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Čelutkienė J, Čerlinskaitė-Bajorė K, Cotter G, Edwards C, Adamo M, Arrigo M, Barros M, Biegus J, Chioncel O, Cohen-Solal A, Damasceno A, Diaz R, Filippatos G, Gayat E, Kimmoun A, Léopold V, Metra M, Novosadova M, Pagnesi M, Pang PS, Ponikowski P, Saidu H, Sliwa K, Takagi K, Ter Maaten JM, Tomasoni D, Lam CSP, Voors AA, Mebazaa A, Davison B. Impact of Rapid Up-Titration of Guideline-Directed Medical Therapies on Quality of Life: Insights From the STRONG-HF Trial. Circ Heart Fail 2024; 17:e011221. [PMID: 38445950 DOI: 10.1161/circheartfailure.123.011221] [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: 09/11/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND This analysis provides details on baseline and changes in quality of life (QoL) and its components as measured by EQ-5D-5L questionnaire, as well as association with objective outcomes, applying high-intensity heart failure (HF) care in patients with acute HF. METHODS In STRONG-HF trial (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) patients with acute HF were randomized just before discharge to either usual care or a high-intensity care strategy of guideline-directed medical therapy up-titration. Patients ranked their state of health on the EQ-5D visual analog scale score ranging from 0 (the worst imaginable health) to 100 (the best imaginable health) at baseline and at 90 days follow-up. RESULTS In 1072 patients with acute HF with available assessment of QoL (539/533 patients assigned high-intensity care/usual care) the mean baseline EQ-visual analog scale score was 59.2 (SD, 15.1) with no difference between the treatment groups. Patients with lower baseline EQ-visual analog scale (meaning worse QoL) were more likely to be women, self-reported Black and non-European (P<0.001). The strongest independent predictors of a greater improvement in QoL were younger age (P<0.001), no HF hospitalization in the previous year (P<0.001), lower NYHA class before hospital admission (P<0.001) and high-intensity care treatment (mean difference, 4.2 [95% CI, 2.5-5.8]; P<0.001). No statistically significant heterogeneity in the benefits of high-intensity care was seen across patient subgroups of different ages, with left ventricular ejection fraction above or below 40%, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and systolic blood pressure above or below the median value. The treatment effect on the primary end point did not vary significantly across baseline EQ-visual analog scale (Pinteraction=0.87). CONCLUSIONS Early up-titration of guideline-directed medical therapy significantly improves all dimensions of QoL in patients with HF and improves prognosis regardless of baseline self-assessed health status. The likelihood of achieving optimal doses of HF medications does not depend on baseline QoL. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03412201.
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Affiliation(s)
- Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (J.Č., K.Č-B.)
| | - Kamilė Čerlinskaitė-Bajorė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (J.Č., K.Č-B.)
| | - Gad Cotter
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), France (G.C., A.C.-S., E.G., V.L., A.M., B.D.)
- Heart Initiative, Durham, NC (G.C., B.D.)
- Momentum Research, Inc, Durham, NC. (G.C., C.E., M.B., M.N., K.T., B.D.)
| | | | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M. Adamo, M.M., M.P., D.T.)
| | - Mattia Arrigo
- Department of Internal Medicine, Stadtspital Zurich, Switzerland (M. Arrigo)
| | - Marianela Barros
- Momentum Research, Inc, Durham, NC. (G.C., C.E., M.B., M.N., K.T., B.D.)
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Poland (J.B., P.P.)
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases "Prof. C.C.Iliescu," University of Medicine "Carol Davila," Bucharest, Romania (O.C.)
| | - Alain Cohen-Solal
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (J.Č., K.Č-B.)
- Department of Cardiology, APHP Nord, Lariboisière University Hospital, Paris, France (A.C.-S.)
| | | | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Argentina (R.D.)
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.)
| | - Etienne Gayat
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (J.Č., K.Č-B.)
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP Nord, Paris, France (E.G., V.L., A.M.)
| | - Antoine Kimmoun
- Université de Lorraine, Nancy; INSERM, Défaillance Circulatoire Aigue et Chronique; Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, France (A.K.)
| | - Valentine Léopold
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (J.Č., K.Č-B.)
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP Nord, Paris, France (E.G., V.L., A.M.)
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M. Adamo, M.M., M.P., D.T.)
| | - Maria Novosadova
- Momentum Research, Inc, Durham, NC. (G.C., C.E., M.B., M.N., K.T., B.D.)
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M. Adamo, M.M., M.P., D.T.)
| | - Peter S Pang
- Departments of Emergency Medicine and Medicine, Indiana University School of Medicine, Indianapolis (P.S.P.)
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Poland (J.B., P.P.)
| | - Hadiza Saidu
- Murtala Muhammed Specialist Hospital/Bayero University Kano, Nigeria (H.S.)
| | - Karen Sliwa
- Cape Heart Institute, Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (K.S.)
| | - Koji Takagi
- Momentum Research, Inc, Durham, NC. (G.C., C.E., M.B., M.N., K.T., B.D.)
| | - Jozine M Ter Maaten
- Department of Cardiology, Medical Centre Groningen, the Netherlands (J.M.T.M., A.A.V.)
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M. Adamo, M.M., M.P., D.T.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.)
- Baim Institute for Clinical Research, Boston, MA (C.S.P.L.)
- University Medical Centre Groningen, the Netherlands (C.S.P.L.)
| | - Adriaan A Voors
- Department of Cardiology, Medical Centre Groningen, the Netherlands (J.M.T.M., A.A.V.)
| | - Alexandre Mebazaa
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (J.Č., K.Č-B.)
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP Nord, Paris, France (E.G., V.L., A.M.)
| | - Beth Davison
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (J.Č., K.Č-B.)
- Heart Initiative, Durham, NC (G.C., B.D.)
- Momentum Research, Inc, Durham, NC. (G.C., C.E., M.B., M.N., K.T., B.D.)
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Ze R, Li L, Qi B, Chen D, Liu Y, Bai L, Xu J, Wang Q. The effects of palliative care on patients with different classes heart function: A pilot study. Geriatr Nurs 2023; 54:129-134. [PMID: 37782975 DOI: 10.1016/j.gerinurse.2023.09.015] [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] [Received: 06/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Abstract
The aim of this study was to explore effects of palliative care (PC) on patients with different heart function. Patients with NYHA (New York Heart Association) class II, III, IV were divided into separate groups. The KCCQ (Kansas City Cardiomyopathy Questionnaire) and HADS (Hospital Anxiety and Depression Scale) scores were compared before and 3 months after PC intervention. After 3 months, compared with the control group, PC could further significantly improve the KCCQ, HADS-depression and -anxiety scores of patients in NYHA class IV (P < 0.05); PC could significantly improve the HADS-depression and -anxiety scores of patients with NYHA class III (P < 0.05), and had an improvement tendency on KCCQ score. The study revealed that PC can significantly improve anxiety and depression of patients with NYHA class III or IV, and significantly improve the quality of life of patients with NYHA class IV, but had no effects on patients with NYHA class II.
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Affiliation(s)
- Renhao Ze
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; MDT Team of Geriatric Palliative Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Ling Li
- MDT Team of Geriatric Palliative Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Benling Qi
- MDT Team of Geriatric Palliative Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Dongping Chen
- MDT Team of Geriatric Palliative Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei 430022, China
| | - Yihui Liu
- MDT Team of Geriatric Palliative Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Lijuan Bai
- MDT Team of Geriatric Palliative Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Jiaqiang Xu
- MDT Team of Geriatric Palliative Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Qin Wang
- MDT Team of Geriatric Palliative Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei 430022, China.
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Kerrigan DJ, Reddy M, Walker EM, Cook B, McCord J, Loutfi R, Saval MA, Baxter J, Brawner CA, Keteyian SJ. Cardiac Rehabilitation Improves Fitness in Patients With Subclinical Markers of Cardiotoxicity While Receiving Chemotherapy: A RANDOMIZED CONTROLLED STUDY. J Cardiopulm Rehabil Prev 2023; 43:129-134. [PMID: 35940850 DOI: 10.1097/hcr.0000000000000719] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Heart failure (HF) due to cardiotoxicity is a leading non-cancer-related cause of morbidity and mortality in cancer survivors. Cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and reduces morbidity and mortality in patients with HF, but little is known about its effects on cardiotoxicity in the cancer population. The objective of this study was to determine whether participation in CR improves CRF in patients undergoing treatment with either doxorubicin or trastuzumab who exhibit markers of subclinical cardiotoxicity. METHODS Female patients with cancer (n = 28: breast, n = 1: leiomyosarcoma) and evidence of subclinical cardiotoxicity (ie, >10% relative decrease in global longitudinal strain or a cardiac troponin of >40 ng·L -1 ) were randomized to 10 wk of CR or usual care. Exercise consisted of 3 d/wk of interval training at 60-90% of heart rate reserve. RESULTS Cardiorespiratory fitness, as measured by peak oxygen uptake (V˙ o2peak ), improved in the CR group (16.9 + 5.0 to 18.5 + 6.0 mL∙kg -1 ∙min -1 ) while it decreased in the usual care group (17.9 + 3.9 to 16.9 + 4.0 mL∙kg -1 ∙min -1 ) ( P = .009). No changes were observed between groups with respect to high-sensitivity troponin or global longitudinal strain. CONCLUSION This study suggests that the use of CR may be a viable option to attenuate the reduction in CRF that occurs in patients undergoing cardiotoxic chemotherapy. The long-term effects of exercise on chemotherapy-induced HF warrant further investigation.
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Affiliation(s)
- Dennis J Kerrigan
- Division of Cardiovascular Medicine (Drs Kerrigan, Reddy, McCord, Brawner, and Keteyian, Mr Saval, and Ms Baxter) and Department of Pathology (Dr Cook), Henry Ford Hospital, Detroit, Michigan; and Departments of Radiation Oncology (Dr Walker) and Medical Oncology (Dr Loutfi), Henry Ford Cancer Institute at Henry Ford Health System, Detroit, Michigan
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Lawson CA, Lam C, Jaarsma T, Kadam U, Stromberg A, Ali M, Tay WT, Clayton L, Khunti K, Squire I. Developing a core outcome set for patient-reported symptom monitoring to reduce hospital admissions for patients with heart failure. Eur J Cardiovasc Nurs 2022; 21:830-839. [PMID: 35404418 DOI: 10.1093/eurjcn/zvac019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/29/2022]
Abstract
AIMS In patients with heart failure (HF), hospitalization rates are increasing, particularly for non-HF causes and over half may be avoidable. Self-monitoring of symptoms plays a key part in the early identification of deterioration. Our objective was to develop expert consensus for a core outcome set (COS) of symptoms to be monitored by patients, using validated single-item patient-reported outcome measures (PROMs), focused on the key priority of reducing admissions in HF. METHODS AND RESULTS A rigorous COS development process incorporating systematic review, modified e-Delphi and nominal group technique (NGT) methods. Participants included 24 HF patients, 4 carers, 29 HF nurses, and 9 doctors. In three Delphi and NGT rounds, participants rated potential outcomes on their importance before a HF or a non-HF admission using a 5-point Likert scale. Opinion change between rounds was assessed and a two-thirds threshold was used for outcome selection.Item generation using systematic review identified 100 validated single-item PROMs covering 34 symptoms or signs, relevant to admission for people with HF. De-duplication and formal consensus processes, resulted in a COS comprising eight symptoms and signs; shortness of breath, arm or leg swelling, abdomen bloating, palpitations, weight gain, chest pain, anxiety, and overall health. In the NGT, a numerical rating scale was selected as the optimal approach to symptom monitoring. CONCLUSION Recognition of a range of HF-specific and general symptoms, alongside comorbidities, is an important consideration for admission prevention. Further work is needed to validate and integrate the COS in routine care with the aim of facilitating faster identification of clinical deterioration.
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Affiliation(s)
- Claire A Lawson
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, Leicestershire LE5 4PW, UK
| | - Carolyn Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,University Medical Centre Groningen, Groningen, The Netherlands.,The George Institute for Global Health, Newton, NSW, Australia
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Umesh Kadam
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna Stromberg
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Mohammad Ali
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, Leicestershire LE5 4PW, UK
| | | | - Louise Clayton
- Department of Cardiology, University Hospitals of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, Leicestershire LE5 4PW, UK
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Cakmak AS, Perez Alday EA, Densen S, Najarro G, Rout P, Rozell CJ, Inan OT, Shah AJ, Clifford GD. Passively Captured Interpersonal Social Interactions and Motion From Smartphones for Predicting Decompensation in Heart Failure: Observational Cohort Study. JMIR Form Res 2022; 6:e36972. [PMID: 36001367 PMCID: PMC9453583 DOI: 10.2196/36972] [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: 02/01/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022] Open
Abstract
Background Heart failure (HF) is a major cause of frequent hospitalization and death. Early detection of HF symptoms using smartphone-based monitoring may reduce adverse events in a low-cost, scalable way. Objective We examined the relationship of HF decompensation events with smartphone-based features derived from passively and actively acquired data. Methods This was a prospective cohort study in which we monitored HF participants’ social and movement activities using a smartphone app and followed them for clinical events via phone and chart review and classified the encounters as compensated or decompensated by reviewing the provider notes in detail. We extracted motion, location, and social interaction passive features and self-reported quality of life weekly (active) with the short Kansas City Cardiomyopathy Questionnaire (KCCQ-12) survey. We developed and validated an algorithm for classifying decompensated versus compensated clinical encounters (hospitalizations or clinic visits). We evaluated models based on single modality as well as early and late fusion approaches combining patient-reported outcomes and passive smartphone data. We used Shapley additive explanation values to quantify the contribution and impact of each feature to the model. Results We evaluated 28 participants with a mean age of 67 years (SD 8), among whom 11% (3/28) were female and 46% (13/28) were Black. We identified 62 compensated and 48 decompensated clinical events from 24 and 22 participants, respectively. The highest area under the precision-recall curve (AUCPr) for classifying decompensation was with a late fusion approach combining KCCQ-12, motion, and social contact features using leave-one-subject-out cross-validation for a 2-day prediction window. It had an AUCPr of 0.80, with an area under the receiver operator curve (AUC) of 0.83, a positive predictive value (PPV) of 0.73, a sensitivity of 0.77, and a specificity of 0.88 for a 2-day prediction window. Similarly, the 4-day window model had an AUC of 0.82, an AUCPr of 0.69, a PPV of 0.62, a sensitivity of 0.68, and a specificity of 0.87. Passive social data provided some of the most informative features, with fewer calls of longer duration associating with a higher probability of future HF decompensation. Conclusions Smartphone-based data that includes both passive monitoring and actively collected surveys may provide important behavioral and functional health information on HF status in advance of clinical visits. This proof-of-concept study, although small, offers important insight into the social and behavioral determinants of health and the feasibility of using smartphone-based monitoring in this population. Our strong results are comparable to those of more active and expensive monitoring approaches, and underscore the need for larger studies to understand the clinical significance of this monitoring method.
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Affiliation(s)
- Ayse S Cakmak
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Erick A Perez Alday
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
| | - Samuel Densen
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Gabriel Najarro
- Emory Healthcare, Emory University, Atlanta, GA, United States
| | - Pratik Rout
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Christopher J Rozell
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Omer T Inan
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Atlanta Veterans Affairs Health Care System, Atlanta, GA, United States
| | - Gari D Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
- The Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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Hussey AJ, McKelvie RS, Ferrone M, To T, Fisk M, Singh D, Faulds C, Licskai C. Primary care-based integrated disease management for heart failure: a study protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e058608. [PMID: 35551078 PMCID: PMC9109105 DOI: 10.1136/bmjopen-2021-058608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is a common chronic disease that increases in prevalence with age. It is associated with high hospitalisation rates, poor quality of life and high mortality. Management is complex with most interactions occurring in primary care. Disease management programmes implemented during or after an HF hospitalisation have been shown to reduce hospitalisation and mortality rates. Evidence for integrated disease management (IDM) serving the primary care HF population has been investigated but is less conclusive. The aim of this study is to evaluate the efficacy of IDM, focused on, optimising medication, self-management and structured follow-up, in a high-risk primary care HF population. METHODS AND ANALYSIS 100 family physician clusters will be recruited in this Canadian primary care multicentre cluster randomised controlled trial. Physicians will be randomised to IDM or to care as usual. The IDM programme under evaluation will include case management, medication management, education, and skills training delivered collaboratively by the family physician and a trained HF educator. The primary outcome will measure the combined rate (events/patient-years) of all-cause hospitalisations, emergency department visits and mortality over a 12-month follow-up. Secondary outcomes include other health service utilisation, quality of life, knowledge assessments and acute HF episodes. Two to three HF patients will be recruited per physician cluster to give a total sample size of 280. The study has 90% power to detect a 35% reduction in the primary outcome. The difference in primary outcome between IDM and usual care will be modelled using a negative binomial regression model adjusted for baseline, clustering and for individuals experiencing multiple events. ETHICS AND DISSEMINATION The study has obtained approval from the Research Ethics Board at the University of Western Ontario, London, Canada (ID 114089). Findings will be disseminated through local reports, presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04066907.
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Affiliation(s)
- Anna J Hussey
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Robert S McKelvie
- Department of Medicine, Western University, London, Ontario, Canada
- St Joseph's Health Care, London, Ontario, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Teresa To
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Fisk
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | | | - Cathy Faulds
- St Joseph's Health Care, London, Ontario, Canada
- Family Medicine, Western University, London, Ontario, Canada
| | - Christopher Licskai
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
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Masterson Creber RM, Daniels B, Munjal K, Reading Turchioe M, Shafran Topaz L, Goytia C, Díaz I, Goyal P, Weiner M, Yu J, Khullar D, Slotwiner D, Ramasubbu K, Kaushal R. Using Mobile Integrated Health and telehealth to support transitions of care among patients with heart failure (MIGHTy-Heart): protocol for a pragmatic randomised controlled trial. BMJ Open 2022; 12:e054956. [PMID: 35273051 PMCID: PMC8915277 DOI: 10.1136/bmjopen-2021-054956] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/16/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Nearly one-quarter of patients discharged from the hospital with heart failure (HF) are readmitted within 30 days, placing a significant burden on patients, families and health systems. The objective of the 'Using Mobile Integrated Health and Telehealth to support transitions of care among patients with Heart failure' (MIGHTy-Heart) study is to compare the effectiveness of two postdischarge interventions on healthcare utilisation, patient-reported outcomes and healthcare quality among patients with HF. METHODS AND ANALYSIS The MIGHTy-Heart study is a pragmatic comparative effectiveness trial comparing two interventions demonstrated to improve the hospital to home transition for patients with HF: mobile integrated health (MIH) and transitions of care coordinators (TOCC). The MIH intervention bundles home visits from a community paramedic (CP) with telehealth video visits by emergency medicine physicians to support the management of acute symptoms and postdischarge care coordination. The TOCC intervention consists of follow-up phone calls from a registered nurse within 48-72 hours of discharge to assess a patient's clinical status, identify unmet clinical and social needs and reinforce patient education (eg, medication adherence and lifestyle changes). MIGHTy-Heart is enrolling and randomising (1:1) 2100 patients with HF who are discharged to home following a hospitalisation in two New York City (NY, USA) academic health systems. The coprimary study outcomes are all-cause 30-day hospital readmissions and quality of life measured with the Kansas City Cardiomyopathy Questionnaire 30 days after hospital discharge. The secondary endpoints are days at home, preventable emergency department visits, unplanned hospital admissions and patient-reported symptoms. Data sources for the study outcomes include patient surveys, electronic health records and claims submitted to Medicare and Medicaid. ETHICS AND DISSEMINATION All participants provide written or verbal informed consent prior to randomisation in English, Spanish, French, Mandarin or Russian. Study findings are being disseminated to scientific audiences through peer-reviewed publications and presentations at national and international conferences. This study has been approved by: Biomedical Research Alliance of New York (BRANY #20-08-329-380), Weill Cornell Medicine Institutional Review Board (20-08022605) and Mt. Sinai Institutional Review Board (20-01901). TRIAL REGISTRATION NUMBER Clinicaltrials.gov, NCT04662541.
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Affiliation(s)
| | - Brock Daniels
- Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Kevin Munjal
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Leah Shafran Topaz
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Crispin Goytia
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iván Díaz
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Parag Goyal
- Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mark Weiner
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jiani Yu
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Dhruv Khullar
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - David Slotwiner
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Kumudha Ramasubbu
- Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Rainu Kaushal
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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8
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Zia A, Stanek J, Christian‐Rancy M, Savelli S, O'Brien SH. Iron deficiency and fatigue among adolescents with bleeding disorders. Am J Hematol 2022; 97:60-67. [PMID: 34710246 DOI: 10.1002/ajh.26389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 01/01/2023]
Abstract
Iron deficiency anemia is associated with heavy menstrual bleeding (HMB) and, by extension, a bleeding disorder (BD). It is unknown if iron deficiency without anemia is associated with a BD in adolescents. Moreover, the threshold of ferritin associated with fatigue in adolescents with HMB is unclear. In this multicenter study, we enrolled adolescents with HMB without BD. Participants underwent BD and anemia work-up in Young Women's Hematology Clinics and completed the Peds QL™ fatigue scale. BDs were defined as von Willebrand Disease, platelet function defect, clotting factor deficiencies, and hypermobility syndrome. Two hundred and fifty consecutive adolescents were enrolled, of whom 196 met eligibility criteria. Overall, 43% (95% confidence interval: 36%-50%) were diagnosed with BD. A total of 61% (n = 119) had serum ferritin levels < 15 ng/mL, 23.5% (n = 46) had iron deficiency only, and 37% (n = 73) had iron deficiency anemia. Low ferritin or ferritin dichotomized as < 15 or ≥ 15 ng/mL was not associated with BD on univariable analysis (p = .24) or when accounting for age, race, ethnicity, body mass index, and hemoglobin (p = .35). A total of 85% had total fatigue score below the population mean of 80.5, and 52% (n = 102) were > 2 SD (or < 54) below the mean, the cut-off associated with severe fatigue. A ferritin threshold of < 6 ng/mL had a specificity of 79.8% but a sensitivity of 36% for severe fatigue. In conclusion, iron deficiency without anemia is not a predictor of BD in adolescents with HMB in a specialty setting. Severe fatigue, especially sleep fatigue, is prevalent in adolescents with BD. Ferritin of < 6 ng/mL has ~80% specificity for severe fatigue in adolescents with HMB.
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Affiliation(s)
- Ayesha Zia
- Division of Pediatric Hematology/Oncology University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
| | - Myra Christian‐Rancy
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
| | - Stephanie Savelli
- Department of Pediatrics, Akron Children's Hospital, The Ohio State University Columbus Ohio USA
- Northeastern Ohio Universities College of Medicine Columbus Ohio USA
| | - Sarah H. O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
- Department of Pediatrics The Ohio State University, College of Medicine Columbus Ohio USA
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9
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Brown T, Chen S, Ou Z, McDonald N, Bennett-Murphy L, Schneider L, Giles L, Molina K, Cox D, Hoskoppal A, Glotzbach K, Stehlik J, May L. Feasibility of Assessing Adolescent and Young Adult Heart Transplant Recipient Mental Health and Resilience Using Patient-Reported Outcome Measures. J Acad Consult Liaison Psychiatry 2022; 63:153-162. [PMID: 34438097 PMCID: PMC8866525 DOI: 10.1016/j.jaclp.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/05/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although adolescents and young adults may be particularly prone to mental health symptoms after heart transplant, screening practices are variable. OBJECTIVE To assess the feasibility of using patient-reported outcome (PRO) measures to assess mental health, functional status, and resiliency in posttransplant adolescents and young adult patients. METHODS Patients transplanted between ages 15 and 25 years at 3 centers completed 6 PRO instruments via web-based platforms: PROMIS instruments for anxiety, depression, satisfaction with social roles, and physical functioning; the Posttraumatic Stress Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, version 5; and the Connor-Davidson Resilience Scale-10. Feasibility (completion, time to completion, and measure missingness) and PRO results were described and compared between patients with congenital heart disease and cardiomyopathy. RESULTS Nineteen patients (median age at transplant 17.7 y [interquartile range 16.3, 19.2 y], 84% male) were enrolled at an average of 3 ± 1.8 years after transplant. Enrollment was 90% among eligible patients. Measure missingness was zero. The average completion time was 12 ± 15 minutes for all instruments. Timely PRO completion was facilitated by in-clinic application. The PRO results indicated that 9 patients (47%) had at least mild posttraumatic stress disorder symptoms (≥11 points on Posttraumatic Stress Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, version 5). Among them, 4 patients had scores >28 suggestive of probable posttraumatic stress disorder. Two (11%) and 6 (32%) patients had anxious and depressive symptoms, respectively. The cardiomyopathy cohort had a higher median Posttraumatic Stress Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, version 5 score than that of the congenital heart disease subgroup (11.0 vs 6.0; P = 0.015). Twelve (63%) had resiliency scores that were lower than the population average. No significant differences were found in PRO results between patients with cardiomyopathy and congenital heart disease apart from the posttraumatic stress disorder assessment. CONCLUSIONS This novel PRO-based approach to psychiatric screening of adolescents and young adult patients after transplant appears feasible for assessing mental health, functional status, and resiliency, with excellent enrollment and completion rates. These instruments characterized the burden of mental health symptoms within this adolescents and young adult heart transplant cohort, with a high prevalence of posttraumatic stress disorder symptoms. Resiliency scores were lower than in a comparison population. Electronically-administered PRO administration could facilitate more consistent mental health screening in this at-risk group.
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Affiliation(s)
- Tyler Brown
- Department of Pediatrics, University of Utah, Salt Lake City, UT.
| | | | - Zhining Ou
- Division of Epidemiology, Internal Medicine, University of Utah, Salt Lake City, UT
| | | | | | | | - Lisa Giles
- Pediatrics, University of Utah, Salt Lake City, UT
| | - Kimberly Molina
- Pediatric Cardiology, University of Utah, Salt Lake City, UT
| | - Daniel Cox
- Pediatric Cardiology, University of Utah, Salt Lake City, UT
| | | | | | - Josef Stehlik
- Cardiovascular Medicine, University of Utah, Salt Lake City, UT
| | - Lindsay May
- Pediatric Cardiology, University of Utah, Salt Lake City, UT
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10
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Hendricks-Sturrup RM, Block R, Lu CY. Integrating Patient-Reported Outcomes Into Clinical Genetic Testing for Familial Hypercholesterolemia. J Patient Cent Res Rev 2021; 8:336-339. [PMID: 34722802 DOI: 10.17294/2330-0698.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patient-reported outcomes (PROs) and PRO measures (PROMs) are often used to help clinicians and researchers understand patients' personal concerns, feelings, experiences, and perspectives following the implementation of an intervention. Notably, PROs and PROMs can inform health systems, health policy, and payers on the utility of clinical genetic testing based on each patient's personal values, perspectives, and potential health behaviors subsequent to testing. In this topic synopsis, we discuss the underexplored role of and implications for PROs and PROMs following genetic testing for familial hypercholesterolemia (FH), an autosomal dominant genetic disorder of cholesterol metabolism that can lead to highly premature fatal and nonfatal myocardial infarction and stroke. We also discuss why the use and consideration of patient perspectives, via PROs and PROMs, are critical to the process of optimizing patient care across various FH treatment contexts. As expert clinician groups consider the latest evidence when establishing recommendations for FH genetic testing, there is a ripe opportunity for clinicians and researchers to explore the value and utility of PROs to inform and possibly improve care for patients diagnosed with FH.
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Affiliation(s)
- Rachele M Hendricks-Sturrup
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA
| | - Robert Block
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.,Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Christine Y Lu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA
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11
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Blood Lactate AUC Is a Sensitive Test for Evaluating the Effect of Exercise Training on Functional Work Capacity in Patients with Chronic Heart Failure. Rehabil Res Pract 2021; 2021:6619747. [PMID: 34631167 PMCID: PMC8497121 DOI: 10.1155/2021/6619747] [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: 12/13/2020] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Exercise training is an essential treatment option for patients with chronic heart failure (CHF). However, it remains controversial, which surrogate measures of functional work capacity are most reliable. The purpose of this paper was to compare functional capacity work measured as capillary lactate concentrations area under the curve (AUC) with standard cardiopulmonary exercise testing (CPET) with VO2peak and the 6-minute walk test (6 MWT). Methods Twenty-three patients in New York Heart Association (NYHA) class II/III with left ventricular ejection fraction (LVEF) <35% were randomised to home-based recommendation of regular exercise (RRE) (controls), moderate continuous training (MCT) or aerobic interval training (AIT). The MCT and AIT groups underwent 12 weeks of supervised exercise training. Exercise testing was performed as standard CPET treadmill test with analysis of VO2peak, the 6 MWT and a novel 30-minute submaximal treadmill test with capillary lactate AUC. Results All patients had statistically significant improvements in VO2peak, 6 MWT and lactate AUC after 12 weeks of exercise training: 6 MWT (p =0.035), VO2peak (p =0.049) and lactate AUC (p =0.002). Lactate AUC (p =0.046) and 6MWT (p =0.035), but not VO2peak revealed difference between the exercise modalities regarding functional work capacity. Conclusion 6-MWT and lactate AUC, but not VO2peak, were able to reveal a statistically significant improvement in functional capacity between different exercise modalities.
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12
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Stubblefield WB, Jenkins CA, Liu D, Storrow AB, Spertus JA, Pang PS, Levy PD, Butler J, Chang AM, Char D, Diercks DB, Fermann GJ, Han JH, Hiestand BC, Hogan CJ, Khan Y, Lee S, Lindenfeld JM, McNaughton CD, Miller K, Peacock WF, Schrock JW, Self WH, Singer AJ, Sterling SA, Collins SP. Improvement in Kansas City Cardiomyopathy Questionnaire Scores After a Self-Care Intervention in Patients With Acute Heart Failure Discharged From the Emergency Department. Circ Cardiovasc Qual Outcomes 2021; 14:e007956. [PMID: 34555929 PMCID: PMC8628372 DOI: 10.1161/circoutcomes.121.007956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We conducted a secondary analysis of changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 over 30 days in a randomized trial of self-care coaching versus structured usual care in patients with acute heart failure who were discharged from the emergency department. METHODS Patients in 15 emergency departments completed the KCCQ-12 at emergency department discharge and at 30 days. We compared change in KCCQ-12 scores between the intervention and usual care arms, adjusted for enrollment KCCQ-12 and demographic characteristics. We used linear regression to describe changes in KCCQ-12 summary scores and logistic regression to characterize clinically meaningful KCCQ-12 subdomain changes at 30 days. RESULTS There were 350 patients with both enrollment and 30-day KCCQ summary scores available; 166 allocated to usual care and 184 to the intervention arm. Median age was 64 years (interquartile range, 55-70), 37% were female participants, 63% were Black, median KCCQ-12 summary score at enrollment was 47 (interquartile range, 33-64). Self-care coaching resulted in significantly greater improvement in health status compared with structured usual care (5.4-point greater improvement, 95% CI, 1.12-9.68; P=0.01). Improvements in health status in the intervention arm were driven by improvements within the symptom frequency (adjusted odds ratio, 1.62 [95% CI, 1.01-2.59]) and quality of life (adjusted odds ratio, 2.39 [95% CI, 1.46-3.90]) subdomains. CONCLUSIONS In this secondary analysis, patients with acute heart failure who received a tailored, self-care intervention after emergency department discharge had clinically significant improvements in health status at 30 days compared with structured usual care largely due to improvements within the symptom frequency and quality of life subdomains of the KCCQ-12. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02519283.
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Affiliation(s)
- William B Stubblefield
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Cathy A Jenkins
- Department of Biostatistics (C.A.J., D.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Dandan Liu
- Department of Biostatistics (C.A.J., D.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Alan B Storrow
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - John A Spertus
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City and Saint Luke's Mid America Heart Institute, MO (J.A.S.)
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.S.P.)
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI (P.D.L.)
| | - Javed Butler
- Department of Medicine (J.B.), University of Mississippi Medical Center, Jackson
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital (A.M.C.)
| | - Douglas Char
- Division of Emergency Medicine, Department of Internal Medicine, Washington University, Seattle (D.C.)
| | - Deborah B Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX (D.B.D.)
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.)
| | - Jin H Han
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Brian C Hiestand
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (B.C.H.)
| | - Christopher J Hogan
- Division of Trauma/Critical Care, Departments of Emergency Medicine and Surgery, Virginia Commonwealth University Medical Center, Richmond (C.J.H.)
| | - Yosef Khan
- Health Informatics and Analytics, Centers for Health Metrics and Evaluation, American Heart Association (Y.K.)
| | - Sangil Lee
- Department of Emergency Medicine, University of Iowa Carver College of Medicine (S.L.)
| | - JoAnn M Lindenfeld
- Division of Cardiovascular Disease (J.M.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Candace D McNaughton
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Karen Miller
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.)
| | - Jon W Schrock
- Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (J.W.S.)
| | - Wesley H Self
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, NY (A.J.S.)
| | - Sarah A Sterling
- Department of Emergency Medicine (S.A.S.), University of Mississippi Medical Center, Jackson
| | - Sean P Collins
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
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13
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Rationale and design of the EPCHF trial: the early palliative care in heart failure trial (EPCHF). Clin Res Cardiol 2021; 111:359-367. [PMID: 34241674 PMCID: PMC8266990 DOI: 10.1007/s00392-021-01903-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
The progressive nature of heart failure (HF) coupled with high mortality and poor quality-of-life (QoL) mandates greater attention to palliative care (PC) as a routine component of HF management. Limited evidence exists from randomized controlled trials supporting the use of interdisciplinary palliative care in the progressive course of HF. The early palliative care in heart failure trial (EPCHF) is a prospective, controlled, nonblinded, multicenter study of an interdisciplinary palliative care intervention in 200 patients with symptomatic HF characterized by NYHA ≥ 2. The 12-month EPCHF intervention includes monthly consultations by a palliative care team focusing on physical and psychosocial symptom relief, attention to spiritual concerns and advance care planning. The primary endpoint is evaluated by health-related QoL questionnaires after 12 months of treatment. First the functional assessment of chronic illness therapy palliative care (FACIT-Pal) score evaluating QoL living with a chronic disease and second the Kansas City cardiomyopathy questionnaire (KCCQ) measuring QoL living with heart failure will be determined. Secondary endpoints are changes in anxiety/depression (HADS), symptom burden score (MIDOS), spiritual well-being functional assessment of chronic illness therapy spiritual well-being scale (FACIT-Sp), medical resource and cost assessment. EPCHF will help evaluate the efficacy and cost-effectiveness of palliative care in symptomatic HF using a patient-centered outcome as well as clinical and economic endpoints. EPCHF is funded by the Bundesministerium für Bildung und Forschung (BMBF, 01GY17).
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14
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Michelis KC, Grodin JL, Zhong L, Pandey A, Toto K, Ayers CR, Thibodeau JT, Drazner MH. Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing. J Am Heart Assoc 2021; 10:e019864. [PMID: 34180246 PMCID: PMC8403334 DOI: 10.1161/jaha.120.019864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Patient‐reported outcomes may be discordant to severity of illness as assessed by objective parameters. The frequency of this discordance and its influence on clinical outcomes in patients with heart failure is unknown. Methods and Results In HF‐ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), participants (N=2062) had baseline assessment of health‐related quality of life via the Kansas City Cardiomyopathy Clinical Summary score (KCCQ‐CS) and objective severity by cardiopulmonary stress testing (minute ventilation [VE]/carbon dioxide production [VCO2] slope). We defined 4 groups by median values: 2 concordant (lower severity: high KCCQ‐CS and low VE/VCO2 slope; higher severity: low KCCQ‐CS and high VE/VCO2 slope) and 2 discordant (symptom minimizer: high KCCQ‐CS and high VE/VCO2 slope; symptom magnifier: low KCCQ‐CS and low VE/VCO2 slope). The association of group assignment with mortality was assessed in adjusted Cox models. Symptom magnification (23%) and symptom minimization (23%) were common. Despite comparable KCCQ‐CS scores, the risk of all‐cause mortality in symptom minimizers versus concordant–lower severity participants was increased significantly (hazard ratio [HR], 1.79; 95% CI, 1.27–2.50; P<0.001). Furthermore, despite symptom magnifiers having a KCCQ‐CS score 28 points lower (poorer QOL) than symptom minimizers, their risk of mortality was not increased (HR, 0.79; 95% CI, 0.57–1.1; P=0.18, respectively). Conclusions Severity of illness by patient report versus cardiopulmonary exercise testing was frequently discordant. Mortality tracked more closely with the objective data, highlighting the importance of relying not only on patient report, but also objective data when risk stratifying patients with heart failure.
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Affiliation(s)
- Katherine C Michelis
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Justin L Grodin
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Lin Zhong
- Division of Bioinformatics Department of Clinical Sciences University of Texas Southwestern Medical Center Dallas TX
| | - Ambarish Pandey
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Kathleen Toto
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Colby R Ayers
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Jennifer T Thibodeau
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Mark H Drazner
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
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15
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Shah SJ, Cowie MR, Wachter R, Szecsödy P, Shi V, Ibram G, Hu M, Zhao Z, Gong J, Pieske B. Baseline characteristics of patients in the PARALLAX trial: insights into quality of life and exercise capacity in heart failure with preserved ejection fraction. Eur J Heart Fail 2021; 23:1541-1551. [PMID: 34170062 DOI: 10.1002/ejhf.2277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/06/2022] Open
Abstract
AIMS We sought to describe the baseline characteristics of PARALLAX [a randomized controlled trial of sacubitril/valsartan vs. individualized medical therapy in heart failure (HF) with mildly reduced and preserved ejection fraction (HFpEF)]; compare PARALLAX to recent HFpEF trials; and examine the clinical characteristics associated with quality of life (QOL) and 6-min walk test distance (6MWD). METHODS AND RESULTS A total of 2566 patients with HF and left ventricular ejection fraction (LVEF) >40% were randomized, of whom 96% had an LVEF ≥45%. Multivariable linear regression was used to determine characteristics associated with Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS) and 6MWD. Mean age was 73 ± 8 years, 51% were female, and comorbidities were common. Of the QOL measures tested in PARALLAX, the Short Form Health Survey-36 physical functioning score was most closely correlated with 6MWD (R = 0.41, P < 0.001), and outperformed the KCCQ physical limitation score (R = 0.33) and KCCQ-CSS (R = 0.31) on multivariable analyses. Female sex, higher body mass index, history of coronary artery disease, lower LVEF, and higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) were associated with worse (lower) KCCQ-CSS; older age, female sex, higher body mass index, diabetes, coronary artery disease, chronic obstructive pulmonary disease, prior HF hospitalization, lower LVEF, and higher NT-proBNP were associated with shorter 6MWD (P < 0.05 for all associations). CONCLUSIONS PARALLAX is the largest HFpEF study to date to examine 6MWD together with QOL. The KCCQ-CSS and 6MWD were modestly correlated, and several factors were associated with worse values of both. These results provide insight into the association between QOL and exercise capacity in HFpEF.
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Affiliation(s)
- Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Martin R Cowie
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany.,Clinic for Cardiology and Pneumology, University Medicine Göttingen and DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | | | | | | | - Mo Hu
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
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16
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Jain SS, Cohen DJ, Zhang Z, Uriel N, Sayer G, Lindenfeld J, Abraham WT, Mack MJ, Stone GW, Arnold SV. Defining a Clinically Important Change in 6-Minute Walk Distance in Patients With Heart Failure and Mitral Valve Disease. Circ Heart Fail 2021; 14:e007564. [PMID: 33663234 DOI: 10.1161/circheartfailure.120.007564] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sneha S Jain
- Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center (S.S.J., N.U., G.S.)
| | | | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.Z., G.W.S.)
| | - Nir Uriel
- Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center (S.S.J., N.U., G.S.)
| | - Gabriel Sayer
- Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center (S.S.J., N.U., G.S.)
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus (W.T.A.)
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.Z., G.W.S.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S.)
| | - Suzanne V Arnold
- University of Missouri-Kansas City (D.J.C., S.V.A.).,Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A.)
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17
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Impact of Tafamidis on Health-Related Quality of Life in Patients With Transthyretin Amyloid Cardiomyopathy (from the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial). Am J Cardiol 2021; 141:98-105. [PMID: 33220323 DOI: 10.1016/j.amjcard.2020.10.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial, tafamidis significantly reduced all-cause mortality and cardiovascular-related hospitalizations in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). ATTR-CM is associated with a significant burden of disease; further analysis of patient-reported quality of life will provide additional data on the efficacy of tafamidis. In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial, 441 adult patients with ATTR-CM were randomized (2:1:2) to tafamidis 80 mg, tafamidis 20 mg, or placebo for 30 months, with pooled tafamidis (80 mg and 20 mg) compared with placebo. Change in Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) domain scores, EQ-5D-3L scores, and patient global assessment, were prespecified exploratory end points. A greater proportion of patients improved KCCQ-OS score at month 30 with tafamidis (41.8%) versus placebo (21.4%). Tafamidis significantly reduced the decline in all 4 KCCQ-OS domains (p <0.0001 for all), and in EQ-5D-3L utility (0.09 [confidence interval 0.05 to 0.12]; p <0.0001) and EQ visual analog scale (9.11 [confidence interval 5.39 to 12.83]; p <0.0001) scores at month 30 versus placebo. A larger proportion of tafamidis-treated patients reported their patient global assessment improved at month 30 (42.3% vs 23.8% with placebo). In conclusion, tafamidis effectively reduced the decline in patient-reported outcomes, providing further insight into its efficacy in health-related quality of life in patients with ATTR-CM.
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18
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Blacher M, Zimerman A, Engster PHB, Grespan E, Polanczyk CA, Rover MM, Neto JADF, Danzmann LC, Bertoldi EG, Simões MV, Beck-da-Silva L, Biolo A, Rohde LE. Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II. Heart 2020; 107:1487-1492. [PMID: 33361353 DOI: 10.1136/heartjnl-2020-317984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE New York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial. METHODS The ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient's self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0-100). RESULTS Of 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4-30) for class I vs 27.5 (11-49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248-1333) vs 778 (421-1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330-466) vs 351 m (286-408), p=0.028; overlap=64%). Among NYHA class I patients, 19%-34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%-10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14). CONCLUSIONS Most patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.
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Affiliation(s)
- Mariana Blacher
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - André Zimerman
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro H B Engster
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo Grespan
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carisi A Polanczyk
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Luiz C Danzmann
- Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil
| | | | | | - Luis Beck-da-Silva
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Andréia Biolo
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luis E Rohde
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil .,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Piña IL, Camacho A, Ibrahim NE, Felker GM, Butler J, Maisel AS, Prescott MF, Williamson KM, Claggett BL, Desai AS, Solomon SD, Januzzi JL. Improvement of Health Status Following Initiation of Sacubitril/Valsartan in Heart Failure and Reduced Ejection Fraction. JACC-HEART FAILURE 2020; 9:42-51. [PMID: 33189630 DOI: 10.1016/j.jchf.2020.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/01/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treatment of heart failure with reduced ejection fraction (EF) may improve patient-reported health outcomes. OBJECTIVES The purpose of this study was to determine timing and magnitude of change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 scores following initiation of sacubitril/valsartan and interaction with change in amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations. METHODS From a single-arm, open-label study of patients initiated on sacubitril/valsartan, KCCQ-23 scores and NT-proBNP were obtained at baseline and follow-up through 12 months. Cross-sectional and longitudinal analyses evaluated magnitude and rate of change in KCCQ-23 scores and associations with NT-proBNP. Patient-level data from the randomized EVALUATE-HF study were used as historic controls. RESULTS The analysis cohort (n = 678, age 64.7 years, 71.5% men, EF 28.9%) had a baseline KCCQ-23 overall score (OS) of 65.6. Following sacubitril/valsartan initiation, the majority (n = 412; 60.8%) of participants experienced a rise in KCCQ-23 OS ≥10 points; 26.0% increased by ≥20 points. Comparable improvement in KCCQ-23 scores was seen in various subgroups. Change in KCCQ-23 OS was inversely associated with change in circulating NT-proBNP concentrations. Among a control group of patients in EVALUATE-HF, linear rate of change in KCCQ-12 OS/14-day interval in the enalapril arm was 0.37 points (p = 0.06), whereas in the sacubitril/valsartan arm, scores increased at a rate of 1.19 points (p < 0.001), nearly identical to this dataset (1.08 points; p < 0.001). CONCLUSIONS Treatment of heart failure with reduced EF with sacubitril/valsartan is associated with rapid and significant improvement in KCCQ-23 scores which was significantly related to change in NT-proBNP. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes [PROVE-HF]; NCT02887183).
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Affiliation(s)
| | - Alexander Camacho
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nasrien E Ibrahim
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - G Michael Felker
- Cardiology Division, Duke University, Durham, North Carolina, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Alan S Maisel
- Cardiology Division, University of California San Diego, San Diego, California, USA
| | | | | | | | - Akshay S Desai
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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Butler J, Khan MS, Mori C, Filippatos GS, Ponikowski P, Comin-Colet J, Roubert B, Spertus JA, Anker SD. Minimal clinically important difference in quality of life scores for patients with heart failure and reduced ejection fraction. Eur J Heart Fail 2020; 22:999-1005. [PMID: 32239794 DOI: 10.1002/ejhf.1810] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/25/2020] [Accepted: 06/07/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS While the associations of health-related quality of life scores in heart failure (HF) [e.g. the Kansas City Cardiomyopathy Questionnaire (KCCQ)] with clinical outcomes are well established, their interpretation in the context of what magnitudes of change are clinically important to patients is less clear. The main objective of this study was to correlate the changes in the KCCQ and Patient Global Assessment (PGA) in patients with HF with reduced ejection fraction (HFrEF) to determine minimal clinically important difference (MCID). METHODS AND RESULTS We analysed data from 459 patients of the FAIR-HF trial. Both KCCQ and PGA were assessed at 4 and 24 weeks after enrolment. An anchor-based approach was used to calculate MCID at week 4 and 24. PGA was chosen as the clinical anchor against which changes in the KCCQ scores were calibrated. For each category of change in PGA, the corresponding differences were calculated by the mean scores of various domains of KCCQ along with 95% confidence intervals (CIs). There was fair correlation between PGA and changes in overall summary scores (OSS) (r = 0.31; P < 0.001), clinical summary scores (CSS) (r = 0.36; P < 0.001) and physical limitation scores (PLS) (r = 0.31; P < 0.001) from baseline to week 4. KCCQ OSS, CSS and PLS MCID for 'little improvement' at week 4 were 3.6 (1.0-6.2), 4.5 (1.8-7.2) and 4.7 (1.4-8.0) points, respectively. OSS, CSS and PLS MCID for 'little improvement' at week 24 were 4.3 (0.2-8.4), 4.5 (0.5-8.5) and 4.0 (-0.9-9.0) points, respectively. CONCLUSION The MCID threshold for KCCQ score was generally consistent and numerically lower than the threshold of 5-point change considered for clinical outcome prognosis and were stable between 4 and 24 weeks. This suggests that even changes smaller than the traditional 5-point improvements in KCCQ may be clinically meaningful. Also, these results can aid in the clinical interpretation of patient-reported outcomes, and better endpoint selection in future studies.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MO, USA
| | | | | | - Gerasimos S Filippatos
- Medical School, University of Cyprus, Nicosia, Cyprus.,National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | | | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital and IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | | | - John A Spertus
- Department of Cardiology, University of Missouri-Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany
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21
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Colin-Ramirez E, Ezekowitz JA. Rationale and design of the Study of Dietary Intervention Under 100 MMOL in Heart Failure (SODIUM-HF). Am Heart J 2018; 205:87-96. [PMID: 30205241 DOI: 10.1016/j.ahj.2018.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with heart failure (HF) remain at high risk for future events despite medical and device therapy. Dietary sodium reduction is often recommended based on limited evidence. However, it is not known whether dietary sodium reduction reduces the morbidity or mortality associated with HF. METHODS The SODIUM study is a pragmatic, randomized, open-label trial assessing the efficacy of dietary sodium reduction to <1500 mg daily counseling compared to usual care for patients with chronic HF. The intervention is provided by trained personnel at the site and uses 3-day food records for directing counseling. The primary outcome is an intention-to-treat analysis on the time to first cardiovascular event or death measured at 12 months. Secondary end points include the change in quality of life (using the Kansas City Cardiomyopathy Questionnaire), change in New York Heart Association class, and change in 6-minute walk test. The first patient was enrolled in March 2014, and subsequently, 27 sites in 6 countries enrolled patients. CONCLUSIONS The SODIUM-HF trial will provide a robust evaluation of the effects of dietary sodium reduction in patients with HF. Results are expected in 2020.
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Affiliation(s)
- Eloisa Colin-Ramirez
- National Council of Science and Technology (CONACYT), and National Institute of Cardiology 'Ignacio Chavez', Mexico City, Mexico; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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22
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Abstract
OBJECTIVES Health-related quality of life (HR-QoL) of patients with heart failure (HF) is low despite the aim of HF treatment to improve HR-QoL. To date, most studies have focused on medical and physical factors in relation to HR-QoL, few data are available on the role of emotional factors such as dispositional optimism. This study examines the prevalence of optimism and pessimism in HF patients and investigates how optimism and pessimism are associated with different patient characteristics and HR-QoL. METHODS Dispositional optimism was assessed in 86 HF patients (mean age 70 ± 9 years, 28% female, mean left ventricular ejection fraction 33%) with the Revised Life Orientation Test (LOT-R). HR-QoL was assessed with the Minnesota Living with Heart Failure Questionnaire and the EuroQol. RESULTS The (mean ± SD) total score on the LOT-R was 14.6 ± 2.9 (theoretical range 0-24) and the scores on the subscales optimism and pessimism were 8.1 ± 1.9 and 5.5 ± 2.5, respectively. Higher age was related to more optimism (r = 0.22, p < 0.05), and optimism was associated with higher generic HR-QoL (B = 0.04, p < 0.05).Significance of resultsThe association found between optimism and generic HR-QoL of HF patients can lead to promising strategies to improve HF patients' HR-QoL, particularly because the literature has indicated that optimism is a modifiable condition.
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23
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Collins SP, Thorn M, Nowak RM, Levy PD, Fermann GJ, Hiestand BC, Cowart TD, Venuti RP, Hiatt WR, Foo S, Pang PS. Feasibility of Serial 6-min Walk Tests in Patients with Acute Heart Failure. J Clin Med 2017; 6:jcm6090084. [PMID: 28891981 PMCID: PMC5615277 DOI: 10.3390/jcm6090084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 12/28/2022] Open
Abstract
Background: Functional status assessment is common in many cardiovascular diseases but it has undergone limited study in the setting of acute heart failure (AHF). Accordingly, we performed a pilot study of the feasibility of the six-minute walk test (6MWT) at the emergency department (ED) presentation and through the hospitalization in patients with AHF. Methods and Results: From November 2014 to February 2015, we conducted a multicenter, observational study of ED patients, aged 18–85 years, whose primary ED admission diagnosis was AHF. Other criteria for enrollment included a left ventricular ejection fraction ≤40%, systolic blood pressure between 90 and 170 mmHg, and verbal confirmation that the patient was able to walk >30 m at the baseline, prior to ED presentation. Study teams were uniformly trained to administer a 6MWT. Patients underwent a baseline 6MWT within 24 h of ED presentation (Day 1) and follow-up 6MWTs at 24 (Day 2), 48 (Day 3), and 120 h (Day 5). A total of 46 patients (65.2% male, 73.9% African American) had a day one mean walk distance of 137.3 ± 78 m, day 2 of 170.9 ± 100 m, and day 3 of 180.8 ± 98 m. The 6MWT demonstrated good reproducibility, as the distance walked on the first 6MWT on Day 3 was similar to the distance on the repeated 6MWT the same day. Conclusions: Our pilot study demonstrates the feasibility of the 6MWT as a functional status endpoint in AHF patients. A larger study in a more demographically diverse cohort of patients is necessary to confirm its utility and association with 30-day heart failure (HF) events.
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Affiliation(s)
- Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center and Tennessee Valley Healthcare System, Nashville, TN 37232, USA.
| | - Michael Thorn
- Statistical Resources, Inc., Chapel Hill, NC 27514, USA.
| | - Richard M Nowak
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI 48126, USA.
| | - Phillip D Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI 48201, USA.
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267, USA.
| | | | | | - Robert P Venuti
- Previously of Cardioxyl Pharmaceuticals, Chapel Hill, NC 27514, USA.
| | - William R Hiatt
- Division of Cardiology, University of Colorado School of Medicine and CPC Clinical Research, Aurora, CO 80045, USA.
| | - ShiYin Foo
- Orchard Biomedical Consulting LLC, Brookline, MA 02446, USA.
| | - Peter S Pang
- Department of Emergency Medicine & Indianapolis EMS, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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24
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Lewis EF, Claggett BL, McMurray JJV, Packer M, Lefkowitz MP, Rouleau JL, Liu J, Shi VC, Zile MR, Desai AS, Solomon SD, Swedberg K. Health-Related Quality of Life Outcomes in PARADIGM-HF. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003430. [DOI: 10.1161/circheartfailure.116.003430] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/17/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Eldrin F. Lewis
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Brian L. Claggett
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - John J. V. McMurray
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Milton Packer
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Martin P. Lefkowitz
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Jean L. Rouleau
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Jiankang Liu
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Victor C. Shi
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Michael R. Zile
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Akshay S. Desai
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Scott D. Solomon
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Karl Swedberg
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
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Suresh R, Wang W, Koh KWL, Shorey S, Lopez V. Self-Efficacy and Health-Related Quality of Life Among Heart Failure Patients in Singapore: A Descriptive Correlational Study. J Transcult Nurs 2017; 29:326-334. [DOI: 10.1177/1043659617723437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Heart failure (HF) accounts for 30% of all global deaths and Asians are likely to suffer from HF 10 years earlier than their Western counterparts. Low self-efficacy and poor health-related quality of life (HRQoL) have been reported in patients with HF. Methodology: A descriptive correlational design was adopted to investigate the associations between self-efficacy and HRQoL in 91 patients with HF in Singapore. Results: Patients with HF demonstrated moderately good self-efficacy ( M = 3.05, SD = 0.61) and HRQoL ( M = 22.48, SD = 18.99). Significant differences were found between total self-efficacy scores and education levels ( p = .05), and between overall HRQoL and smoking status ( p < .05). Self-efficacy was not significantly correlated to HRQoL. Smoking status, HF classification, and self-efficacy in maintaining function predicted HRQoL. Discussion: Health care professionals should assess each patient’s demographics, smoking status, and clinical condition before delivering individualized education to enhance their self-efficacy and, in turn, overall HRQoL.
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Affiliation(s)
| | - Wenru Wang
- National University of Singapore, Singapore
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26
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Rogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M, Adams PA, Speck A, Johnson KS, Krishnamoorthy A, Yang H, Anstrom KJ, Dodson GC, Taylor DH, Kirchner JL, Mark DB, O'Connor CM, Tulsky JA. Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial. J Am Coll Cardiol 2017; 70:331-341. [PMID: 28705314 PMCID: PMC5664956 DOI: 10.1016/j.jacc.2017.05.030] [Citation(s) in RCA: 371] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/23/2017] [Accepted: 05/12/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life. OBJECTIVES The authors investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes. METHODS The authors randomized 150 patients with advanced HF between August 15, 2012, and June 25, 2015, to usual care (UC) (n = 75) or UC plus a palliative care intervention (UC + PAL) (n = 75) at a single center. Primary endpoints were 2 quality-of-life measurements, the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal), assessed at 6 months. Secondary endpoints included assessments of depression and anxiety (measured via the Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (measured via the FACIT-Spiritual Well-Being scale [FACIT-Sp]), hospitalizations, and mortality. RESULTS Patients randomized to UC + PAL versus UC alone had clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months (KCCQ difference = 9.49 points, 95% confidence interval [CI]: 0.94 to 18.05, p = 0.030; FACIT-Pal difference = 11.77 points, 95% CI: 0.84 to 22.71, p = 0.035). Depression improved in UC + PAL patients (HADS-depression difference = -1.94 points; p = 0.020) versus UC-alone patients, with similar findings for anxiety (HADS-anxiety difference = -1.83 points; p = 0.048). Spiritual well-being was improved in UC + PAL versus UC-alone patients (FACIT-Sp difference = 3.98 points; p = 0.027). Randomization to UC + PAL did not affect rehospitalization or mortality. CONCLUSIONS An interdisciplinary palliative care intervention in advanced HF patients showed consistently greater benefits in quality of life, anxiety, depression, and spiritual well-being compared with UC alone. (Palliative Care in Heart Failure [PAL-HF]; NCT01589601).
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Affiliation(s)
- Joseph G Rogers
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Chetan B Patel
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Robert J Mentz
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Bradi B Granger
- Duke School of Nursing, Duke University, Durham, North Carolina
| | - Karen E Steinhauser
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Center for Health Services Research and Development in Primary Care, Durham VA Medical Center, Durham, North Carolina
| | - Mona Fiuzat
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Patricia A Adams
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Adam Speck
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | | | - Hongqiu Yang
- Duke Clinical Research Institute, Durham, North Carolina
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Gwen C Dodson
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Donald H Taylor
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Sanford School of Public Policy, Duke University, Durham, North Carolina; Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | | | - Daniel B Mark
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Christopher M O'Connor
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Inova Heart & Vascular Institute, Falls Church, Virginia
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Stehlik J, Estep JD, Selzman CH, Rogers JG, Spertus JA, Shah KB, Chuang J, Farrar DJ, Starling RC. Patient-Reported Health-Related Quality of Life Is a Predictor of Outcomes in Ambulatory Heart Failure Patients Treated With Left Ventricular Assist Device Compared With Medical Management. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003910. [DOI: 10.1161/circheartfailure.116.003910] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 11/16/2022]
Abstract
Background—
The prospective observational ROADMAP study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management) demonstrated that ambulatory advanced heart failure patients selected for left ventricular assist device (LVAD) were more likely to be alive at 1 year on original therapy with ≥75-m improvement in 6-minute walk distance compared with patients assigned to optimal medical management. Whether baseline health-related quality of life (hrQoL) resulted in a heterogeneity of this treatment benefit is unknown.
Methods and Results—
Patient-reported hrQoL was assessed with EuroQol questionnaire and visual analogue scale (VAS). We aimed to identify predictors of event-free survival and survival with acceptable hrQoL (VAS≥60). LVAD patients had significant improvement in 3 of 5 EuroQol dimensions (
P
<0.05), but no significant changes were observed with optimal medical management. Among patients with baseline VAS<55, survival on original treatment was lower for optimal medical management patients compared with those assigned to LVAD (58±7% versus 82±5%;
P
=0.004). No such difference was seen if baseline VAS was ≥55 (70±7% versus 75±9%;
P
=0.79). Survival on original therapy with acceptable quality of life was also more likely with LVAD versus optimal medical management if baseline VAS was <55, whereas outcomes in patients with higher baseline VAS scores were similar regardless of treatment assignment (
P
=0.046 for treatment arm and baseline VAS interaction).
Conclusions—
LVAD therapy resulted in improvement of patient health status in heart failure patients with low self-reported hrQoL, but not in patients with acceptable quality of life at the time of LVAD implantation. Patient-reported hrQoL should be integrated into decision making concerning the use and timing of LVAD therapy in heart failure patients who are symptom limited but remain ambulatory.
Clinical Trial Registration—
URL:
http://www.ClinicalTrials.gov
. Unique identifier: NCT01452802.
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Affiliation(s)
- Josef Stehlik
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Jerry D. Estep
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Craig H. Selzman
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Joseph G. Rogers
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - John A. Spertus
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Keyur B. Shah
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Joyce Chuang
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - David J. Farrar
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Randall C. Starling
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
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Schwartzman S, Li Y, Zhou H, Palmer JB. Economic impact of biologic utilization patterns in patients with psoriatic arthritis. Clin Rheumatol 2017; 36:1579-1588. [PMID: 28474139 PMCID: PMC5486473 DOI: 10.1007/s10067-017-3636-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/16/2022]
Abstract
The aim of the study is to examine the frequency and costs associated with above-label dosing of biologics in patients with psoriatic arthritis (PsA). MarketScan identified adults with ≥1 International Classification of Diseases, Clinical Modification diagnosis for PsA and ≥1 pharmacy claim for biologics of interest between January 1, 2011 and December 31, 2013. The first biologic claim was the index date with a 1-year follow-up period and three additional months to confirm continuous biologic use. Exclusion criteria included switching to a different biologic or diagnosis with another autoimmune disease. During the follow-up period, duration was stratified into three groups: <30, 30–179, and ≥180 days of above-label dosing (>10% of the labeled dose). One-tailed t test was conducted to examine the impact of above-label duration on healthcare costs. We identified 4245 PsA patients receiving etanercept (n = 2342), adalimumab (n = 1788), and golimumab (n = 115). Above-label dosing of <30 days (85% adalimumab, 90.4% etanercept, and 95.7% golimumab) and ≥180 days (9.6% adalimumab, 4.1% etanercept, and 2.6% golimumab) was observed. All-cause total healthcare costs for <30 days of above-label use (etanercept $30,625, adalimumab $31,620, and golimumab $37,224), 30–179 days (etanercept $35,602, adalimumab $38,915, and golimumab $64,349), and ≥180 days (etanercept $55,349, adalimumab $54,176, and golimumab $47,993) were reported. Longer above-label duration (30–179 versus <30 days, ≥180 versus 30–179 and ≥180 days) with etanercept or adalimumab was significantly associated with higher mean increased total all-cause healthcare, PsA-specific healthcare, and biologic costs (p < 0.05). Above-label use of anti-TNF biologics does occur and is associated with significantly increased healthcare costs.
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Affiliation(s)
- Sergio Schwartzman
- The Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
| | - Yunfeng Li
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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29
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Hawwa N, Vest AR, Kumar R, Lahoud R, Young JB, Wu Y, Gorodeski EZ, Cho L. Comparison Between the Kansas City Cardiomyopathy Questionnaire and New York Heart Association in Assessing Functional Capacity and Clinical Outcomes. J Card Fail 2017; 23:280-285. [DOI: 10.1016/j.cardfail.2016.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
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30
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Flint KM, Spertus JA, Tang F, Jones P, Fendler TJ, Allen LA. Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation. BMC Cardiovasc Disord 2017; 17:78. [PMID: 28288574 PMCID: PMC5348898 DOI: 10.1186/s12872-017-0510-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied. METHODS We included 3,836 continuous-flow LVAD patients in the INTERMACS registry. Health status was measured pre-operatively and 3 months post-LVAD using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol visual analog scale (VAS). Primary outcomes were mortality/rehospitalization. Inverse propensity weighting was used to minimize bias from missing data. RESULTS Pre-operative global and heart failure-specific health status were very poor: KCCQ median 34.6 (IQR 21.4-50.5); VAS median 43 (interquartile range (IQR) 25-65). Health status measures improved 3 months after LVAD placement: KCCQ median 69.3 (IQR 54.2-82.3); VAS median 75 (IQR 60-85). Pre-operative health status was not associated with death (unadjusted HR for lowest vs. highest score quartiles: 1.09 (0.85-1.41) KCCQ; 1.12 (0.85-1.49) VAS) or rehospitalization (unadjusted HR 0.83 (0.72-0.96) KCCQ; 0.99 (0.85-1.16) VAS). Three-month KCCQ was associated with mortality (unadjusted HR 2.17 (1.47-3.21); VAS was not (1.43 (0.94-2.17). Three-month KCCQ added incremental discriminatory value to the HeartMate II Risk Score for death (c-stat 0.60 to 0.66); VAS did not (c-stat 0.59 to 0.60). Three-month health status was associated with rehospitalization (unadjusted HR 1.31 (1.15-1.57) KCCQ; 1.24 (1.05-1.46) VAS), but did not add incremental discriminatory value (c-stat 0.52 to 0.55 and 0.54, respectively). CONCLUSIONS These real-world data suggest that pre-operative health status has limited association with outcomes after LVAD. However, persistently low health status after surgery may independently signal higher risk for subsequent death. Further study is needed to determine the clinical utility of routinely collected health status data after LVAD implantation.
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Affiliation(s)
- Kelsey M. Flint
- Division of Cardiology, University of Colorado Denver School of Medicine, Aurora, Colorado; Center for Cardiovascular Outcomes Research, 12631 East 17th Ave,, B130, Aurora, CO 80045 Denver, USA
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute and University of Missouri - Kansas City, Kansas City, MO USA
| | - Fengming Tang
- Saint Luke’s Mid America Heart Institute and University of Missouri - Kansas City, Kansas City, MO USA
| | - Philip Jones
- Saint Luke’s Mid America Heart Institute and University of Missouri - Kansas City, Kansas City, MO USA
| | - Timothy J. Fendler
- Saint Luke’s Mid America Heart Institute and University of Missouri - Kansas City, Kansas City, MO USA
| | - Larry A. Allen
- Division of Cardiology, Section of Advanced Heart Failure and Transplantation, University of Colorado Denver School of Medicine, Aurora, Colorado; Center for Cardiovascular Outcomes Research, Denver, CO USA
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31
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Odom D, McLeod L, Sherif B, Nelson L, McSorley D. Longitudinal Modeling Approaches to Assess the Association Between Changes in 2 Clinical Outcome Assessments. Ther Innov Regul Sci 2017; 52:306-312. [PMID: 29714541 DOI: 10.1177/2168479017731584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding how one clinical outcome assessment (COA) (eg, a patient-reported outcome [PRO]) relates to a second COA (eg, a clinician-reported outcome [ClinRO]) may provide insights into disease burden or treatment efficacy. We aimed to briefly review commonly used cross-sectional methods to evaluate the association between a PRO and a ClinRO and to demonstrate the advantages of longitudinal modeling approaches, particularly a joint mixed model for repeated measures (MMRM), to evaluate this association. METHODS We generated an example longitudinal data set that included a PRO measured on an 11-point numeric rating scale and a binary ClinRO. The association between change in PRO score and ClinRO response at each time point was examined using 2 cross-sectional analyses: point biserial correlation and logistic regression. We conducted longitudinal analyses of the association between the 2 COAs across time points using MMRM and joint MMRM approaches. RESULTS Point-biserial correlation and logistic regression analyses correctly captured the "built in" associations between the 2 COAs that strengthened over time, but each association was applicable only for a single time point. The MMRM approach provided correlations over time but only for a single outcome variable. The joint MMRM approach modeled the relationship between both outcome variables simultaneously, allowing for evaluation of the correlations both within and between the variables over time. CONCLUSION Each analysis demonstrated the relationship between PRO score changes and ClinRO response. Longitudinal analysis methods, particularly the joint MMRM, allow for a more thorough examination of the correlations among the 2 outcomes than cross-sectional analysis methods.
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Affiliation(s)
- Dawn Odom
- 1 RTI Health Solutions, Research Triangle Park, NC, USA
| | - Lori McLeod
- 1 RTI Health Solutions, Research Triangle Park, NC, USA
| | - Bintu Sherif
- 1 RTI Health Solutions, Research Triangle Park, NC, USA
| | - Lauren Nelson
- 1 RTI Health Solutions, Research Triangle Park, NC, USA
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Stewart GC, Kittleson MM, Patel PC, Cowger JA, Patel CB, Mountis MM, Johnson FL, Guglin ME, Rame JE, Teuteberg JJ, Stevenson LW. INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profiling Identifies Ambulatory Patients at High Risk on Medical Therapy After Hospitalizations for Heart Failure. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.116.003032. [DOI: 10.1161/circheartfailure.116.003032] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 10/07/2016] [Indexed: 11/16/2022]
Abstract
Background—
INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles provide important prognostic information for patients with advanced heart failure (HF) receiving mechanical support. The value of INTERMACS profiling has not been shown for patients followed on medical therapy for advanced HF at centers that also offer mechanical circulatory support.
Methods and Results—
This prospective, observational study enrolled 166 patients with chronic New York Heart Association class III–IV HF, ejection fraction ≤30%, and ≥1 HF hospitalization in the previous year, excluding patients listed for transplant or receiving chronic intravenous inotropic therapy. Subjects were followed for at least 12 months or until death, mechanical support, or transplant. Baseline features, quality of life, and outcomes were compared according to INTERMACS profile. Mean age was 57 years, ejection fraction 18%, and 57% had HF >5 years, whereas 23% of subjects were INTERMACS profile 4, 32% profile 5, and 45% profile 6/7. At 1 year, only 47% of this ambulatory advanced HF cohort remained alive on medical therapy. Patients in INTERMACS profile 4 were more likely to die or require mechanical support, with only 52% of these patients alive without support after the first 6 months. Profile 6/7 patients had 1-year survival of 84%, similar to outcomes for contemporary destination left ventricular assist device recipients. Quality of life using the indexed EuroQol score was poor across profiles 4 to 7, although severe limitation was less common than for ambulatory patients enrolled in INTERMACS before ventricular assist device implantation.
Conclusions—
Ambulatory patients with systolic HF, a heavy symptom burden, and at least 1 recent HF hospitalization are at high risk for death or left ventricular assist device rescue. INTERMACS profiles help identify ambulatory patients with advanced HF who may benefit from current mechanical support devices under existing indications.
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Affiliation(s)
- Garrick C. Stewart
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Michelle M. Kittleson
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Parag C. Patel
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Jennifer A. Cowger
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Chetan B. Patel
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Maria M. Mountis
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Frances L. Johnson
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Maya E. Guglin
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - J. Eduardo Rame
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Jeffrey J. Teuteberg
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
| | - Lynne W. Stevenson
- From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic
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Xu Y, Deforest M, Grabell J, Hopman W, James P. Relative contributions of bleeding scores and iron status on health-related quality of life in von Willebrand disease: a cross-sectional study. Haemophilia 2016; 23:115-121. [DOI: 10.1111/hae.13062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Y. Xu
- School of Medicine; Queen's University; Kingston Canada
| | - M. Deforest
- NCIC Clinical Trials Group; Queen's University; Kingston Canada
| | - J. Grabell
- Department of Pathology and Molecular Medicine; Queen's University; Kingston Canada
| | - W. Hopman
- Clinical Research Centre, Kingston General Hospital; Queen's University; Kingston Canada
- Department of Public Health Sciences; Queen's University; Kingston Canada
| | - P. James
- Department of Pathology and Molecular Medicine; Queen's University; Kingston Canada
- Department of Medicine; Queen's University; Kingston Canada
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Dreyer RP, Jones PG, Kutty S, Spertus JA. Quantifying clinical change: discrepancies between patients' and providers' perspectives. Qual Life Res 2016; 25:2213-20. [PMID: 26995561 DOI: 10.1007/s11136-016-1267-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Interpreting the clinical significance of changes in patient-reported outcomes (PROs) is critically important. The most commonly used approach is to anchor mean changes on PRO scores against a global assessment of change. Whether the assessor of global change should be patients or their physicians is unknown. We compared patients' and physicians' assessments of change over time to examine which was more aligned with patients' changes in PRO measures. METHODS A total of 459 chronic heart failure patients aged >30 years were enrolled from 13 US centers. Data were obtained by medical record abstraction, physical assessments, and patient interviews at a baseline clinic visit and 6 weeks later. Health status was measured with the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ), and both patients and physicians completed a validated 15-level global assessment of change, ranging from large deterioration to large improvement. RESULTS There was substantial variation between physicians/patients' global assessment of clinical change (weighted kappa = 0.36, 95 % CI 0.28, 0.43). Overall, physician assessments were more strongly correlated with change on the KCCQ summary score than were patients' assessments (physician R = 0.37, patient R = 0.29). CONCLUSION There was substantial variation between patients' and physicians' global assessment of 6-week change in heart failure status. Physician assessments of the importance of clinical changes were more strongly associated with changes in all domains of patient-reported health status, as assessed by the KCCQ, and may provide a more consistent method for defining the clinical importance of changes in patients' health status.
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Affiliation(s)
- Rachel P Dreyer
- Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Philip G Jones
- School of Medicine, Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, MO, USA.,Saint Luke's Mid America Heart Institute, University of Missouri - Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Shelby Kutty
- Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE, USA
| | - John A Spertus
- School of Medicine, Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, MO, USA. .,Saint Luke's Mid America Heart Institute, University of Missouri - Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA.
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Cooper LB, Mentz RJ, Sun JL, Schulte PJ, Fleg JL, Cooper LS, Piña IL, Leifer ES, Kraus WE, Whellan DJ, Keteyian SJ, O'Connor CM. Psychosocial Factors, Exercise Adherence, and Outcomes in Heart Failure Patients: Insights From Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION). Circ Heart Fail 2016; 8:1044-51. [PMID: 26578668 DOI: 10.1161/circheartfailure.115.002327] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychosocial factors may influence adherence with exercise training for heart failure (HF) patients. We aimed to describe the association between social support and barriers to participation with exercise adherence and clinical outcomes. METHODS AND RESULTS Of patients enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION), 2279 (97.8%) completed surveys to assess social support and barriers to exercise, resulting in the perceived social support score (PSSS) and barriers to exercise score (BTES). Higher PSSS indicated higher levels of social support, whereas higher BTES indicated more barriers to exercise. Exercise time at 3 and 12 months correlated with PSSS (r= 0.09 and r= 0.13, respectively) and BTES (r=-0.11 and r=-0.12, respectively), with higher exercise time associated with higher PSSS and lower BTES (All P<0.005). For cardiovascular death or HF hospitalization, there was a significant interaction between the randomization group and BTES (P=0.035), which corresponded to a borderline association between increasing BTES and cardiovascular death or HF hospitalization in the exercise group (hazard ratio 1.25, 95% confidence interval 0.99, 1.59), but no association in the usual care group (hazard ratio 0.83, 95% confidence interval 0.66, 1.06). CONCLUSIONS Poor social support and high barriers to exercise were associated with lower exercise time. PSSS did not impact the effect of exercise training on outcomes. However, for cardiovascular death or HF hospitalization, exercise training had a greater impact on patients with lower BTES. Given that exercise training improves outcomes in HF patients, assessment of perceived barriers may facilitate individualized approaches to implement exercise training therapy in clinical practice. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437.
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Affiliation(s)
- Lauren B Cooper
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
| | - Robert J Mentz
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Jie-Lena Sun
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Phillip J Schulte
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Jerome L Fleg
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Lawton S Cooper
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Ileana L Piña
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Eric S Leifer
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - William E Kraus
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - David J Whellan
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Steven J Keteyian
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Christopher M O'Connor
- From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
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Mastenbroek MH, Pedersen SS, Meine M, Versteeg H. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy. Qual Life Res 2015; 25:1451-60. [PMID: 26563250 PMCID: PMC4870284 DOI: 10.1007/s11136-015-1176-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 11/18/2022]
Abstract
Purpose It is well known that a significant proportion of heart failure patients (10–44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation. Methods A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12–14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time. Results All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12–20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation. Conclusions Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients’ psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.
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Affiliation(s)
- Mirjam H Mastenbroek
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. .,CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
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Mastenbroek MH, Van't Sant J, Versteeg H, Cramer MJ, Doevendans PA, Pedersen SS, Meine M. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy. J Card Fail 2015; 22:385-94. [PMID: 26363091 DOI: 10.1016/j.cardfail.2015.08.342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS Eighty-four patients with a 1st-time CRT-defibrillator (mean age 65 ± 11; 73% male) underwent echocardiography and cardiopulmonary exercise testing (CPX) before implantation (baseline) and 6 months after implantation. At baseline, patients also completed a set of questionnaires measuring mental and physical health. The association between echocardiographic response (left ventricular end-systolic volume decrease ≥15%) and a comprehensive set of CPX results was examined. Echocardiographic responders (54%) demonstrated higher peak oxygen consumption and better exercise performance than nonresponders at baseline and at 6-month follow-up. Furthermore, only echocardiographic responders showed improvements in ventilatory efficiency during follow-up. Multivariable repeated measures analyses revealed that, besides reverse remodeling, New York Heart Association functional class II and good patient-reported health status before implantation were the most important correlates of higher average oxygen consumption during exercise, and that nonischemic etiology and smaller pre-implantation QRS width were associated with better ventilatory efficiency over time. CONCLUSIONS During the first 6 months of CRT there was a significant positive association between reverse remodeling and cardiopulmonary exercise capacity.
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Affiliation(s)
- Mirjam H Mastenbroek
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
| | - Jetske Van't Sant
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Susanne S Pedersen
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mathias Meine
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
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The long-term effects of dietary sodium restriction on clinical outcomes in patients with heart failure. The SODIUM-HF (Study of Dietary Intervention Under 100 mmol in Heart Failure): a pilot study. Am Heart J 2015; 169:274-281.e1. [PMID: 25641537 DOI: 10.1016/j.ahj.2014.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/11/2014] [Indexed: 01/08/2023]
Abstract
AIMS To determine the feasibility of conducting a randomized controlled trial comparing a low-sodium to a moderate-sodium diet in heart failure (HF) patients. METHODS AND RESULTS Patients with HF (New York Heart Association classes II-III) were randomized to low (1500 mg/d) or moderate-sodium (2300 mg/d) diet. Dietary intake was evaluated using 3-day food records. The end points were changes in quality of life as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and B-type natriuretic peptide (BNP) levels from baseline to 6 months of follow-up presented as medians [25th, 75th percentiles]. Thirty-eight patients were enrolled (19/group). After 6 months, median sodium intake declined from 2137 to 1398 mg/d in the low-sodium and from 2678 to 1461 mg/d in the moderate-sodium diet group. Median BNP levels in the low-sodium diet group declined (216-71 pg/mL, P = .006), whereas in the moderate-sodium diet group, there was no change in BNP (171-188 pg/mL, P = .7; P = .17 between groups). For 6 months, median KCCQ clinical score increased in both groups (63-75 [P = .006] in the low-sodium diet group and 66-73 [P = .07] in the moderate-sodium group; P = .4 between groups). At 6 months, a post hoc analysis based on the dietary sodium intake achieved (> or ≤ 1,500 mg/d) in all patients showed an association between a sodium intake ≤ 1,500 mg/d and improvement in BNP levels and KCCQ scores. CONCLUSIONS A dietary intervention restricting sodium intake was feasible, and achievement of this sodium goal was associated with lower BNP levels and improved quality of life in patients with HF.
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Mentz RJ, Tulsky JA, Granger BB, Anstrom KJ, Adams PA, Dodson GC, Fiuzat M, Johnson KS, Patel CB, Steinhauser KE, Taylor DH, O’Connor CM, Rogers JG. The palliative care in heart failure trial: rationale and design. Am Heart J 2014; 168:645-651.e1. [PMID: 25440791 DOI: 10.1016/j.ahj.2014.07.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/24/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF. METHODS PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning. The primary end point is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary end points include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization, and quality of life. CONCLUSIONS PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic end points.
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Kerrigan DJ, Williams CT, Ehrman JK, Saval MA, Bronsteen K, Schairer JR, Swaffer M, Brawner CA, Lanfear DE, Selektor Y, Velez M, Tita C, Keteyian SJ. Cardiac rehabilitation improves functional capacity and patient-reported health status in patients with continuous-flow left ventricular assist devices: the Rehab-VAD randomized controlled trial. JACC-HEART FAILURE 2014; 2:653-9. [PMID: 25447348 DOI: 10.1016/j.jchf.2014.06.011] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study examined the effects of a cardiac rehabilitation (CR) program on functional capacity and health status (HS) in patients with newly implanted left ventricular assist devices (LVADs). BACKGROUND Reduced functional capacity and HS are independent predictors of mortality in patients with heart failure. CR improves both, and is related to improved outcomes in patients with heart failure; however, there is a paucity of data that describe the effects of CR in patients with LVADs. METHODS Enrolled subjects (n = 26; 7 women; age 55 ± 13 years; ejection fraction 21 ± 8%) completed a symptom-limited cardiopulmonary exercise test, the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 6-min walk test (6MW), and single-leg isokinetic strength test before 2:1 randomization to CR versus usual care. Subjects in the CR group underwent 18 visits of aerobic exercise at 60% to 80% of heart rate reserve. Within-group changes from baseline to follow-up were analyzed with a paired t-test, whereas an independent t-test was used to determine differences in the change between groups. RESULTS Within-group improvements were observed in the CR group for peak oxygen uptake (10%), treadmill time (3.1 min), KCCQ score (14.4 points), 6MW distance (52.3 m), and leg strength (17%). Significant differences among groups were observed for KCCQ, leg strength, and total treadmill time. CONCLUSIONS Indicators of functional capacity and HS are improved in patients with continuous-flow LVADs who attend CR. Future trials should examine the mechanisms responsible for these improvements, and if such improvements translate into improved clinical outcomes. (Cardiac Rehabilitation in Patients With Continuous Flow Left Ventricular Assist Devices:Rehab VAD Trial [RehabVAD]; NCT01584895).
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Affiliation(s)
- Dennis J Kerrigan
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
| | - Celeste T Williams
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Matthew A Saval
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Kyle Bronsteen
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - John R Schairer
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Meghan Swaffer
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - David E Lanfear
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Yelena Selektor
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Mauricio Velez
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Cristina Tita
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
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Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128:873-934. [PMID: 23877260 DOI: 10.1161/cir.0b013e31829b5b44] [Citation(s) in RCA: 1205] [Impact Index Per Article: 109.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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CHU SH, LEE WH, YOO JS, KIM SS, KO IS, OH EG, LEE J, CHOI M, CHEON JY, SHIM CY, KANG SM. Factors affecting quality of life in Korean patients with chronic heart failure. Jpn J Nurs Sci 2012; 11:54-64. [DOI: 10.1111/jjns.12002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 09/09/2012] [Indexed: 01/28/2023]
Affiliation(s)
- Sang Hui CHU
- Nursing Policy and Research Institute; Biobehavioral Research Center; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Won Hee LEE
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Ji Soo YOO
- Nursing Policy and Research Institute; Biobehavioral Research Center; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - So Sun KIM
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Il Sun KO
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Eui Geum OH
- Nursing Policy and Research Institute; Biobehavioral Research Center; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - JuHee LEE
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Mona CHOI
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Joo Young CHEON
- Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Chi Young SHIM
- Divisiont of Cardiology; Yonsei University College of Medicine; Seoul Korea
| | - Seok-Min KANG
- Divisiont of Cardiology; Yonsei University College of Medicine; Seoul Korea
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Schulz T, Niesing J, Stewart RE, Westerhuis R, Hagedoorn M, Ploeg RJ, Homan van der Heide JJ, Ranchor AV. The role of personal characteristics in the relationship between health and psychological distress among kidney transplant recipients. Soc Sci Med 2012; 75:1547-54. [DOI: 10.1016/j.socscimed.2012.05.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/28/2012] [Accepted: 05/24/2012] [Indexed: 12/21/2022]
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Iron deficiency predicts impaired exercise capacity in patients with systolic chronic heart failure. J Card Fail 2012; 17:899-906. [PMID: 22041326 DOI: 10.1016/j.cardfail.2011.08.003] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 07/30/2011] [Accepted: 08/01/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Iron is an indispensable element of hemoglobin, myoglobin, and cytochromes, and, beyond erythropoiesis, is involved in oxidative metabolism and cellular energetics. Hence, iron deficiency (ID) is anticipated to limit exercise capacity. We investigated whether ID predicted exercise intolerance in patients with systolic chronic heart failure (CHF). METHODS AND RESULTS We prospectively studied 443 patients with stable systolic CHF (age 54 ± 10 years, males 90%, ejection fraction 26 ± 7%, New York Heart Association Class I/II/III/IV 49/188/180/26). ID was defined as: serum ferritin <100 μg/L or serum ferritin 100-300 μg/L with serum transferrin saturation <20%. Exercise capacity was expressed as peak oxygen consumption (VO(2)) and ventilatory response to exercise (VE-VCO(2) slope). ID was present in 35 ± 4% (±95% confidence interval) of patients with systolic CHF. Those with ID had reduced peak VO(2) and increased VE-VCO(2) slope as compared to subjects without ID (peak VO(2): 13.3 ± 4.0 versus 15.3 ± 4.5 mL•min•kg, VE-VCO(2) slope: 50.9 ± 15.8 versus 43.1 ± 11.1, respectively, both P < .001, P < .05). In multivariable models, the presence of ID was associated with reduced peak VO(2) (β = -0.14, P < .01 P < .05) and higher VE-VCO(2) slope (β = 0.14, P < .01 P < .05), adjusted for demographics and clinical variables. Analogous associations were found between serum ferritin, and both peak VO(2) and VE-VCO(2) slope (P < .05). CONCLUSIONS ID independently predicts exercise intolerance in patients with systolic CHF, but the strength of these associations is relatively weak. Whether iron supplementation would improve exercise capacity in iron-deficient subjects requires further studies.
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Flynn KE, Lin L, Moe GW, Howlett JG, Fine LJ, Spertus JA, McConnell TR, Piña IL, Weinfurt KP. Relationships between changes in patient-reported health status and functional capacity in outpatients with heart failure. Am Heart J 2012; 163:88-94.e3. [PMID: 22172441 DOI: 10.1016/j.ahj.2011.09.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 09/29/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure trials use a variety of measures of functional capacity and quality of life. Lack of formal assessments of the relationships between changes in multiple aspects of patient-reported health status and measures of functional capacity over time limits the ability to compare results across studies. METHODS Using data from HF-ACTION (N = 2331), we used the Pearson correlation coefficients and predicted change scores from linear mixed-effects modeling to demonstrate the associations between changes in patient-reported health status measured with the EQ-5D visual analog scale and the Kansas City Cardiomyopathy Questionnaire (KCCQ) and changes in peak VO(2) and 6-minute walk distance at 3 and 12 months. We examined a 5-point change in KCCQ within individuals to provide a framework for interpreting changes in these measures. RESULTS After adjustment for baseline characteristics, correlations between changes in the visual analog scale and changes in peak VO(2) and 6-minute walk distance ranged from 0.13 to 0.28, and correlations between changes in the KCCQ overall and subscale scores and changes in peak VO(2) and 6-minute walk distance ranged from 0.18 to 0.34. A 5-point change in KCCQ was associated with a 2.50-mL kg(-1) min(-1) change in peak VO(2) (95% CI 2.21-2.86) and a 112-m change in 6-minute walk distance (95% CI 96-134). CONCLUSIONS Changes in patient-reported health status are not highly correlated with changes in functional capacity. Our findings generally support the current practice of considering a 5-point change in the KCCQ within individuals to be clinically meaningful.
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Affiliation(s)
- Kathryn E Flynn
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
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Ekman I, Chassany O, Komajda M, Böhm M, Borer JS, Ford I, Tavazzi L, Swedberg K. Heart rate reduction with ivabradine and health related quality of life in patients with chronic heart failure: results from the SHIFT study. Eur Heart J 2011; 32:2395-404. [DOI: 10.1093/eurheartj/ehr343] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chatzikyriakou SV, Tziakas DN, Chalikias GK, Stakos D, Papazoglou D, Lantzouraki A, Thomaidi A, Boudoulas H, Konstantinides S. Circulating levels of a biomarker of collagen metabolism are associated with health-related quality of life in patients with chronic heart failure. Qual Life Res 2011; 21:143-53. [DOI: 10.1007/s11136-011-9932-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2011] [Indexed: 10/18/2022]
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Abstract
The etiology, predictive value, and biobehavioral aspects of depression in heart failure (HF) are described in this article. Clinically elevated levels of depressive symptoms are present in approximately 1 out of 5 patients with HF. Depression is associated with poor quality of life and a greater than 2-fold risk of clinical HF progression and mortality. The biobehavioral mechanisms accounting for these adverse outcomes include biological processes (elevated neurohormones, autonomic nervous system dysregulation, and inflammation) and adverse health behaviors (physical inactivity, medication nonadherence, poor dietary control, and smoking). Depression often remains undetected because of its partial overlap with HF-related symptoms and lack of systematic screening. Behavioral and pharmacologic antidepressive interventions commonly result in statistically significant but clinically modest improvements in depression and quality of life in HF, but not consistently better clinical HF or cardiovascular disease outcomes. Documentation of the biobehavioral pathways by which depression affects HF progression will be important to identify potential targets for novel integrative behavioral and pharmacologic interventions.
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Affiliation(s)
- Willem J Kop
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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Sebern MD, Woda A. Shared care dyadic intervention: outcome patterns for heart failure care partners. West J Nurs Res 2011; 34:289-316. [PMID: 21383082 DOI: 10.1177/0193945911399088] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Up to half of heart failure (HF) patients are readmitted to hospitals within 6 months of discharge. Many readmissions are linked to inadequate self-care or family support. To improve care, practitioners may need to intervene with both the HF patient and family caregiver. Despite the recognition that family interventions improve patient outcomes, there is a lack of evidence to support dyadic interventions in HF. Thus, the purpose of this study was to test the Shared Care Dyadic Intervention (SCDI) designed to improve self-care in HF. The theoretical base of the SCDI was a construct called Shared Care. Shared Care represents a system of processes used in family care to exchange support. Key findings were as follows: the SCDI was acceptable to both care partners and the data supported improved shared care for both. For the patient, there were improvements in self-care. For the caregivers, there were improvements in relationship quality and health.
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Peters-Klimm F, Kunz CU, Laux G, Szecsenyi J, Müller-Tasch T. Patient- and provider-related determinants of generic and specific health-related quality of life of patients with chronic systolic heart failure in primary care: a cross-sectional study. Health Qual Life Outcomes 2010; 8:98. [PMID: 20831837 PMCID: PMC2945966 DOI: 10.1186/1477-7525-8-98] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 09/13/2010] [Indexed: 12/21/2022] Open
Abstract
Background Identifying the determinants of health-related quality of life (HRQOL) in patients with systolic heart failure (CHF) is rare in primary care; studies often lack a defined sample, a comprehensive set of variables and clear HRQOL outcomes. Our aim was to explore the impact of such a set of variables on generic and disease-specific HRQOL. Methods In a cross-sectional study, we evaluated data from 318 eligible patients. HRQOL measures used were the SF-36 (Physical/Mental Component Summary, PCS/MCS) and four domains of the KCCQ (Functional status, Quality of life, Self efficacy, Social limitation). Potential determinants (instruments) included socio-demographical variables (age, sex, socio-economic status: SES), clinical (e.g. NYHA class, LVEF, NT-proBNP levels, multimorbidity (CIRS-G)), depression (PHQ-9), behavioural (EHFScBs and prescribing) and provider (e.g. list size of and number. of GPs in practice) variables. We performed linear (mixed) regression modelling accounting for clustering. Results Patients were predominantly male (71.4%), had a mean age of 69.0 (SD: 10.4) years, 12.9% had major depression, according to PHQ-9. Across the final regression models, eleven determinants explained 27% to 55% of variance (frequency across models, lowest/highest β): Depression (6×, -0.3/-0.7); age (4×, -0.1/-0.2); multimorbidity (4×, 0.1); list size (2×, -0.2); SES (2×, 0.1/0.2); and each of the following once: no. of GPs per practice, NYHA class, COPD, history of CABG surgery, aldosterone antagonist medication and Self-care (0.1/-0.2/-0.2/0.1/-0.1/-0.2). Conclusions HRQOL was determined by a variety of established individual variables. Additionally the presence of multimorbidity burden, behavioural (self-care) and provider determinants may influence clinicians in tailoring care to individual patients and highlight future research priorities.
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Affiliation(s)
- Frank Peters-Klimm
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
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