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Balasubramanian A, Larive AB, Horn EM, DuBrock HM, Mehra R, Jacob MS, Hemnes AR, Leopold JA, Radeva MK, Hill NS, Erzurum SC, Rosenzweig EB, Frantz RP, Rischard FP, Beck GJ, Hassoun PM, Mathai SC. Health-Related Quality of Life Across the Spectrum of Pulmonary Hypertension. Chest 2024; 165:1493-1504. [PMID: 38354903 PMCID: PMC11177102 DOI: 10.1016/j.chest.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) is frequently impaired in pulmonary arterial hypertension. However, little is known about HRQOL in other forms of pulmonary hypertension (PH). RESEARCH QUESTION Does HRQOL vary across groups of the World Symposium on Pulmonary Hypertension (WSPH) classification system? STUDY DESIGN AND METHODS This cross-sectional study included patients with PH from the Pulmonary Vascular Disease Phenomics (PVDOMICS) cohort study. HRQOL was assessed by using emPHasis-10 (e-10), the 36-item Medical Outcomes Study Short Form survey (physical component score [PCS] and mental component score), and the Minnesota Living with Heart Failure Questionnaire. Pearson correlations between HRQOL and demographic, physiologic, and imaging characteristics within each WSPH group were tested. Multivariable linear regressions compared HRQOL across WSPH groups, adjusting for demographic characteristics, disease prevalence, functional class, and hemodynamics. Cox proportional hazards models were used to assess associations between HRQOL and survival across WSPH groups. RESULTS Among 691 patients with PH, HRQOL correlated with functional class and 6-min walk distance but not hemodynamics. HRQOL was severely depressed across WSPH groups for all measures except the 36-item Medical Outcomes Study Short Form survey mental component score. Compared with Group 1 participants, Group 2 participants had significantly worse HRQOL (e-10 score, 29 vs 24 [P = .001]; PCS, 32.9 ± 8 vs 38.4 ± 10 [P < .0001]; and Minnesota Living with Heart Failure Questionnaire score, 50 vs 38 [P = .003]). Group 3 participants similarly had a worse e-10 score (31 vs 24; P < .0001) and PCS (33.3 ± 9 vs 38.4 ± 10; P < .0001) compared with Group 1 participants, which persisted in multivariable models (P < .05). HRQOL was associated in adjusted models with survival across Groups 1, 2, and 3. INTERPRETATION HRQOL was depressed in PH and particularly in Groups 2 and 3 despite less severe hemodynamics. HRQOL is associated with functional capacity, but the severity of hemodynamic disease poorly estimates the impact of PH on patients' lives. Further studies are needed to better identify predictors and treatments to improve HRQOL across the spectrum of PH.
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Affiliation(s)
- Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MA
| | - A Brett Larive
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Evelyn M Horn
- Division of Cardiology, Weill Cornell Medicine, New York, NY
| | - Hilary M DuBrock
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Reena Mehra
- Neurologic and Respiratory Institutes, Cleveland Clinic, Cleveland, OH
| | - Miriam S Jacob
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Milena K Radeva
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, MA
| | | | - Erika B Rosenzweig
- Department of Pediatrics and Medicine, Columbia University, New York, NY
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Franz P Rischard
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MA.
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Gomberg-Maitland M, Souza R. Patient-Reported Outcomes Instruments: The Important Balance Between Feasibility and Analysis. JACC. HEART FAILURE 2024; 12:377-379. [PMID: 38099891 DOI: 10.1016/j.jchf.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Mardi Gomberg-Maitland
- Division of Cardiovascular Medicine, Department of Medicine, George Washington University, School of Medicine, Washington, DC, USA.
| | - Rogerio Souza
- Pulmonary Division, Instituto do Coração, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
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Auth R, Klinger JR. Emerging pharmacotherapies for the treatment of pulmonary arterial hypertension. Expert Opin Investig Drugs 2023; 32:1025-1042. [PMID: 37881882 DOI: 10.1080/13543784.2023.2274439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease. Approved treatment options currently primarily target abnormal cell signaling pathways involved in vasoconstriction and proliferation, such as those mediated by prostacyclin, cyclic guanosine monophosphate, and endothelin. AREAS COVERED Recent advancements have led to new applications and modes of delivery of currently approved PAH medications. At the same time, novel drugs targeting specific molecular pathways involved in PAH pathogenesis have been developed and are being investigated in clinical trials. This review summarizes investigational drug trials for PAH gathered from a comprehensive search using PubMed and ClinicalTrials.gov between 2003 and 2023. It includes both currently approved medications studied at different doses or new administration forms and experimental drugs that have not yet been approved. EXPERT OPINION Approved treatments for PAH target imbalances in pulmonary vasoactive pathways that work primarily on enhancing pulmonary vasodilation with less salient effects on pulmonary vascular remodeling. The advent of more locally acting inhaled medications offers additional therapeutic options that may improve the ease of drug delivery and reduce adverse systemic effects. The more recent emphasis on developing and applying therapeutics that directly impact the aberrant signaling pathways implicated in PAH appears more likely to advance the treatment of this devastating disease.
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Affiliation(s)
- Roger Auth
- Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
| | - James R Klinger
- Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
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Yarlas A, Mathai SC, Nathan SD, DuBrock HM, Morland K, Anderson N, Kosinski M, Lin X, Classi P. Considerations When Selecting Patient-Reported Outcome Measures for Assessment of Health-Related Quality of Life in Patients With Pulmonary Hypertension. Chest 2022; 162:1163-1175. [DOI: 10.1016/j.chest.2022.08.2206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022] Open
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Hendriks PM, van Thor MCJ, Wapenaar M, Chandoesing P, van den Toorn LM, van den Bosch AE, Post MC, Boomars KA. The longitudinal use of EmPHasis-10 and CAMPHOR questionnaire health-related quality of life scores in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Respir Med 2021; 186:106525. [PMID: 34218166 DOI: 10.1016/j.rmed.2021.106525] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/11/2021] [Accepted: 06/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is impaired in patients with pulmonary hypertension (PH). The EmPHasis-10 and CAMPHOR questionnaires are developed to evaluate HRQoL specifically in patients with PH. Data on the longitudinal use of both questionnaires are still limited. We evaluated the longitudinal value of both questionnaires and established minimal clinically important differences (MCID). METHODS Sixty-one treatment naïve pulmonary arterial hypertension or chronic thromboembolic patients were prospectively included. Patients were treated according to the current ESC/ERS guidelines. We compared EmPHasis-10 and CAMPHOR scores between baseline, 6 and 12 months of follow-up and evaluated the correlation between these scores and a 5-scale symptom severity score, 5-scale overall health score, NYHA-classification, 6 min walk test distance (6MWD), NT-proBNP and echocardiographic parameters. RESULTS After one year of treatment a significant reduction in EmPHasis-10 score and CAMPHOR QoL and symptoms domain score was observed. Moderate to good correlations were observed between the questionnaires and the overall-health and symptom severity score and 6MWD. No relevant correlations were seen between the questionnaires and NT-pro-BNP and echocardiographic parameters. EmPHasis-10 scores showed strong correlations with all CAMPHOR domains. The MCID for the EmPHasis-10 questionnaire was -8. The MCIDs for the CAMPHOR domains were: activity -3, symptoms -4, QoL -3. CONCLUSION The EmPHasis-10 and CAMPHOR questionnaires are valid tools for the longitudinal measurement of HRQoL in patients with PH. The much shorter EmPHasis-10 correlates well with the CAMPHOR domain scores and with the clinical endpoints and it may be easier to use in daily practice.
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Affiliation(s)
- Paul M Hendriks
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Mitch C J van Thor
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, the Netherlands
| | - Monique Wapenaar
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Prewesh Chandoesing
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Leon M van den Toorn
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, the Netherlands; Department of Cardiology, Utrecht University Medical Center, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - Karin A Boomars
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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Bunclark K, Doughty N, Michael A, Abraham N, Ali S, Cannon JE, Sheares K, Speed N, Taboada D, Toshner M, Pepke-Zaba J. A minimal clinically important difference measured by the Cambridge Pulmonary Hypertension Outcome Review for patients with idiopathic pulmonary arterial hypertension. Pulm Circ 2021; 11:2045894021995055. [PMID: 34104417 PMCID: PMC8149778 DOI: 10.1177/2045894021995055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/22/2021] [Indexed: 12/27/2022] Open
Abstract
Several patient-reported outcome measures have been developed to assess health
status in pulmonary arterial hypertension. The required change in instrument
scores needed, to be seen as meaningful to the individual, however remain
unknown. We sought to identify minimal clinically important differences in the
Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) and to validate these
against objective markers of functional capacity. Minimal clinically important
differences were established from a discovery cohort (n = 129)
of consecutive incident cases of idiopathic pulmonary arterial hypertension with
CAMPHOR scores recorded at treatment-naïve baseline and 4–12 months following
pulmonary arterial hypertension therapy. An independent validation cohort
(n = 87) was used to verify minimal clinically important
differences. Concurrent measures of functional capacity relative to CAMPHOR
scores were collected. Minimal clinically important differences were derived
using anchor- and distributional-based approaches. In the discovery cohort, mean
(SD) was 54.4 (16.4) years and 64% were female. Most patients (63%) were treated
with sequential pulmonary arterial hypertension therapy. Baseline CAMPHOR scores
were: Symptoms, 12 (7); Activity, 12 (7) and quality of life, 10 (7). Pulmonary
arterial hypertension treatment resulted in significant improvements in CAMPHOR
scores (p < 0.05). CAMPHOR minimal clinically important
differences averaged across methods for health status improvement were:
Symptoms, –4 points; Activity, –4 points and quality of life –3 points. CAMPHOR
Activity score change ≥minimal clinically important difference was associated
with significantly greater improvement in six-minute walk distance, in both
discovery and validation populations. In conclusion, CAMPHOR scores are
responsive to pulmonary arterial hypertension treatment. Minimal clinically
important differences in pulmonary hypertension-specific scales may provide
useful insights into treatment response in future clinical trials.
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Affiliation(s)
- Katherine Bunclark
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Natalie Doughty
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Alice Michael
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nisha Abraham
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Samantha Ali
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - John E Cannon
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Karen Sheares
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicola Speed
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Dolores Taboada
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Mark Toshner
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Lewis RA, Armstrong I, Bergbaum C, Brewis MJ, Cannon J, Charalampopoulos A, Church AC, Coghlan JG, Davies RJ, Dimopoulos K, Elliot C, Gibbs JSR, Gin-Sing W, Haji G, Hameed AG, Howard LS, Johnson MK, Kempny A, Kiely DG, Lo Giudice F, McCabe C, Peacock AJ, Peleyeju O, Pepke-Zaba J, Polwarth G, Price L, Sabroe I, Schreiber BE, Sheares K, Taboada D, Thompson AAR, Toshner MR, Wanjiku I, Wort SJ, Yorke J, Condliffe R. EmPHasis-10 health-related quality of life score predicts outcomes in patients with idiopathic and connective tissue disease-associated pulmonary arterial hypertension: results from a UK multicentre study. Eur Respir J 2021; 57:13993003.00124-2020. [PMID: 32631835 PMCID: PMC7905834 DOI: 10.1183/13993003.00124-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023]
Abstract
Health-related quality of life (HRQoL) scores assess symptom burden in pulmonary arterial hypertension (PAH) but data regarding their role in prognostication and risk stratification are limited. We assessed these relationships using the emPHasis-10 HRQoL measure.1745 patients with idiopathic PAH (IPAH), drug-induced PAH (DPAH), heritable PAH (HPAH) (collectively "(I/D/H)PAH"), or connective tissue disease-associated PAH (CTD-PAH), who had completed emPHasis-10 questionnaires at one of six UK referral centres between 2014 and 2017, were identified. Correlations with exercise capacity and World Health Organization (WHO) functional class were assessed, and exploratory risk stratification thresholds were tested.Moderate correlations were seen between emPHasis-10 scores and 6-min walk distance (r=-0.546), incremental shuttle walk distance (r=-0.504) and WHO functional class (r=0.497) (all p<0.0001). Distribution of emPHasis-10 score differed significantly between each WHO functional class (all p<0.0001). On multivariate analysis, emPHasis-10 score, but not WHO functional class, was an independent predictor of mortality. In a risk stratification approach, scores of 0-16, 17-33 and 34-50 identified incident patients with 1-year mortality of 5%, 10% and 23%, respectively. Survival of patients in WHO functional class III could be further stratified using an emPHasis-10 score ≥34 (p<0.01). At follow-up, patients with improved emPHasis-10 scores had improved exercise capacity (p<0.0001) and patients who transitioned between risk groups demonstrated similar survival to patients originally in those risk groups.The emPHasis-10 score is an independent prognostic marker in patients with (I/D/H)PAH or CTD-PAH. It has utility in risk stratification in addition to currently used parameters. Improvement in emPHasis-10 score is associated with improved exercise capacity.
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Affiliation(s)
- Robert A Lewis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Carmel Bergbaum
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Melanie J Brewis
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - John Cannon
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - A Colin Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - J Gerry Coghlan
- Pulmonary Hypertension Unit, Royal Free Hospital, London, UK
| | - Rachel J Davies
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Charlie Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - J Simon R Gibbs
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Wendy Gin-Sing
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Gulam Haji
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Abdul G Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Aleksander Kempny
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Joanna Pepke-Zaba
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Gary Polwarth
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Laura Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Ian Sabroe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Karen Sheares
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Dolores Taboada
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - A A Roger Thompson
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Mark R Toshner
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Ivy Wanjiku
- Pulmonary Hypertension Unit, Royal Free Hospital, London, UK
| | - S John Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Janelle Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
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Palliative Care in Pulmonary Arterial Hypertension. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Corrêa RA, Pereira MC, Bizzi MF, de Oliveira RWR, Rezende CF, de Oliveira BCMT, Heaney A, McKenna SP, Ribeiro-Oliveira A. Adaptation and validation of the quality of life assessment of the Cambridge pulmonary hypertension outcome review (CAMPHOR) for Brazil. J Patient Rep Outcomes 2020; 4:43. [PMID: 32504261 PMCID: PMC7275099 DOI: 10.1186/s41687-020-00209-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background Pulmonary Hypertension (PH) impacts negatively on patients’ health-related quality of life (HRQoL). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) was the first PH-specific and validated instrument for use in different languages worldwide. This report describes the adaptation and psychometric validation of the CAMPHOR into Brazilian Portuguese language. Methods The translation and validation process included a bilingual and lay panel translation; cognitive debriefing interviews; psychometric testing in two repeated times assessing internal consistency, reproducibility and validity of the questionnaire. The Nottingham Health Profile (NHP) questionnaire was used as a comparator to test for convergent validity. Results The translation captured the same concepts as the English questionnaire and produced a comprehensive instrument in a Brazilian-Portuguese version expressing common, natural language. The psychometric evaluation involved 102 patients (48.8 ± 14.5 years, 80,4% female]. Cronbach’s alpha coefficients were above 0.9 on all three CAMPHOR scales. There was excellent test-retest reliability (coefficients above 0.85 on all scales). CAMPHOR Symptoms scale and Activities scale correlated highly with Physical Mobility section and CAMPHOR QoL scale was strongly associated with the Emotional Reactions and Social Isolation sections of NHP. There was a significant association between gender and perceived general health (p < 0.05). There were significant differences in CAMPHOR scale scores between patients who differed according to their perceived disease severity and general health. Conclusions The present CAMPHOR version demonstrated good psychometric properties and provides a reliable instrument for assessing HRQL and QoL in Brazilian PH patients, addressing patients’ perspective of their illness in a comprehensive way.
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Affiliation(s)
- Ricardo Amorim Corrêa
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Mariana Ferreira Bizzi
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael W R de Oliveira
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila Farnese Rezende
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Antonio Ribeiro-Oliveira
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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10
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Villaquirán C, Moreno S, Dueñas R, Acuña P, Lutz JR, Wilburn J, Heaney A. Cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review for use in patients with pulmonary hypertension in Colombia. J Bras Pneumol 2019; 45:e20180332. [PMID: 31365733 PMCID: PMC6715158 DOI: 10.1590/1806-3713/e20180332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/20/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To conduct a cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) as an instrument to evaluate the perception of symptoms, functional limitation, and health-related quality of life (HRQoL) in subjects diagnosed with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Colombia. METHODS The adaptation process involved 3 phases: translation, cognitive debriefing interviews, and a validation survey. To evaluate the psychometric properties, we recruited individuals ≥ 18 years of age who had been diagnosed with PAH or CTEPH to take part in the latter two stages of the adaptation process. All individuals were being followed on an outpatient basis by the pulmonary hypertension programs at Hospital Universitario San Ignacio, Fundación Clínica Shaio,and Clínicos IPS, all located in the city of Bogotá, Colombia. RESULTS A Spanish-language version of the CAMPHOR was developed for use in Colombia. The internal consistency was excellent for the symptoms, functioning, and quality of life scales (Cronbach's alpha coefficients of 0.92, 0.87, and 0.93, respectively). Test-retest reliability was above 0.70. The evaluation of the convergent validity and known group validity of the CAMPHOR scales confirmed that there were moderate and strong correlations with the related constructs of the Medical Outcomes Study 36-item Short-Form Health Survey, version 2, as well as showing their capacity to discriminate disease severity. CONCLUSIONS The Spanish-language version of the CAMPHOR developed for use in Colombia was the result of a translation and cultural adaptation process that allows us to consider it equivalent to the original version, having shown good psychometric properties in the study sample. Therefore, its use to assess the impact of interventions on the HRQoL of patients with PAH or CTEPH is recommended, in research and clinical practice.
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Affiliation(s)
- Claudio Villaquirán
- . Unidad de Enfermedades Respiratorias, Departamento de Medicina Interna, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
- . Clínicos IPS, Bogotá, Colombia
| | - Socorro Moreno
- . Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Paola Acuña
- . Departamento de Medicina Interna, Pontificia Universidad Javeriana, Bogotá, Colombia
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11
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Hećimović A, Heaney A, McKenna SP, Basara L, Jakopović M, Vukić Dugac A, Redžepi G, Rotim C, Samaržija M, Jokić-Begić N, Popović-Grle S. ADAPTATION AND VALIDATION OF THE CAMBRIDGE PULMONARY HYPERTENSION OUTCOME REVIEW (CAMPHOR) FOR CROATIA. Acta Clin Croat 2019; 58:3-12. [PMID: 31363319 PMCID: PMC6629211 DOI: 10.20471/acc.2019.58.01.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Pulmonary hypertension (PH) is a chronic disease which severely impairs quality of life (QoL). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is the first disease-specific tool to assess patient-reported symptoms, functioning and QoL in PH patients. The aim of this study was to adapt and validate the CAMPHOR for use in Croatia. The adaptation process involved three stages: translation (bilingual and lay panel), cognitive debriefing interviews with patients and psychometric validation. For the latter stage, a postal survey was conducted with 50 patients to examine the reliability and validity of the adapted scale. All three scales of the Croatian CAMPHOR demonstrated excellent internal consistency (Symptoms = 0.93; Activity limitations = 0.94; QoL = 0.92) and test-retest reliability correlations (Symptoms = 0.90; Activity limitations = 0.95; QoL = 0.90). Predicted correlations with the SF-36 scales provided evidence for construct validity of the CAMPHOR scales. Evidence for known group validity was shown by the ability of the scales to distinguish between participants based on patient-perceived general health and disease severity. The Croatian version of the CAMPHOR is a valid and reliable tool for use in clinical routine and clinical research.
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Affiliation(s)
| | - Alice Heaney
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Stephen P McKenna
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Latinka Basara
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Marko Jakopović
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Andrea Vukić Dugac
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Gzim Redžepi
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Cecilija Rotim
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Miroslav Samaržija
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Nataša Jokić-Begić
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
| | - Sanja Popović-Grle
- 1Department for Lung Diseases, Zagreb University Hospital Centre, Zagreb, Croatia; 2Galen Research, Manchester, UK; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Dr. Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Faculty of Humanities and Social Science, University of Zagreb, Zagreb, Croatia
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Chandrasekhar M, Rao A, Ruiz G, Groninger H. Palliative Care Issues in Pulmonary Arterial Hypertension #367. J Palliat Med 2019; 22:220-222. [DOI: 10.1089/jpm.2018.0618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Małaczynska-Rajpold K, Smukowska-Gorynia A, Heaney A, McKenna SP, Janus M, Araszkiewicz A, Jankiewicz S, Slawek-Szmyt S, Tomaszewska I, Mularek-Kubzdela T. The Polish adaptation of the CAMbridge Pulmonary Hypertension Outcome Review (CAMPHOR). Cardiol J 2018; 27:608-615. [PMID: 30338844 PMCID: PMC8078996 DOI: 10.5603/cj.a2018.0119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/09/2018] [Accepted: 09/02/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) results in severely impaired quality of life (QoL) in people with this condition. The CAMbridge Pulmonary Hypertension Outcome Review (CAMPHOR) is the only questionnaire providing a disease-specific measurement of symptoms, functioning and QoL in PH patients. It has already been adapted for use in several countries. The aim of this study was to adapt and validate CAMPHOR for the Polish-speaking population. METHODS Two panels (bilingual and lay) were conducted to translate CAMPHOR into Polish. This new version was then tested by cognitive debriefing interviews with 15 patients. Finally, a postal validation survey was conducted with 56 patients on two occasions 2 weeks apart to assess its psychometric properties. RESULTS No problems were experienced in producing a Polish translation of CAMPHOR. Interviewees responded well to the Polish CAMPHOR, finding it relevant, comprehensible and easy to complete. For all three CAMPHOR scales (Symptoms, Activity, QoL), The Cronbach alpha coefficients were above 0.8 at both time points, indicating high internal consistency. Test-retest reliability for the three scales achieved a value above 0.80. Predicted correlations with the Nottingham Health Profile provided evidence of the construct validity of CAMPHOR scales. The Polish CAMPHOR could distinguish between patients who differed according to their perceived general health and perceived disease severity. No significant differences in scores were found between participants grouped by gender or age. CONCLUSIONS The Polish version of CAMPHOR demonstrated good psychometric properties and is recommended for use in clinical practice.
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Affiliation(s)
| | | | | | - Stephen P McKenna
- Galen Research Ltd., Manchester, United Kingdom
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Magdalena Janus
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland, Poland
| | | | - Stanislaw Jankiewicz
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland, Poland
| | - Sylwia Slawek-Szmyt
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland, Poland
| | - Iga Tomaszewska
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland, Poland
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Reis A, Santos M, Vicente M, Furtado I, Cruz C, Melo A, Carvalho L, Gonçalves F, Sa-Couto P, Almeida L. Health-Related Quality of Life in Pulmonary Hypertension and Its Clinical Correlates: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3924517. [PMID: 29750153 PMCID: PMC5884279 DOI: 10.1155/2018/3924517] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/18/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) impairment is common in pulmonary hypertension (PH), but its clinical predictors are not well established. This study aims to characterize the HRQoL of patients with pulmonary arterial hypertension (PAH) and other precapillary forms of PH (pcPH) and to explore its clinical correlates. MATERIALS AND METHODS A cross-sectional, observational study of patients with documented PAH and other forms of pcPH. Patients completed two patient-reported outcome measures (PROM): Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) and Nottingham Health Profile (NHP). Clinical characteristics were retrieved from electronic medical records. RESULTS Mean CAMPHOR and NHP scores for the study population were indicative of a moderate HRQoL impairment. Patients in World Health Organisation Functional Classes (WHO FC) III/IV showed significantly worse HRQoL. The main clinical correlates of HRQoL were WHO FC, 6-minute walking distance (6MWD), and Borg dyspnoea index. Overall quality of life (QoL), assessed through CAMPHOR's QoL domain, showed patterns comparable to HRQoL measured by both instruments. CONCLUSIONS HRQoL, measured by two different PROMs, is impaired in Portuguese patients with PAH and other forms of pcPH, particularly in patients with increased disease severity. WHO FC, 6MWD, and Borg dyspnoea index are highly correlated with HRQoL and QoL.
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Affiliation(s)
- Abílio Reis
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Mário Santos
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
- Cardiology Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto, Porto, Portugal
| | - Margarida Vicente
- Department of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Inês Furtado
- Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Célia Cruz
- Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Alzira Melo
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Luísa Carvalho
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
- Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Fabienne Gonçalves
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
- Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Pedro Sa-Couto
- Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Luís Almeida
- MedInUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
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Pfeuffer E, Krannich H, Halank M, Wilkens H, Kolb P, Jany B, Held M. Anxiety, Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH. Lung 2017; 195:759-768. [PMID: 28993877 DOI: 10.1007/s00408-017-0052-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/10/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening diseases with a high burden of symptoms. Although depression, anxiety, and reduced health related quality of life (HRQOL) have also been reported, a comparative analysis which explores these traits and their underlying factors was lacking. METHODS A retrospective analysis of depression, anxiety, and health related QOL was conducted using a Hospital anxiety and depression scale (HADS) as well as the SF-36 HRQOL questionnaire. Results from these tools were compared with haemodynamic and functional parameters in 70 PAH and 23 CTEPH outpatients from a German tertiary care center specializing in pulmonary hypertension. RESULTS Although HRQOL was reduced in both cohorts of patients, individuals diagnosed with CTEPH scored lower in nearly all SF-36 parameters. Significance was noted in both "mental health" (p = 0.01) and "mental component summary score" (MCS) (p = 0.02). Depression was also more frequent in patients with CTEPH (56%) than in patients with PAH (30%), (p = 0.03). Overall, depression and anxiety correlated with most SF-36 scales in both PAH and CTEPH. In CTEPH, depression also correlated with the Borg Dyspnea Scale (r = 0.44, p = 0.01). These patients also had significantly lower pCO2 levels than the PAH cohort reflecting more severe ventilation/perfusion mismatch. All other haemodynamic and functional parameters did not differ across the groups. CONCLUSION While both cohorts of patients suffer from a reduced HRQOL as well as depression and anxiety, decreases in mental health parameters are more pronounced in the CTEPH cohort. This suggests a strong effort to improve early detection, especially in dyspneic patients with classical risk factors for CTEPH and PAH and argues for mental illness interventions alongside routine clinical care provided to patients diagnosed with PAH or CTEPH.
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Affiliation(s)
- Elena Pfeuffer
- Department of Internal Medicine, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Medical Mission Hospital, Salvatorstrasse 7, 97074, Würzburg, Germany.,Medical Clinic I, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany
| | - Holger Krannich
- Department of Quality Management and Clinical Risk Management, Hospital of Julius Maximilian University of Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany
| | - Michael Halank
- Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Heinrike Wilkens
- Department of Internal Medicine V, Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University, Kirrberger Strasse, Homburg, 66424, Homburg Saar, Germany
| | - Philipp Kolb
- Department of Medicine, Firestone Institute for Respiratory Health, Pathology & Molecular Medicine, McMaster University, 50 Charlton Ave East, T2131, Hamilton, ON, L8N 4A6, Canada
| | - Berthold Jany
- Department of Internal Medicine, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Medical Mission Hospital, Salvatorstrasse 7, 97074, Würzburg, Germany
| | - Matthias Held
- Department of Internal Medicine, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Medical Mission Hospital, Salvatorstrasse 7, 97074, Würzburg, Germany.
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Farha S, Saygin D, Park MM, Cheong HI, Asosingh K, Comhair SA, Stephens OR, Roach EC, Sharp J, Highland KB, DiFilippo FP, Neumann DR, Tang WHW, Erzurum SC. Pulmonary arterial hypertension treatment with carvedilol for heart failure: a randomized controlled trial. JCI Insight 2017; 2:95240. [PMID: 28814664 DOI: 10.1172/jci.insight.95240] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/18/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Right-sided heart failure is the leading cause of death in pulmonary arterial hypertension (PAH). Similar to left heart failure, sympathetic overactivation and β-adrenoreceptor (βAR) abnormalities are found in PAH. Based on successful therapy of left heart failure with β-blockade, the safety and benefits of the nonselective β-blocker/vasodilator carvedilol were evaluated in PAH. METHODS PAH Treatment with Carvedilol for Heart Failure (PAHTCH) is a single-center, double-blind, randomized, controlled trial. Following 1-week run-in, 30 participants were randomized to 1 of 3 arms for 24 weeks: placebo, low-fixed-dose, or dose-escalating carvedilol. Outcomes included clinical measures and mechanistic biomarkers. RESULTS Decreases in heart rate and blood pressure with carvedilol were well tolerated; heart rate correlated with carvedilol dose. Carvedilol-treated groups had no decrease in exercise capacity measured by 6-minute walk, but had lower heart rates at peak and after exercise, and faster heart rate recovery. Dose-escalating carvedilol was associated with reduction in right ventricular (RV) glycolytic rate and increase in βAR levels. There was no evidence of RV functional deterioration; rather, cardiac output was maintained. CONCLUSIONS Carvedilol is likely safe in PAH over 6 months of therapy and has clinical and mechanistic benefits associated with improved outcomes. The data provide support for longer and larger studies to establish guidelines for use of β-blockers in PAH. TRIAL REGISTRATION ClinicalTrials.gov NCT01586156FUNDING. This project was supported by NIH R01HL115008 and R01HL60917 and in part by the National Center for Advancing Translational Sciences, UL1TR000439.
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Adaptación y validación del cuestionario Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) para uso en España. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Oudiz R, Agarwal M, Rischard F, De Marco T. An advanced protocol-driven transition from parenteral prostanoids to inhaled trepostinil in pulmonary arterial hypertension. Pulm Circ 2017; 6:532-538. [PMID: 28090295 DOI: 10.1086/688711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Patients with pulmonary arterial hypertension (PAH) often require parenteral prostanoids to improve symptoms and signs of PAH. Complications of parenteral prostanoids-such as catheter-related infections and intolerable adverse effects-may develop, prompting transition to inhaled prostanoids. We report a prospective, protocol-driven transition from parenteral prostanoids to inhaled prostanoids with monitoring of exercise gas exchange and acute hemodynamics. Three PAH centers recruited patients transitioning from parenteral prostanoids to inhaled trepostinil. Rigid inclusion criteria were used, including parenteral prostanoid dose < 30 ng/kg/min, New York Heart Association functional class (FC) < 3, and pulmonary vascular resistance (PVR) < 6 Wood units. Of the 9 patients meeting initial inclusion criteria, 3 were excluded. In the remaining patients, the parenteral prostanoid was reduced and the inhaled prostanoid was increased over 24-36 hours with continuous hemodynamic monitoring. Exercise capacity and FC were measured at baseline and weeks 1, 4, and 12. All patients were successfully weaned from parenteral prostanoids. An acute PVR decrease was seen with most inhaled prostanoid doses, but PVR varied throughout the transition. Patients tolerated inhaled prostanoids for 9-12 breaths 4 times a day with no treatment-limiting adverse events. At week 12, FC was unchanged, and all patients continued to receive inhaled prostanoids without serious adverse events or additional PAH therapy. In 5 of 6 patients, 6-minute walk distance and peak [Formula: see text] were within 10% of baseline. Using a strict transition protocol and rigid patient selection criteria, the parenteral prostanoid to inhaled prostanoid transition appeared safe and well tolerated and did not result in clinical deterioration over 12 weeks. Hemodynamic variability noted acutely during transition in our study did not adversely affect successful transition. (Trial registration: ClinicalTrials.gov identifier: NCT01268553).
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Affiliation(s)
- Ronald Oudiz
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Manyoo Agarwal
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Franz Rischard
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Teresa De Marco
- Division of Cardiology, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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Aguirre-Camacho A, Stepanous J, Blanco-Donoso LM, Moreno-Jiménez B, Wilburn J, González-Saiz L, McKenna SP. Adaptation and Validation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) for Use in Spain. ACTA ACUST UNITED AC 2016; 70:467-473. [PMID: 27989660 DOI: 10.1016/j.rec.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/02/2016] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is a patient-reported outcome measure of health-related quality of life and quality of life specific to individuals with pulmonary hypertension (PH). This questionnaire has demonstrated superiority over other instruments assessing similar domains. The objective of the present study was to adapt and validate the Spanish version of the questionnaire. METHODS The adaptation consisted of 3 stages: translation from English to Spanish using bilingual and lay panels, cognitive debriefing interviews with patients, and assessment of psychometric properties by means of a postal validation survey. RESULTS The translation panels produced a version of the CAMPHOR that was considered suitable for use by Spanish PH patients. The relevance, comprehensiveness, and acceptability of this version were confirmed in interviews with PH patients. Finally, the validation survey (n = 70) revealed that the 3 CAMPHOR scales (Symptoms, Activities, and Quality of life) showed strong psychometric properties. The internal consistency (Cronbach α) coefficients of the scales were above 0.89, and the test-retest reliability was above 0.87. The convergent and known group validity of the CAMPHOR scales was also demonstrated. CONCLUSIONS The Spanish version of the CAMPHOR is a valid and reliable instrument for the assessment of health-related quality of life and quality of life in Spanish PH patients. Therefore, it is recommended for use in future research and clinical practice in the Spanish population of PH patients.
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Affiliation(s)
- Aldo Aguirre-Camacho
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain; Asociación Nacional de Hipertensión Pulmonar, Aranjuez, Madrid, Spain.
| | | | - Luis M Blanco-Donoso
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain; Asociación Nacional de Hipertensión Pulmonar, Aranjuez, Madrid, Spain
| | - Bernardo Moreno-Jiménez
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
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Bernstein EJ, Gordon JK, Spiera RF, Huang WT, Horn EM, Mandl LA. Comparison of change in end tidal carbon dioxide after three minutes of step exercise between systemic sclerosis patients with and without pulmonary hypertension. Rheumatology (Oxford) 2016; 56:87-94. [PMID: 28028158 DOI: 10.1093/rheumatology/kew365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/06/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Pulmonary hypertension (PH) is an important cause of morbidity and mortality in patients with SSc. The submaximal heart and pulmonary evaluation (step test) is a non-invasive, submaximal stress test that could be used to identify SSc patients with PH. Our aims were to determine whether change in end tidal carbon dioxide ([Formula: see text]) from rest to end-exercise, and the minute ventilation to carbon dioxide production ratio ([Formula: see text]), both as measured by the step test, differ between SSc patients with and without PH. We also examined differences in validated self-report questionnaires and potential PH biomarkers between SSc patients with and without PH. METHODS We performed a cross-sectional study of 27 patients with limited or dcSSc who underwent a right heart catheterization within 24 months prior to study entry. The study visit consisted of questionnaire completion; history; physical examination; step test performance; and phlebotomy. [Formula: see text], [Formula: see text], self-report data and biomarkers were compared between patients with and without PH. RESULTS SSc patients with PH had a statistically significantly lower median (interquartile range) [Formula: see text] than SSc patients without PH [-2.1 (-5.1 to 0.7) vs 1.2 (-0.7 to 5.4) mmHg, P = 0.035], and a statistically significantly higher median (interquartile range) [Formula: see text] [53.4 (39-64.1) vs 36.4 (31.9-41.1), P = 0.035]. There were no statistically significant differences in self-report data or biomarkers between groups. CONCLUSION [Formula: see text] and [Formula: see text] as measured by the step test are statistically significantly different between SSc patients with and without PH. [Formula: see text] and [Formula: see text] may be useful screening tools for PH in the SSc population.
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Affiliation(s)
- Elana J Bernstein
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital
| | - Jessica K Gordon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery
| | - Robert F Spiera
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery
| | - Wei-Ti Huang
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery
| | - Evelyn M Horn
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery
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Health-related quality of life of patients with pulmonary arterial hypertension associated with CHD: the multicentre cross-sectional ACHILLE study. Cardiol Young 2016; 26:1250-9. [PMID: 26980152 DOI: 10.1017/s1047951116000056] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of this study was to assess health-related quality of life in patients with pulmonary arterial hypertension associated with CHD and correlations with clinical status. METHODS This prospective cross-sectional observational study included CHD patients with pulmonary arterial hypertension in 14 tertiary-care centres in France. We used two health-related quality of life questionnaires - SF-36 and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) - and one anxiety/depression Hospital Anxiety and Depression Scale (HADS) questionnaire. RESULTS Clinical data were collected for the 208 included patients (mean age: 42.6 years, range from 15.1 to 85.8 years, 69.7% female). Most patients were in NYHA functional class II (48.1%) and III (37.5%). Patients' phenotype was classified as Eisenmenger syndrome (70.7%), pulmonary arterial hypertension associated with systemic-to-pulmonary shunts (12.0%), with small defects (3.4%), or after corrective cardiac surgery (13.9%). In total, 76.4% of the patients were receiving pulmonary arterial hypertension-specific treatments. SF-36 scores showed impairment compared with normalised data. Health-related quality of life scores were significantly lower in females than in males for most dimensions of both questionnaires and were independent of the patients' phenotype, even after gender adjustment - except for CAMPHOR functioning - but significantly depended on NYHA functional class. The Hospital Anxiety and Depression Scale (HADS) scores suggested anxiety and depression associated with increasing NYHA functional class but independent of patients' phenotype. NYHA functional class, 6-minute walk distance, HADS, gender, and recent stressful event significantly affected quality of life in the multivariate analysis. CONCLUSIONS This study showed impairment of quality of life in a large cohort of patients with pulmonary arterial hypertension associated with CHD with both generic and specific questionnaires. NYHA functional class and HADS scores were predictive of most quality of life scores.
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Gu S, Hu H, Dong H. Systematic Review of Health-Related Quality of Life in Patients with Pulmonary Arterial Hypertension. PHARMACOECONOMICS 2016; 34:751-770. [PMID: 26951248 DOI: 10.1007/s40273-016-0395-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The increasing survival of patients with pulmonary arterial hypertension (PAH) has shifted attention towards the disease burden that PAH imposes on patients and healthcare systems. Most studies emphasize epidemiology and medications, while large observational studies reporting on the health-related quality of life (HRQOL) of patients with PAH are lacking. OBJECTIVE Our objective was to study the HRQOL of patients with PAH and to summarize the factors that influence it. METHODS We conducted systematic literature searches in English (PubMed, Web of Knowledge, ScienceDirect and OVID) and Chinese (China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP and SinoMed) databases to identify studies published from 2000 to 2015 assessing the HRQOL of patients with PAH. Search results were independently reviewed and extracted by two reviewers. RESULTS Of 3392 records identified in the initial search, 20 eligible papers (19 English, 1 Chinese) were finally included. Studies used a range of instruments; the generic 36-item Short Form Survey (SF-36) was the most widely used, and the disease-specific Cambridge Pulmonary Hypertension Outcome Survey (CAMPHOR) was the second mostly widely used. Mean HRQOL scores assessed via the SF-36 (physical component summary [PCS] 25.4-80.1; mental component summary [MCS] 33.2-76.0) and CAMPHOR (symptom scores 3.1-17; total HRQOL 2.8-12.6; activity scores 3.8-18.1) varied across studies, reporting decreased HRQOL in patients. Mental health (depression, anxiety, stress), physical health (exercise capacity, symptoms) and medical therapies were reported to affect HRQOL. CONCLUSION We found that PAH places a substantial burden on patients, particularly in terms of HRQOL; however, the paucity of large observational studies in this area requires the attention of researchers, especially in China.
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Affiliation(s)
- Shuyan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
| | - Huimei Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
- Department of Public Health, Zhejiang Medical College, Hangzhou, Zhejiang Province, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China.
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Reis A, Twiss J, Vicente M, Gonçalves F, Carvalho L, Meireles J, Melo A, McKenna SP, Almeida L. Portuguese validation of the Cambridge pulmonary hypertension outcome review (CAMPHOR) questionnaire. Health Qual Life Outcomes 2016; 14:110. [PMID: 27460644 PMCID: PMC4962538 DOI: 10.1186/s12955-016-0513-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 07/21/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients with pulmonary arterial hypertension (PAH) and other forms of precapillary pulmonary hypertension (PH) have impaired quality of life (QoL). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is a PH-specific patient-reported outcome measure that assesses symptoms, activity limitations and QoL. It was originally developed in UK-English. The main objective of this study was to create an adaptation of the CAMPHOR suitable for a Portuguese-speaking population. METHODS A multi-step approach was followed: bilingual and lay panel translation; cognitive debriefing interviews; and psychometric testing in repeated postal surveys (2 weeks apart) including assessment of internal consistency, reproducibility and validity. The Nottingham Health Profile (NHP) questionnaire was used as a comparator instrument to test convergent validity. RESULTS The CAMPHOR was translated without difficulty by the two panels. Cognitive debriefing interviews showed the questionnaire was easily understood and considered relevant to patients' experience with their illness. Psychometric evaluation was performed with 50 PAH patients (47 ± 14 years, 37 women). Cronbach's alpha coefficients showed good internal consistency for the three CAMPHOR scales [Symptoms = 0.95; Activities = 0.93 and QoL = 0.94]. Test-retest coefficients showed that all scales had excellent reliability (Symptoms = 0.94; Activities = 0.89 and QoL = 0.93), indicating low levels of random measurement error. The CAMPHOR correlated as expected with the NHP. The magnitude of correlations followed a similar pattern to those in the original development study. The CAMPHOR also exhibited evidence of known group validity in its ability to distinguish between self-reported severity and general health groups. CONCLUSIONS A valid and reliable version of the CAMPHOR questionnaire for the European Portuguese-speaking population was developed and is recommended for use.
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Affiliation(s)
- Abílio Reis
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto-Hospital de Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | | | - Margarida Vicente
- Department of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Fabienne Gonçalves
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto-Hospital de Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Luísa Carvalho
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto-Hospital de Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - José Meireles
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto-Hospital de Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Alzira Melo
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto-Hospital de Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | | | - Luís Almeida
- Department of Health Sciences, University of Aveiro, Aveiro, Portugal
- Faculty of Medicine, Department of Pharmacology & Therapeutics, University of Porto, Porto, Portugal
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Chakinala MM, Feldman JP, Rischard F, Mathier M, Broderick M, Leedom N, Laliberte K, White RJ. Transition from parenteral to oral treprostinil in pulmonary arterial hypertension. J Heart Lung Transplant 2016; 36:193-201. [PMID: 27469018 DOI: 10.1016/j.healun.2016.06.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/12/2016] [Accepted: 06/22/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Parenteral prostanoids are effective treatment for pulmonary arterial hypertension, but long-term pump infusion systems have significant delivery-related safety and convenience limitations. METHODS Subjects with a favorable risk profile transitioned from parenteral to oral treprostinil using a protocol-driven titration during 5 days of inpatient observation. Baseline and Week 24 assessments included 6-minute walk distance, echocardiogram, right heart catheterization, pharmacokinetics, treatment satisfaction and quality of life. Thirty-three subjects (76% female, mean age 50 years) enrolled; 85% were using subcutaneous treprostinil with a median dose of 57 (range 25 to 111) ng/kg/min. Participants were using background, approved non-prostanoid therapy, including 9 on 2 oral therapies; baseline right atrial pressure and cardiac output were in the normal range. All 33 subjects transitioned to oral treprostinil therapy within 4 weeks, but 2 transitioned back to parenteral drug before Week 24. At Week 24, subjects were taking a median total daily dose of 44 (15 to 75) mg, with 25 of 31 using a 3-times-daily regimen at 7- to 9-hour intervals. RESULTS The 6-minute walk distance was preserved (median +17 m [-98 to 95 m]) at its baseline of 446 m. Hemodynamic variables, including pulmonary vascular resistance, were similar at Week 24 except for mixed venous saturation, which dropped from a median of 71% to 68% (p < 0.001). Overall quality of life and treatment satisfaction measures did not change; however, mood-related symptom and treatment convenience subscores improved. Common adverse effects included headache, nausea, flushing and diarrhea. CONCLUSIONS Lower risk patients managed on parenteral treprostinil may be candidates for transition to a more convenient, oral form of the drug.
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Affiliation(s)
| | | | - Franz Rischard
- Department of Medicine, University of Arizona, Tuscon, Arizona, USA
| | - Michael Mathier
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meredith Broderick
- United Therapeutics Corporation, Research Triangle Park, North Carolina, USA
| | - Nicole Leedom
- United Therapeutics Corporation, Research Triangle Park, North Carolina, USA
| | - Kevin Laliberte
- United Therapeutics Corporation, Research Triangle Park, North Carolina, USA
| | - R James White
- Division of Pulmonary and Critical Care Medicine and the Mary M. Parkes Center, University of Rochester Medical Center, University of Rochester Medical Center, Rochester, New York, USA.
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Adaptation and validation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) for the Netherlands. Neth Heart J 2016; 24:417-424. [PMID: 27197970 PMCID: PMC4887309 DOI: 10.1007/s12471-016-0849-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is the first disease-specific instrument for pulmonary arterial hypertension (PAH) to assess patient-perceived symptoms, activity limitations and quality of life. To be able to use this questionnaire in the Netherlands, the aim of the study was to translate and validate this instrument for the Dutch-speaking population. Methods First the CAMPHOR was translated into Dutch (by means of a bilingual and a lay panel) and field-tested by means of cognitive debriefing interviews with ten PAH patients. For psychometric evaluation, 80 patients with PAH or chronic thromboembolic pulmonary hypertension (CTEPH) were asked to complete the CAMPHOR twice over a two-week period. To test for construct validity, participants also completed the Nottingham Health Profile (NHP). Results The Dutch version of the CAMPHOR showed high internal consistency for all scales (Cronbach’s alpha 0.89–0.91) and excellent reproducibility over two weeks (reliability coefficients 0.87–0.91). Concurrent validity showed that the CAMPHOR scales correlated as expected with the NHP scales. The CAMPHOR was able to distinguish between patient groups based on self-reported general health status, disease severity and NYHA classification demonstrating evidence of known group validity. The CAMPHOR activity limitations scale correlated moderately with the distance walked during the 6‑minute walk test (r = −0.47, p < 0.01) and the symptoms scale with the Borg dyspnoea score (r = 0.51, p < 0.01). Conclusion The Dutch version of the CAMPHOR is a reliable and valid measure of quality of life and health status in patients with PAH and CTEPH is recommended for use in routine care and in clinical research.
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Mathai SC, Ghofrani HA, Mayer E, Pepke-Zaba J, Nikkho S, Simonneau G. Quality of life in patients with chronic thromboembolic pulmonary hypertension. Eur Respir J 2016; 48:526-37. [PMID: 27076580 PMCID: PMC4967564 DOI: 10.1183/13993003.01626-2015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/06/2016] [Indexed: 01/15/2023]
Abstract
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) experience debilitating symptoms that have a negative impact on their quality of life (QoL) in terms of physical capability, psychological wellbeing and social relationships. The use of QoL measurement tools is important in the assessment of treatment efficacy and in guiding treatment decisions. However, despite the importance of QoL, particularly to the patient, it remains under-reported in clinical studies of CTEPH therapy. CTEPH is unique in pulmonary hypertension in that it is potentially curable by surgery; however, a proportion of patients either have residual PH following surgery or are not operable. Although some patients with CTEPH have been treated off-label with pulmonary arterial hypertension-specific therapies, there have been few randomised controlled trials of these therapies in patients with CTEPH. Moreover, in these trials QoL outcomes are variably assessed, and there is little consistency in the tools used. Here we review the assessment of QoL in patients with CTEPH and the tools that have been used. We also discuss the effect of surgical intervention and medical therapies on QoL. We conclude that further studies of QoL in patients with CTEPH are needed to further validate the optimal QoL tools.
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Affiliation(s)
- Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research (DZL)
| | - Eckhard Mayer
- Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | | | - Sylvia Nikkho
- Global Clinical Development, Bayer Pharma AG, Berlin, Germany
| | - Gérald Simonneau
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, and INSERM Unité 999, Le Kremlin-Bicêtre, France
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Twiss J, McKenna SP, Graham J, Swetz K, Sloan J, Gomberg-Maitland M. Applying Rasch analysis to evaluate measurement equivalence of different administration formats of the Activity Limitation scale of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). Health Qual Life Outcomes 2016; 14:57. [PMID: 27062133 PMCID: PMC4826528 DOI: 10.1186/s12955-016-0462-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic formats of patient-reported outcome (PRO) measures are now routinely used in clinical research studies. When changing from a validated paper and pen to electronic administration it is necessary to establish their equivalence. This study reports on the value of Rasch analysis in this process. METHODS Three groups of US pulmonary hypertension (PH) patients participated. The first completed an electronic version of the CAMPHOR Activity Limitation scale (e-sample) and this was compared with two pen and paper administrated samples (pp1 and pp2). The three databases were combined and analysed for fit to the Rasch model. Equivalence was evaluated by differential item functioning (DIF) analyses. RESULTS The three datasets were matched randomly in terms of sample size (n = 147). Mean age (years) and percentage of male respondents were as follows: e-sample (51.7, 16.0 %); pp1 (50.0, 14.0 %); pp2 (55.5, 40.4 %). The combined dataset achieved fit to the Rasch model. Two items showed evidence of borderline DIF. Further analyses showed the inclusion of these items had little impact on Rasch estimates indicating the DIF identified was unimportant. CONCLUSIONS Differences between the performance of the electronic and pen and paper administrations of the CAMPHOR Activity Limitation scale were minor. The results were successful in showing how the Rasch model can be used to determine the equivalence of alternative formats of PRO measures.
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Affiliation(s)
- J Twiss
- Galen Research, B1 Chorlton Mill, 3 Cambridge Street, Manchester, M1 5BY, UK.
| | - S P McKenna
- Galen Research, B1 Chorlton Mill, 3 Cambridge Street, Manchester, M1 5BY, UK
| | - J Graham
- Galen Research, B1 Chorlton Mill, 3 Cambridge Street, Manchester, M1 5BY, UK
| | - K Swetz
- Mayo Clinic, Rochester, Minnesota, USA
| | - J Sloan
- Mayo Clinic, Rochester, Minnesota, USA
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Matura LA, Shou H, Fritz JS, Smith KA, Vaidya A, Pinder D, Archer-Chicko C, Dubow D, Palevsky HI, Sommers MS, Kawut SM. Physical Activity and Symptoms in Pulmonary Arterial Hypertension. Chest 2016; 150:46-56. [PMID: 26892602 DOI: 10.1016/j.chest.2016.02.633] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom in patients with pulmonary arterial hypertension (PAH); however, the impact of fatigue on daily physical activity in PAH is unknown. Accelerometry is a validated measure for assessing physical activity. We hypothesized that patients with PAH reporting higher levels of fatigue would have lower daily physical activity measured by accelerometry. METHODS We performed a prospective cohort study of 15 women with PAH. On day 1, subjects completed the Multidimensional Fatigue Inventory (MFI), the United States Cambridge Pulmonary Hypertension Outcome Review (US CAMPHOR), and a 6-min walk test. Subjects wore the accelerometer on their dominant hip and completed an activity diary for 7 days. On day 15, subjects repeated the MFI and the US CAMPHOR, and then wore the accelerometer and completed an activity diary for an additional 7 days. All multivariate analyses were adjusted for age, BMI, and PAH type. RESULTS The mean age was 50.5 years, and 53% had idiopathic or heritable PAH. During the 2 weeks, subjects were mostly sedentary (85% of the time), although 10% of their time was spent performing low-level activity. Lower average daily counts were associated with worse self-reported energy levels, whereas less day-to-day physical activity variability was associated with more self-reported mental fatigue, physical fatigue, and total activity. Higher percentage of activity bouts was also associated with worse energy. CONCLUSIONS Women with PAH may spend most of their time being sedentary, and lower self-reported energy levels are associated with less daily activity. Interventions to improve symptoms such as fatigue may also increase physical activity levels in PAH.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania School of Nursing, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
| | - Haochang Shou
- Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Jason S Fritz
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - K Akaya Smith
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Anjali Vaidya
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Diane Pinder
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Christine Archer-Chicko
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Danielle Dubow
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Harold I Palevsky
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Marilyn S Sommers
- University of Pennsylvania School of Nursing, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
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Matura LA, McDonough A, Carroll DL. Symptom Interference Severity and Health-Related Quality of Life in Pulmonary Arterial Hypertension. J Pain Symptom Manage 2016; 51:25-32. [PMID: 26300023 PMCID: PMC4698220 DOI: 10.1016/j.jpainsymman.2015.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/08/2015] [Accepted: 07/23/2015] [Indexed: 02/02/2023]
Abstract
CONTEXT While assessing symptom severity is an important component of evaluating symptoms, understanding those symptoms that interfere with patients' lives is also key. Pulmonary arterial hypertension (PAH) is a chronic disease resulting in right heart failure and increased mortality. Patients with PAH experience multiple symptoms but we do not know which symptoms and to what extent their symptoms interfere with daily life. OBJECTIVES To: (1) describe the prevalence of those symptoms that interfere with life; (2) describe the severity of symptom interference; and (3) determine those sociodemographic and clinical characteristics and interfering symptoms associated with health-related quality of life (HRQOL) in patients with PAH. METHODS A convenience sample of 191 patients with PAH completed a sociodemographic form, the Pulmonary Arterial Hypertension Symptom Interference Scale (PAHSIS) and the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hierarchical multiple linear regression was used to analyze demographic and medical characteristics along with symptom interference from the PAHSIS as predictors of HRQOL from the composite mental and physical health summary scores of the Short Form-36. RESULTS The most interfering symptoms reported were fatigue, shortness of breath with exertion, and difficulty sleeping. Age, gender, functional class, oxygen use, fatigue, dizziness, and Raynaud phenomenon were associated with the HRQOL physical health summary scores. The symptoms fatigue and SOB while lying down were associated with the HRQOL mental health summary scores. CONCLUSION Patients with PAH are experiencing multiple symptoms that are interfering with their HRQOL and ability to function.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
| | | | - Diane L Carroll
- Yvonne L. Munn Center for Nursing Research, Institute for Patient Care, Massachusetts General Hospital, Boston, Massachusetts, USA
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Fenstad ER, Wordingham SE, Swetz KM. Pulmonary Hypertension and Palliative Care: What, When, Where, and Why? ACTA ACUST UNITED AC 2016. [DOI: 10.21693/1933-088x.15.1.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Summary:
Pulmonary hypertension (PH) can be associated with a high level of symptom burden from the disease as well as its treatment. Involvement of palliative care (PC) services may help facilitate discussion regarding goals of care, prognostic planning, and treatment options focused on improving quality of life (QOL).
Background:
PC is active total care of a patient whose disease is not fully responsive to curative therapies, with symptom control as the top priority. After a life-limiting diagnosis is made, health care teams and patients determine prognosis, whether cure is attainable or reasonable, what treatment options are available, risks and benefits of associated treatments, and how treatment or nontreatment will impact QOL and survival. QOL is often the focus of palliative interventions, with the goal to minimize symptoms and empower patients with accurate information to help affirm life and meet objectives of care.
Implications for clinicians:
PC can begin at the onset of symptoms in a disease that cannot be cured. Early PC may help facilitate discussion regarding goals of care when patient expectations are discordant with prognosis. While PC is a responsibility of all clinicians, subspecialist assistance can be helpful when a clinical decline occurs, in the setting of uncertainty, when patients are removed from the transplant list, or when long-term QOL issues are present.
Conclusion:
Communication with patients who have PH can be delicate and requires an understanding of the disease's process, trajectory, and prognosis. PC teams possess communication skills that may benefit patients and providers with QOL optimization, delivery of difficult news, advanced care planning, and shared decision-making.
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Affiliation(s)
- Eric R. Fenstad
- Clinical Cardiologist, Minneapolis Heart Institute Baxter, MN
| | - Sara E. Wordingham
- Instructor in Medicine, Mayo Clinic College of Medicine Mayo Clinic Arizona Phoenix, AZ
| | - Keith M. Swetz
- Associate Professor of Medicine, University of Alabama School of Medicine Assistant Director, UAB Center for Palliative and Supportive Care Section Chief, Palliative Care, Birmingham VA Medical Center Birmingham, AL
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Gomberg-Maitland M, Schilz R, Mediratta A, Addetia K, Coslet S, Thomeas V, Gillies H, Oudiz RJ. Phase I safety study of ranolazine in pulmonary arterial hypertension. Pulm Circ 2015; 5:691-700. [PMID: 26697176 DOI: 10.1086/683813] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
UNLABELLED Pulmonary arterial hypertension (PAH) causes right ventricular ischemia, dysfunction, and failure. PAH patients may benefit from antianginal agents based on a shared pathophysiology with left ventricular ischemia. A single-center, randomized, placebo-controlled trial (1∶1) to assess the acute vasoreactivity and safety of ranolazine in PAH was conducted. Plasma samples for pharmacokinetic (PK) studies were drawn during hemodynamic measurements at 0, 60, 90, 120, 240, and 360 minutes from a Swan-Ganz catheter. All patients received 500-mg doses, uptitrated to 1,000 mg at week 4, monthly evaluations, and a complete objective assessment after 12 weeks, followed by an open-label extension. Thirteen patients were randomized and 12 enrolled (6 ranolazine, 6 placebo). All patients completed the acute phase; 10 completed the 12-week study. There were no acute changes in invasive hemodynamics. At 12 weeks ranolazine was well tolerated. Only 1 of the 5 patients on ranolazine had a serum concentration considered to be in the therapeutic range. Two serious adverse events required early withdrawal (both in the ranolazine group); gastrointestinal complaints were the most common adverse event. Efficacy measures did not demonstrate any differences between treatment groups. During the open-label trial, 2 additional patients reached a therapeutic concentration. Ranolazine in PAH appears safe, without acute hemodynamic effects after a 500-mg dose. Ranolazine administrated to PAH patients receiving background PAH therapies did not consistently reach therapeutic levels. Future studies should first perform PK analysis in PAH patients receiving PAH therapies and explore the safety and tolerability of the higher doses perhaps necessary to achieve therapeutic levels in PAH patients. ( TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01757808.).
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Affiliation(s)
- Mardi Gomberg-Maitland
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA ; Committee on Clinical Pharmacology and Pharmacogenomics, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Robert Schilz
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, Case Western University, Cleveland, Ohio, USA
| | - Anuj Mediratta
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Karima Addetia
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Sandra Coslet
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Vasiliki Thomeas
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA ; Committee on Clinical Pharmacology and Pharmacogenomics, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Ronald J Oudiz
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
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Interleukin-6 and tumor necrosis factor-α are associated with quality of life-related symptoms in pulmonary arterial hypertension. Ann Am Thorac Soc 2015; 12:370-5. [PMID: 25615959 DOI: 10.1513/annalsats.201410-463oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Inflammation is associated with symptoms in many chronic illnesses; however, this link has not been established in pulmonary arterial hypertension. OBJECTIVES The objective of this study was to investigate the association between inflammatory markers and quality of life-related symptoms in patients with pulmonary arterial hypertension. We hypothesized that higher circulating IL-6 and tumor necrosis factor-α levels would be associated with worse quality of life-related symptoms. METHODS We performed a secondary analysis using baseline and 3-month assessments of 62 subjects in a clinical trial of aspirin and simvastatin to determine the association between plasma IL-6 and tumor necrosis factor-α levels and the Medical Outcomes Study Short Form-36 subscales (pain, vitality, mental health). MEASUREMENTS AND MAIN RESULTS The mean age was 49.7±13.4 years; 87% were female. Higher IL-6 levels were significantly associated with lower Medical Outcomes Study Short Form-36 subscale scores, indicating worse bodily pain, vitality, and mental health (all P<0.01). Higher tumor necrosis factor-α levels were significantly associated with increased bodily pain, but better mental health scores. CONCLUSIONS IL-6 and tumor necrosis factor-α levels are associated with certain quality of life domains in patients with pulmonary arterial hypertension. Clinical trial registered with www.clinicaltrials.gov (NCT00384865).
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Fenstad ER, Shanafelt TD, Sloan JA, Novotny PJ, Durst LA, Frantz RP, McGoon MD, Swetz KM. Physician attitudes toward palliative care for patients with pulmonary arterial hypertension: results of a cross-sectional survey. Pulm Circ 2015; 4:504-10. [PMID: 25621164 DOI: 10.1086/677365] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/16/2014] [Indexed: 11/03/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic, symptomatic, life-threatening illness; however, it is complex, with variable expression regarding impact on quality of life (QOL). This study investigated attitudes and comfort of physicians regarding palliative care (PC) for patients with PAH and explored potential barriers to PC in PAH. An internet-based, mixed-methods survey was distributed to Pulmonary Hypertension Clinicians and Researchers, a professional organization within the Pulmonary Hypertension Association. Only responses from physicians involved in clinical care of patients with PAH were analyzed. Of 355 clinicians/researchers, 79 (22%) returned surveys, including 76 (21%) providers involved in clinical care. Responding physicians were mainly pulmonologists (67%), practiced in university/academic medical centers (89%), had been in practice a mean of 12 ± 7 years, cared for a median of 100 PAH patients per year, and reported a high level of confidence in managing PAH (87%), advanced PAH-specific pharmacologic interventions (95%), and end-of-life care (88%). Smaller proportions were comfortable managing pain (62%) and QOL issues (78%). Most physicians (91%) reported utilizing PC consultation at least once in the prior year, primarily in the setting of end-of-life/active dying (59%), hospice referral (46%), or symptomatic dyspnea/impaired QOL (40%). The most frequent reasons for not referring patients to PC included nonapproval by the patient/family (51%) and concern that PC is "giving up hope" (43%). PAH may result in symptoms that impair QOL despite optimal PAH therapy; however, PC awareness and utilization for PAH providers is low. Opportunities may exist to integrate PC into care for PAH patients.
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Affiliation(s)
- Eric R Fenstad
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tait D Shanafelt
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeff A Sloan
- Section of Cancer Center Statistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul J Novotny
- Section of Cancer Center Statistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Louise A Durst
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert P Frantz
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael D McGoon
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Keith M Swetz
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Health-related quality of life and psychological states in patients with pulmonary arterial hypertension. J Cardiovasc Nurs 2014; 29:178-84. [PMID: 23151837 DOI: 10.1097/jcn.0b013e318275330d] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a chronic illness that impairs physical function and leads to right-sided heart failure and premature death. There is limited knowledge on health-related quality of life (HRQOL) and psychological states in patients with PAH. OBJECTIVE The aim of this study was to determine the HRQOL and the psychological states of patients with PAH along with predictors of HRQOL. METHODS In a cross-sectional design, participants with PAH completed the Medical Outcomes Study Short Form-36 v2 to measure generic HRQOL, the US Cambridge Pulmonary Hypertension Outcome Review to measure disease-specific HRQOL, and the Profile of Mood States to measure the psychological states. Descriptive statistics were used to calculate all sociodemographic and clinical data and were expressed as means and standard deviations for continuous variables and as frequencies and proportions for dichotomous and nominal variables. The statistical significance level was set at P < 0.05. A multiple linear regression analysis was performed to examine the sociodemographic and clinical variables as predictors of HRQOL. A bivariate analysis of the sociodemographic and clinical variables was performed to determine correlates with HRQOL. The variables that correlated with HRQOL at the 0.20 level of significance were included. RESULTS There were 149 participants, 127 women and 22 men, with a mean age of 53.5 years. The participants demonstrated diminished general health, physical functioning, role physical, and vitality on the Short Form-36 v2. Functional class, education level, oxygen use, years since diagnosis, and calcium channel blocker therapy were predictive of poorer HRQOL. CONCLUSIONS Patients with PAH are experiencing diminished physical health and HRQOL. Future studies are needed to design and test interventions to improve HRQOL.
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Fernandes CJCS, Martins BCS, Jardim CVP, Ciconelli RM, Morinaga LK, Breda AP, Hoette S, Souza R. Quality of life as a prognostic marker in pulmonary arterial hypertension. Health Qual Life Outcomes 2014; 12:130. [PMID: 25176512 PMCID: PMC4168058 DOI: 10.1186/s12955-014-0130-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 08/08/2014] [Indexed: 11/12/2022] Open
Abstract
Background Improvement in quality of life together with better survival are the ultimate goals in the treatment of pulmonary arterial hypertension (PAH) patients. The objective of this study was to evaluate the health-related quality of life (HRQL) of pulmonary arterial hypertension (PAH) patients with the SF-36 generic questionnaire and to identify the prognostic implication of this assessment. Methods Fifty-four consecutive newly diagnosed PAH patients (WHO classification group I) in a single PAH reference center were included. Patients were evaluated at baseline for clinical and hemodynamic parameters, and they subsequently received first-line therapy with either an endothelin receptor antagonist or a phosphodiesterase-5 inhibitor. After 16 weeks of specific PAH therapy, all patients were re-evaluated using a 6MWT and a SF 36 questionnaire, and then they were followed up for at least 36 months. Results After treatment, the patients demonstrated an improved 6MWT (414 ± 124 m vs. 440 ± 113 m, p = 0.001). Specific PAH therapy also improved the HRQL scores. Patients with a baseline Physical Component Score (PCS) higher than 32 had a better survival rate than those who had a score under 32 (p = 0.04). Similarly, patients with a PCS of at least a 38 after the 16 week therapy period had a better survival rate when compared with those who did not achieve this value (p = 0.016). Unlike the absolute PCS values, the post-treatment PCS variability was unable to predict better survival rates (p = 0.58). Conclusions Our findings suggest that HRQL is associated with prognosis in PAH. Furthermore, achieving pre-determined PCS scores might represent a specific goal to be reached in treatment-to-target strategies.
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Affiliation(s)
| | | | | | | | | | | | | | - Rogério Souza
- Pulmonary Department, Heart Institute - University of Sao Paulo Medical School, Medical School, Av, Dr, Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
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Minai OA. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Biomarkers in pulmonary arterial hypertension. Ann Thorac Med 2014; 9:S92-7. [PMID: 25077003 PMCID: PMC4114275 DOI: 10.4103/1817-1737.134047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/05/2014] [Indexed: 12/22/2022] Open
Abstract
The biomarker is an indicaror of a biological or pathological process. Clinical observations, measures or environmental events, or measured laboratory values can all be biomarkers in the appropriate setting. An ideal biomarker reflects the underlying biological process, predicts clinical events, is easily obtainable, is reproducible and is not prohibitively expensive. This typically requires validation in longitudinal cohort studies. Biomarkers may help understand the pathological mechanisms responsible for the disease, help as screening tools, predict disease worsening or decline, and determine adequacy of response to therapeutic interventions.
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Affiliation(s)
- Omar A Minai
- Associate Professor of Medicine, Respiratory Institute, Cleveland Clinic, Ohio, USA
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Incremental burden of disease in patients diagnosed with pulmonary arterial hypertension receiving monotherapy and combination vasodilator therapy. Adv Ther 2014; 31:168-79. [PMID: 24449285 DOI: 10.1007/s12325-014-0094-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a rare, severely debilitating disease with high mortality. There are limited data available on treatment patterns and burden of disease from conditions of actual care. METHODS This analysis assesses the burden of disease for patients with PAH treated with monotherapy and combination therapies excluding and including intravenous (IV) prostacyclin analogues (PGI2). Data were drawn from the Adelphi PAH Disease Specific Programme, a cross sectional survey of consulting patients undertaken in the US, Germany, Italy and the UK in 2010. Outcomes included demographics, clinical characteristics, health-care resource utilization, and quality of life measured by the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). RESULTS Data were analyzed from 446 patients receiving ≥1 of 3 PAH-specific treatment classes. Physicians comprised mainly pulmonologists and cardiologists. The symptoms, functioning and quality of life scales of the CAMPHOR instrument were completed by 218, 229, and 214 patients, respectively. Although 46.2% of patients were classified as World Health Organization (WHO) functional class III or IV, only 24.4% of the population received combination therapy. Combination therapy including IV PGI2 was used in 4.7% of all patients. Patients on monotherapy had the lowest pulmonary vascular resistance values, the highest recorded 6-min walk distance and the lowest recorded levels of dyspnea. Patients on combination therapy including IV PGI2 scored worse on all three variables and had more hospitalizations than patients on less aggressive combination therapy. With increasing therapeutic regimens, the CAMPHOR scores were higher, indicating worse states of health. CONCLUSIONS Combination treatment and particularly the use of prostacyclins remain underused in an unselected population of PAH patients surveyed under conditions of actual care. The disease burden is substantial and increases with greater severity of disease and more aggressive treatments. This necessitates improvement in optimizing current therapy, as well as novel and innovative combination options.
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McCabe C, Bennett M, Doughty N, MacKenzie Ross R, Sharples L, Pepke-Zaba J. Patient-reported outcomes assessed by the CAMPHOR questionnaire predict clinical deterioration in idiopathic pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Chest 2014; 144:522-530. [PMID: 23430021 DOI: 10.1378/chest.12-2443] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is a disease-specific assessment tool used for the evaluation and follow-up of patients with pulmonary hypertension (PH). We describe a novel use for this questionnaire in its potential to predict clinical deterioration (CD) in two patient cohorts with subtypes of PH, idiopathic pulmonary arterial hypertension (IPAH), and chronic thromboembolic pulmonary hypertension (CTEPH) during an 8-year period. METHODS We retrospectively analyzed CAMPHOR scores obtained at baseline and at follow-up visits in patients under the care of our unit over an 8-year period to assess CD and survival, as well as 6-min walk distance (6MWD) and New York Heart Association (NYHA) class. RESULTS Using Cox regression, we demonstrated a significant predictive effect of CD from total CAMPHOR scores at study enrollment in IPAH and CTEPH (hazard ratios, 1.03 [95% CI, 1.01-1.05] and 1.04 [95% CI, 1.02-1.06] per unit score increase, respectively), as well as from CAMPHOR subscales as independent predictors. This predictive effect is diluted after adjusting for the prognostic effect of 6MWD and NYHA class. Repeated CAMPHOR assessment over time appears not to add predictive value of CD to that obtained at diagnosis, although it still informs physicians of important changes in self-reported symptoms. CONCLUSIONS When emphasis is placed on the evaluation of patient perceptions, CAMPHOR may represent an alternative method of estimating the likelihood of CD.
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Affiliation(s)
- Colm McCabe
- Pulmonary Vascular Disease Unit, Papworth Hospital NHS Trust, Cambridge, England
| | - Maxine Bennett
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, England
| | - Natalie Doughty
- Pulmonary Vascular Disease Unit, Papworth Hospital NHS Trust, Cambridge, England
| | | | - Linda Sharples
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, England
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Disease Unit, Papworth Hospital NHS Trust, Cambridge, England.
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White RJ, Levin Y, Wessman K, Heininger A, Frutiger K. Subcutaneous treprostinil is well tolerated with infrequent site changes and analgesics. Pulm Circ 2013; 3:611-21. [PMID: 24618545 DOI: 10.1086/674304] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract Continuous prostanoid infusions are recommended for patients with advanced pulmonary arterial hypertension. Infusion site pain has discouraged some physicians from considering subcutaneous (SQ) treprostinil therapy even though it has safety and convenience advantages over intravenous epoprostenol. We conducted a 1-year prospective study of patients utilizing SQ treprostinil. We provided counseling on infrequent site changes and a written analgesic protocol including narcotics. After placement of a new site, subjects recorded daily pain scores and analgesic use. Twenty-six of 29 patients consented, including 4 patients who had recently started therapy. They returned 203 diaries, and we captured every site change in a diary. Sixteen subjects returned 8 or fewer diaries during 12 months, and 20% of diaries documented only mild discomfort. The majority of diaries documented brief periods of severe pain, but this had generally abated by day 7. Contrary to published guidelines, infusion site pain was independent of treprostinil dose in a rigorous analysis. There were 3 significant local reactions but no systemic illness. No subject discontinued SQ treprostinil because of site discomfort. Subjects reported satisfaction with their treatment using a validated assessment, and quality-of-life scores were favorable. A strategy emphasizing infrequent site changes and early analgesia can facilitate use of SQ treprostinil. These data may allow physicians to consider treprostinil earlier in the treatment algorithm for this fatal disease.
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Affiliation(s)
- R James White
- Mary Parkes Center for Asthma, Allergy, and Pulmonary Care, Department of Pulmonary and Critical Care Medicine, University of Rochester, Rochester, New York, USA
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Yorke J, Corris P, Gaine S, Gibbs JSR, Kiely DG, Harries C, Pollock V, Armstrong I. emPHasis-10: development of a health-related quality of life measure in pulmonary hypertension. Eur Respir J 2013; 43:1106-13. [PMID: 24232702 PMCID: PMC3971119 DOI: 10.1183/09031936.00127113] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to develop a measure of the impact of pulmonary hypertension (PH) on health-related quality of life (HRQoL) as there is a need for a short, validated instrument that can be used in routine clinical practice. Interviews were conducted with 30 PH patients to derive 32 statements, which were presented as a semantic differential six-point scale (0–5), with contrasting adjectives at each end. This item list was completed by patients attending PH clinics across the UK and Ireland. Rasch analysis was applied to identify items fitting a uni-dimensional model. 226 patients (mean age 55.6±14 years; 70% female) with PH (82% had pulmonary arterial hypertension) completed the study questionnaires. 10 of the 32 items demonstrated fit to the Rasch model (Chi-squared 16; p>0.05) and generated the emPHasis-10 questionnaire. Test–retest (intraclass correlation coefficient 0.95, n=33) and internal consistency (Chronbach’s α=0.9) were strong. emPHasis-10 scores correlated consistently with other relevant measures and discriminated subgroups of patients stratified by World Health Organization functional class (ANOVA F=1.73; p<0.001). The emPHasis-10 is a short questionnaire for assessing HRQoL in pulmonary arterial hypertension. It has excellent measurement properties and is sensitive to differences in relevant clinical parameters. It is freely available for clinical and academic use. emPHasis-10 is a short, valid tool for routine assessment of health-related quality of life in pulmonary hypertensionhttp://ow.ly/qv75v
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Affiliation(s)
- Janelle Yorke
- Midwifery and Social Work, University of Manchester, Manchester
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Chan L, Chin LMK, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA, Connors G, Weir NA, Drinkard B, Lamberti J, Keyser RE. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest 2013; 143:333-343. [PMID: 22922554 DOI: 10.1378/chest.12-0993] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) restricts the ability to engage in physical activity and decreases longevity. We examined the impact of aerobic exercise training on function and quality of life in patients with World Health Organization group 1 PH. METHODS Patients were randomized to a 10-week education only (EDU) or education/exercise combined (EXE) group. The exercise program consisted of 24-30 sessions of treadmill walking for 30-45 min per session at 70% to 80% of heart rate reserve. Outcome variables included changes in 6-min walk test (6MWT) distance, time to exercise intolerance, peak work rate (WR) from a cardiopulmonary treadmill test, and quality-of-life measures, including the Short Form Health Survey, version 2 (SF-36v2) and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). RESULTS Data are presented as mean SD. Twenty-three women (age, 54 11 years; BMI, 31 7 kg/m 2 ) were randomized to the EDU (n 5 13) or EXE (n 5 10) groups. Following 10 weeks of intervention, patients in the EXE group demonstrated an improvement in 6MWT distance (56 45 m; P 5 .002), increased time to exercise intolerance (1.9 1.3 min; P 5 .001), and peak WR (26 23 W; P 5 .004). Additionally, the EXE group scored significantly ( P , .050) better on six of the eight scales on SF-36v2, and fi ve of the six scales on CAMPHOR. In contrast, no significant improvement was observed for any of the outcome measures following EDU. No adverse events were noted in either group. CONCLUSION Ten weeks of brisk treadmill walking improved 6MWT distance, cardiorespiratory function, and patient-reported quality of life in female patients with group 1 PH.
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Affiliation(s)
- Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD.
| | - Lisa M K Chin
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Michelle Kennedy
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Joshua G Woolstenhulme
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD; Department of Rehabilitation Science, George Mason University, Fairfax, VA
| | - Steven D Nathan
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA
| | - Ali A Weinstein
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
| | - Gerilynn Connors
- Pulmonary Rehabilitation Center, Inova Fairfax Hospital, Falls Church, VA
| | - Nargues A Weir
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA
| | - Bart Drinkard
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - James Lamberti
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA
| | - Randall E Keyser
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD; Department of Rehabilitation Science, George Mason University, Fairfax, VA
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Hassoun PM, Nikkho S, Rosenzweig EB, Moreschi G, Lawrence J, Teeter J, Meier C, Ghofrani AH, Minai O, Rinaldi P, Michelakis E, Oudiz RJ. Updating clinical endpoint definitions. Pulm Circ 2013; 3:206-16. [PMID: 23662199 PMCID: PMC3641732 DOI: 10.4103/2045-8932.109920] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The 6-Minute Walk Distance (6-MWD) has been the most utilized endpoint for judging the efficacy of pulmonary arterial hypertension (PAH) therapy in clinical trials conducted over the past two decades. Despite its simplicity, widespread use in recent trials and overall prognostic value, the 6-MWD has often been criticized over the past several years and pleas from several PAH experts have emerged from the literature to find alternative endpoints that would be more reliable in reflecting the pulmonary vascular resistance as well as cardiac status in PAH and their response to therapy. A meeting of PAH experts and representatives from regulatory agencies and pharmaceutical companies was convened in early 2012 to discuss the validity of current as well as emerging valuable endpoints. The current work represents the proceedings of the conference.
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Swetz KM, Shanafelt TD, Drozdowicz LB, Sloan JA, Novotny PJ, Durst LA, Frantz RP, McGoon MD. Symptom burden, quality of life, and attitudes toward palliative care in patients with pulmonary arterial hypertension: results from a cross-sectional patient survey. J Heart Lung Transplant 2013; 31:1102-8. [PMID: 22975100 DOI: 10.1016/j.healun.2012.08.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/25/2012] [Accepted: 08/04/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a complex disease with variable clinical manifestations; nevertheless, morbidity and mortality associated with PAH are considerable. This study examined quality of life (QOL) in PAH patients and assessed use of palliative care (PC) for addressing QOL issues and what barriers might exist regarding early PC implementation for patients with PAH. METHODS An Internet-based survey was distributed to Pulmonary Hypertension Association patient-related listservs. Symptom burden and QOL were assessed using Linear Analog Self Assessment (LASA) QOL items and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). RESULTS Of 774 eligible patients with active e-mail addresses, 315 returned surveys (41% overall response), and 276 (88%) contained analyzable responses. Responders (mean age, 48.9 years ± 16.0) were predominantly white (85%), female (86%), and with idiopathic PAH (42%). Profound deficiency in overall QOL (40%), fatigue (57%), physical well-being (56%), social activity (49%), emotional well-being (49%), and pain (38%) were reported. Most patients believed their PAH physician had excellent understanding of PAH progression/plan of care (92%), but less were satisfied with care regarding QOL management (77%). Few patients considered PC (8%), or had pain management (4%) or PC involved (1%). Most common reasons were beliefs that patients were doing well/not sick (63%) or that PC had not been suggested (22%). CONCLUSIONS PAH may result in symptoms or QOL impairment persisting despite optimal PAH therapy. However, PC awareness or use by PAH patients and providers is low. Opportunities may exist to integrate PC into care for PAH patients.
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Affiliation(s)
- Keith M Swetz
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Pugh ME, Buchowski MS, Robbins IM, Newman JH, Hemnes AR. Physical activity limitation as measured by accelerometry in pulmonary arterial hypertension. Chest 2013; 142:1391-1398. [PMID: 22576635 DOI: 10.1378/chest.12-0150] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The 6-min walk test, commonly used to assess exercise capacity and response to therapy in pulmonary arterial hypertension (PAH), has many well-described limitations. Sedentary time is associated with adverse cardiovascular outcomes and reduced quality of life, and measuring sedentary time and physical activity using accelerometry is another potential way to quantify exercise capacity in PAH. Whether sedentary time is different in patients with PAH vs control subjects is unknown. METHODS Physical activity was measured in 20 patients with PAH and 30 matched healthy control subjects using accelerometry for 7 consecutive days. Patients with PAH completed standard 6-min walk testing, and baseline demographics were recorded for all study participants. Total daily activity counts, sedentary time, and proportion of time at various activity levels were compared between groups. RESULTS Sedentary time was significantly higher in patients with PAH (mean, 92.1% daily activity; 95% CI, 89.5-94.8%) than in control subjects (mean, 79.9% daily activity; 95% CI, 76.4%-83.5%; P < .001), and all levels of physical activity were reduced in the PAH group compared with the control group ( P < .01 for all). Daily moderate to vigorous physical activity was reduced in the PAH group (7.5 min; 95% CI; 0.8-15.6 min) compared with the control group (mean, 64.7 min; 95% CI, 51.1-78.2 min; P < .001). Activity counts correlated with 6-min walk distance in the PAH group (Spearman rank correlation 5 0.72, P < .001). CONCLUSIONS Sedentary time is increased in patients with PAH and may lead to increased risk for metabolic and cardiovascular morbidity. Quantitation of daily activity and sedentary time using accelerometry may be a novel end point for PAH management and clinical trials.
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Affiliation(s)
- Meredith E Pugh
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
| | - Maciej S Buchowski
- Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN
| | - Ivan M Robbins
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - John H Newman
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
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Saggar R, Khanna D, Shapiro S, Furst DE, Maranian P, Clements P, Abtin F, Dua S, Belperio J, Saggar R. Brief Report: Effect of ambrisentan treatment on exercise-induced pulmonary hypertension in systemic sclerosis: A prospective single-center, open-label pilot study. ACTA ACUST UNITED AC 2012; 64:4072-7. [DOI: 10.1002/art.34614] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 06/26/2012] [Indexed: 11/09/2022]
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Selimovic N, Rundqvist B, Kjörk E, Viriden J, Twiss J, Mckenna SP. Adaptation and validation of the Cambridge pulmonary hypertension outcome review for Sweden. Scand J Public Health 2012; 40:777-83. [DOI: 10.1177/1403494812464445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The Cambridge pulmonary hypertension outcome review (CAMPHOR) is the first pulmonary hypertension-specific instrument for the assessment of the patient’s perceived symptoms, activity limitations and quality of life (QoL). Purpose: To produce and validate a Swedish language version of the CAMPHOR. Methods: Bilingual ( n = 5) and lay panels ( n = 5) were conducted to translate the CAMPHOR into Swedish. This new questionnaire was then field-tested with 14 patients and finally, it underwent psychometric evaluation by means of a postal validation study involving 38 patients with pulmonary hypertension (PH). Results: Few problems were experienced in translating the CAMPHOR into Swedish. The field-test participants found the scales relevant, comprehensible and easy to complete. Psychometric analyses showed that the Swedish adaptation was successful. The Swedish CAMPHOR scales had good internal consistency. Cronbach’s alpha coefficients were 0.92 for the symptoms scale, 0.92 for activity limitations and 0.95 for the quality of life. Predicted correlations with the Nottingham Health Profile provided evidence of the construct validity of the scales. The Swedish scales also indicated known groups validity. Conclusions: The Swedish version of the CAMPHOR is a reliable and valid measure of the impact of pulmonary hypertension on the lives of affected patients. It is recommended for use in clinical studies and routine practice in pulmonary hypertension patients.
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Affiliation(s)
- Nedim Selimovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bengt Rundqvist
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Kjörk
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Cima K, Twiss J, Speich R, McKenna SP, Grünig E, Kähler CM, Ehlken N, Treder U, Crawford SR, Huber LC, Ulrich S. The German adaptation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). Health Qual Life Outcomes 2012; 10:110. [PMID: 22971041 PMCID: PMC3492159 DOI: 10.1186/1477-7525-10-110] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 08/21/2012] [Indexed: 02/07/2023] Open
Abstract
Background Individuals with precapillary pulmonary hypertension (PH) experience severely impaired quality of life. A disease-specific outcome measure for PH, the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) was developed and validated in the UK and subsequently adapted for use in additional countries. The aim of this study was to translate and assess the reliability and validity of the CAMPHOR for German-speaking populations. Methods Three main adaptation stages involved; translation (employing bilingual and lay panels), cognitive debriefing interviews with patients and validation (assessment of the adaptation’s psychometric properties). The psychometric evaluation included 107 patients with precapillary PH (60 females; age mean (standard deviation) 60 (15) years) from 3 centres in Austria, Germany and Switzerland. Results No major problems were found with the translation process with most items easily rendered into acceptable German. Participants in the cognitive debriefing interviews found the questionnaires relevant, comprehensive and easy to complete. Psychometric analyses showed that the adaptation was successful. The three CAMPHOR scales (symptoms, activity limitations and quality of life) had excellent test-retest reliability correlations (Symptoms = 0.91; Activity limitations = 0.91; QoL = 0.90) and internal consistency (Symptoms = 0.94; Activity limitations = 0.93; QoL = 0.94). Predicted correlations with the Nottingham Health Profile provided evidence of the construct validity of the CAMPHOR scales. The CAMPHOR adaptation also showed known group validity in its ability to distinguish between participants based on perceived general health, perceived disease severity, oxygen use and NYHA classification. Conclusions The CAMPHOR has been shown to be valid and reliable in the German population and is recommend for use in clinical practice.
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Affiliation(s)
- Katharina Cima
- Department für Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinik, Innsbruck, Austria
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Pope J. Measures of systemic sclerosis (scleroderma): Health Assessment Questionnaire (HAQ) and Scleroderma HAQ (SHAQ), physician- and patient-rated global assessments, Symptom Burden Index (SBI), University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT) 2.0, Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) (Mahler's Index), Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), and Raynaud's Condition Score (RCS). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S98-111. [PMID: 22588774 DOI: 10.1002/acr.20598] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Janet Pope
- University of Western Ontario, London, Ontario, Canada.
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Predictors of Health-Related Quality of Life in Patients With Idiopathic Pulmonary Arterial Hypertension. J Hosp Palliat Nurs 2012. [DOI: 10.1097/njh.0b013e3182496c04] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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