults was surgery outside Uganda in the social domain. Qualitative interviews identified a number of themes that correlated with survey results including abandonment by family, isolation from peers and community, financial hardship and social stigmatization. Conclusion Health-related quality of life was lower in Ugandan patients after CHD surgery than siblings. Younger patients and those who had surgery outside of Uganda had lower HRQOL. These data have important implications for patients undergoing CHD surgery in LMIC and have potential to inform interventions.
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Affiliation(s)
- Chloe Searchinger
- Princeton University, Princeton, NJ, USA
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | - Rittal Mehta
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | | | | | | | - Rachel Sarnacki
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | - Meredith G. Sherman
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | | | - Chris T. Longenecker
- Division of Cardiology and Department of Global Health University of Washington School of Medicine, Seattle WA, USA
| | - Allison Webel
- University of Washington School of Nursing, Seattle WA, USA
| | - Amy Scheel
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Craig A. Sable
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
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Buchanan M, Spence C, Keir M, Khoury M. Physical Activity Promotion Among Individuals With Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:322-334. [PMID: 38161681 PMCID: PMC10755793 DOI: 10.1016/j.cjcpc.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 01/03/2024]
Abstract
In the general population, the most cited barriers to physical activity (PA) are time, energy, and motivation. Consequently, despite the significant contribution of PA to health and well-being, many individuals are insufficiently active. Physical inactivity and sedentary lifestyles increase the risk of acquired cardiometabolic disease, a risk that may complicate and is compounded by the anatomic and physiologic features inherent in the patient with repaired tetralogy of Fallot (ToF). Individuals with ToF commonly present with reduced exercise capacity and PA levels. In light of historically PA restrictive management of their heart disease, known reductions in exercise capacity among individuals with ToF are combined with psychosocial barriers to their participation, potentially establishing a cycle of further detraining, inactivity, and disease progression/health decline. To this end, children and young adults with ToF are known to have reduced self-efficacy towards PA, defined as their confidence in their ability to participate. In this review, we apply self-efficacy as an overarching mediator of PA participation and explore trends and determinants of PA participation among individuals with ToF and its subsequent impact on exercise capacity, disease risk, and health-related quality of life. We outline the rationale and strategies aimed at improving PA in children and adults with ToF and highlight current knowledge gaps and future directions in the promotion of PA in the population with ToF.
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Affiliation(s)
- Mackenzie Buchanan
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Spence
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Keir
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Inam M, Ladak LA, Janjua M, Malik M, Ali F, Akmal Malik M. Health related quality of life in adults after late repair of tetralogy of fallot: experience from a low-middle income country. Qual Life Res 2023; 32:3063-3074. [PMID: 37318695 DOI: 10.1007/s11136-023-03453-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Without neonatal screening in low middle-income countries like Pakistan, Tetralogy of Fallot (TOF) is a congenital heart disease which frequently remains untreated beyond infancy. The purpose of this study is to determine and assess outcomes and health related quality of life (HRQOL) in patients who undergo complete repair of TOF as adults. METHODS 56 patients who underwent complete TOF repair after 16 years of age were included. Patient data was collected via retrospective chart review, and a semi structured interview along with Short-Form 36 (SF-36) questionnaire were used to assess HRQOL. RESULTS 66.1% of patients were male with the mean age at surgery of 22.3 ± 6.00. All patients had a post-operative NYHA Classification of I or II, 94.6% had an ejection fraction of ≥ 50% and 28.6% showed small residual lesions in follow-up echocardiograms. 32.1% of patients suffered post-operative morbidity. For the quantitative assessment using SF-36 scores, patients showed good scores of median 95 (65-100). A major cause of delay to treatment was lack of consensus between treatments offered by doctors in different parts of Pakistan. There was a pattern of 'inability to fit in' among patients who had had late TOF repair, despite self- reported improved HRQOL. CONCLUSION Our results indicate that even with a delayed diagnosis, surgical repair of TOF produces good functional results. However, these patients face significant psychosocial issues. While early diagnosis remains the ultimate goal, patients undergoing late repair should be managed in more holistic manner with attention to psychological impact of the disease as well.
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Affiliation(s)
- Maha Inam
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Laila Akbar Ladak
- School of Nursing and Midwifery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mahin Janjua
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Maarij Malik
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Fatima Ali
- Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Mahim Akmal Malik
- Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.
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O'Byrne ML. Patient-Reported Outcomes in Tetralogy of Fallot: The Potential of the CORRELATE Cohort. J Am Coll Cardiol 2023; 81:1951-1953. [PMID: 37164528 DOI: 10.1016/j.jacc.2023.03.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology and Clinical Futures, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Kovacs AH, Lebovic G, Raptis S, Blais S, Caldarone CA, Dahdah N, Dallaire F, Drolet C, Grewal J, Hancock Friesen CL, Hickey E, Karur GR, Khairy P, Leonardi B, Keir M, McCrindle BW, Nadeem SN, Ng MY, Shah AH, Tham EB, Therrien J, Warren AE, Vonder Muhll IF, Van de Bruaene A, Yamamura K, Farkouh ME, Wald RM. Patient-Reported Outcomes After Tetralogy of Fallot Repair. J Am Coll Cardiol 2023; 81:1937-1950. [PMID: 37164527 DOI: 10.1016/j.jacc.2023.03.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/01/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Comprehensive assessment of tetralogy of Fallot (TOF) outcomes extends beyond morbidity and mortality to incorporate patient-reported outcomes (PROs), including quality of life (QOL) and health status (HS). OBJECTIVES This study explored PROs in adolescents and adults with TOF and delineated variables associated with PROs. METHODS This was a cross-sectional observational study within a larger prospective registry of adolescents and adults with repaired TOF and moderate or greater pulmonary regurgitation from North America, Europe, and Asia. Participants completed PROs, including a QOL linear analogue scale (QOL-LAS) and an HS visual analogue scale (HS-VAS). Scores were classified according to age cohorts: <18, 18 to 25, 26 to 40, and >40 years. RESULTS The study included 607 patients (46.3% female; median age 28.5 years). Median QOL-LAS scores (0-100) were similar across age cohorts (85, 80, 80, 80; P = 0.056). Median HS-VAS scores (0-100) were lowest for the oldest cohort (77) compared with the 3 younger cohorts (85, 80, 80) (P = 0.004). With advancing age, there were increased reports of poor mobility (P < 0.001) and pain or discomfort (P = 0.004); problems in these dimensions were reported by 19.1% and 37.2% of patients aged >40 years, respectively. Of factors associated with superior PROs on multivariable regression modeling (ie, being White, being nonsyndromic, having employment, and having better left ventricular function; P < 0.05), asymptomatic status (functional class I) was the variable associated with the greatest number of QOL and HS measures (P < 0.001). CONCLUSIONS Strategies to improve TOF outcomes should consider PROs alongside conventional clinical variables. Factors associated with poorer PROs represent opportunities to intervene to improve the lives of patients with TOF.
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Affiliation(s)
- Adrienne H Kovacs
- Equilibria Psychological Health, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Stavroula Raptis
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Samuel Blais
- Division of Pediatrics, University of Sherbrooke, Sherbrokke, Quebec, Canada; Research Centre of the Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | | | - Nagib Dahdah
- Division of Pediatric Cardiology, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Frédéric Dallaire
- Division of Pediatrics, University of Sherbrooke, Sherbrokke, Quebec, Canada; Research Centre of the Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | - Christian Drolet
- Division of Pediatric and Congenital Cardiology, Department of Pediatrics, Laval University Hospital, Quebec City, Quebec, Canada
| | - Jasmine Grewal
- Yasmin and Amir Virani Provincial Adult Congenital Heart Program, Vancouver, British Columbia, Canada
| | | | - Edward Hickey
- Division of Cardiovascular Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Gauri Rani Karur
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Paul Khairy
- Adult Congenital Center, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Hospital and Research Institute, Scientific Institute for Research, Hospitalization, and Health Care, Rome, Italy
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Disease Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Syed Najaf Nadeem
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong; Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ashish H Shah
- Division of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edythe B Tham
- Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Judith Therrien
- MAUDE Unit (McGill University Health Network/Beth Raby Adult Congenital Heart Disease Clinic, Jewish General Hospital), Montreal, Quebec, Canada
| | - Andrew E Warren
- Division of Pediatric Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Michael E Farkouh
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rachel M Wald
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada; Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
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Hutchens J, Frawley J, Sullivan EA. Quality of life and mental health of women who had cardiac disease in pregnancy and postpartum. BMC Pregnancy Childbirth 2022; 22:797. [PMID: 36307772 PMCID: PMC9617394 DOI: 10.1186/s12884-022-05123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/25/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Cardiac disease is a leading cause of maternal morbidity and mortality yet there is limited research on women’s experiences and quality of life (QoL) outcomes. The aim of this study is to explore the general and health-related QoL (HRQoL) and mental health outcomes for women who have experienced cardiac disease in pregnancy and the first 12 months postpartum (CDPP). Methods This exploratory descriptive study recruited 43 women with acquired, genetic and congenital CDPP. Patient reported outcomes measures (PROMs) used were: WHOQoL-Bref, a Kansas City Cardiac Questionnaire (KCCQ), the Depression, Anxiety and Stress Scales-21 (DASS-21), the Cardiac Anxiety Questionnaire (CAQ) plus newly developed questions. Results Women reported low health satisfaction (51.7/100), physical health (55.2/100) and low HRQoL (63.1/100). Women had clinically significant scores for depression (24%), anxiety (22%) and stress (19.5%) (DASS-21) and 44.5% scored at least moderate anxiety on the CAQ. Most women (83.7%) were advised to avoid pregnancy which 88.9% found “upsetting” to “devastating”; 10.0% were offered counselling. Most women were concerned about reduced longevity (88.1%), offspring developing a cardiac condition (73.8%), and the limitations on enjoyment of life (57.1%). Women missed medical appointments due to cost (25.03%) and difficulty arranging childcare (45.5%). Conclusion The majority of women reported inadequate information and counselling support, with women with CDPP having sustained impaired QoL and mental health outcomes. The new and modified questions relating to mothering and children reflected the primacy of mothering to women’s identity and needs. Supplementary information The online version contains supplementary material available at 10.1186/s12884-022-05123-x.
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Association of Health Status Metrics with Clinical Outcomes in Patients with Adult Congenital Heart Disease and Atrial Arrhythmias. J Clin Med 2022; 11:jcm11206181. [PMID: 36294501 PMCID: PMC9605619 DOI: 10.3390/jcm11206181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
The prognostic value of health status metrics in patients with adult congenital heart disease (ACHD) and atrial arrhythmias is unclear. In this retrospective cohort study of an ongoing national, multicenter registry (PROTECT-AR, NCT03854149), ACHD patients with atrial arrhythmias on apixaban are included. At baseline, health metrics were assessed using the physical component summary (PCS), the mental component summary (MCS) of the Short-Form-36 (SF-36) Health Survey, and the modified European Heart Rhythm Association (mEHRA) score. Patients were divided into groups according to their SF-36 PCS and MCS scores, using the normalized population mean of 50 on the PCS and MCS as a threshold. The primary outcome was the composite of mortality from any cause, major thromboembolic events, major/clinically relevant non-major bleedings, or hospitalizations. Multivariable Cox-regression analyses using clinically relevant parameters (age greater than 60 years, anatomic complexity, ejection fraction of the systemic ventricle, and CHA₂DS₂-VASc and HAS-BLED scores) were performed to examine the association of health metrics with the composite outcome. Over a median follow-up period of 20 months, the composite outcome occurred in 50 of 158 (32%) patients. The risk of the outcome was significantly higher in patients with SF-36 PCS ≤ 50 compared with those with PCS > 50 (adjusted hazard ratio (aHR), 1.98; 95% confidence interval [CI], 1.02−3.84; p = 0.04) after adjusting for possible confounders. The SF-36 MCS ≤ 50 was not associated with the outcome. The mEHRA score was incrementally associated with a higher risk of the composite outcome (aHR = 1.44 per 1 unit increase in score; 95% CI, 1.03−2.00; p = 0.03) in multivariable analysis. In ACHD patients with atrial arrhythmias, the SF-36 PCS ≤ 50 and mEHRA scores predicted an increased risk of adverse events.
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‘Health-related quality of life in operated adult patients with Tetralogy of Fallot and correlation with advanced imaging indexes and cardiopulmonary exercise test'a narrative review. Curr Probl Cardiol 2022:101184. [DOI: 10.1016/j.cpcardiol.2022.101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022]
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