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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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Boye KS, Stewart KD, Matza LS. Development of a Patient-Reported Outcome (PRO) Measure to Assess Emotional Impact of Treatment for Type 2 Diabetes. Diabetes Ther 2023:10.1007/s13300-023-01426-0. [PMID: 37351820 PMCID: PMC10363102 DOI: 10.1007/s13300-023-01426-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Patients receiving treatment for type 2 diabetes (T2D) may experience an emotional impact associated with treatment-related changes. A patient-reported outcome (PRO) measure assessing both positive and negative emotional impact of medication treatment for T2D is needed to better understand the patient experience of treatment. The purpose of this qualitative study was to explore the emotional impact of treatment for T2D and support the development of a questionnaire to assess the emotional impact of treatment for T2D. METHODS Exit interviews were conducted with patients with T2D participating in the SURPASS-2 and SURPASS-3 trials for tirzepatide. The exit interviews included a concept elicitation section focusing on the emotional impact of their study treatment. Results were used to develop two questionnaires that were evaluated in cognitive interviews with patients with T2D. RESULTS The concept elicitation interviews included 28 patients (mean age 57.6 years; 64.3% female). Most patients reported positive changes in emotions associated with tirzepatide, including increased confidence (n = 23; 82.1%), hope (n = 23; 82.1%), self-esteem (n = 23; 82.1%), relief (n = 22; 78.6%), optimism (n = 21; 75.0%), sense of control (n = 21; 75.0%), happiness (n = 15; 53.6%), and motivation (n = 15; 53.6%), as well as reduced worry/anxiety (n = 19; 67.9%). Negative emotional impact was less commonly reported but included frustration (n = 2; 7.1%), worry/anxiety (n = 1; 3.6%), fear (n = 1; 3.6%), and feeling depressed (n = 1; 3.6%). Two new PROs, the Emotional Impact of Diabetes Treatment Questionnaires (EIDTQ, status and comparison versions), were developed based on these finding. The status version assesses the emotional impact of current treatment, while the comparison version allows for comparison of the current treatment to a previous treatment. The questionnaires were refined on the basis of cognitive interviews with 20 additional patients (mean age 58.3 years; 60.0% female), and results suggest that the final instruments were clear, comprehensible, and relevant to patients. CONCLUSION The EIDTQ-Status and Comparison measures can be used as a supplement to clinical outcomes, such as hemoglobin A1c (HbA1c) and body weight, to provide a broader picture of the patient's emotional experience with medication treatment for T2D.
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Affiliation(s)
| | - Katie D Stewart
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Louis S Matza
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
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Brown CE, Steiner JM, Leary PJ, Curtis JR, Engelberg RA. A World of Maximalist Medicine: Physician Perspectives on Palliative Care and End-of-life for Patients With Pulmonary Arterial Hypertension. J Pain Symptom Manage 2023; 65:e329-e335. [PMID: 36521765 PMCID: PMC10023342 DOI: 10.1016/j.jpainsymman.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
CONTEXT Physicians who specialize in pulmonary arterial hypertension (PAH) care for patients facing a serious, life-limiting illness. Palliative care is underutilized in patients with PAH, and little is known about how best to provide palliative care to this patient population. OBJECTIVES Using a qualitative approach, assess physicians' perspectives on barriers and facilitators to the use of palliative care in PAH. METHODS Participants were board-certified pulmonologists and cardiologists recruited from the Pulmonary Hypertension Association's list of physician specialists and academic center websites. We performed one-on-one semi-structured interviews that were recorded, transcribed, and analyzed using thematic analysis. RESULTS Twelve physicians participated in the study, with a median age of 48.5 years and 20.5 years of clinical experience caring for patients with PAH. We identified the following themes and associated barriers and facilitators to effective implementation of palliative care for patients with PAH: a tailored approach to the individual patient; a PAH-specialist-led culture of care; effective collaboration with palliative care clinicians; and limitations imposed by health systems. CONCLUSION PAH physicians are open to palliative care for their patients and are willing to partner with palliative care clinicians to implement this effectively and in the right setting. Areas for targeted improvement in enhancing palliative care for patients with PAH exist, especially enhancing collaboration between PAH physicians and palliative care specialists and navigating barriers in health systems.
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Affiliation(s)
- Crystal E Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA; Department of Bioethics and Humanities (C.E.B.), University of Washington, Seattle, WA, USA.
| | - Jill M Steiner
- Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA; Division of Cardiology (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington, Seattle, WA, USA
| | - Peter J Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Department of Epidemiology (P.J.L.), University of Washington, Seattle, WA, USA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA
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Sakamoto H, Goda A, Tobita K, Takeuchi K, Kikuchi H, Inami T, Tamura Y, Kohno T, Yamada S, Soejima K, Satoh T. EmPHasis-10 Health-Related Quality of Life and Exercise Capacity in Chronic Thromboembolic Pulmonary Hypertension After Balloon Angioplasty. J Am Heart Assoc 2022; 11:e026400. [PMID: 36056723 PMCID: PMC9496401 DOI: 10.1161/jaha.122.026400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Whether pulmonary hemodynamic parameters and functional capacity are associated with quality of life in patients with chronic thromboembolic pulmonary hypertension remains unknown. This study aimed to evaluate disease‐specific quality of life using the emPHasis‐10 questionnaire and assess its determinants in patients with chronic thromboembolic pulmonary hypertension with normalized pulmonary hemodynamics. Methods and Results This cross‐sectional study included 187 health status assessments of 143 patients with chronic thromboembolic pulmonary hypertension (median age, 68 [58–75] years; men/women, 51/136; use of home oxygen therapy, 51 patients [27%]) after balloon pulmonary angioplasty with normalized mean pulmonary artery pressure <25 mm Hg at rest. Right heart catheterization was performed, followed by assessment of 6‐minute walk distance and the emPHasis‐10 questionnaire. The median pulmonary artery pressure and pulmonary vascular resistance were 18 (15–21) mm Hg and 2.2 (1.7–2.9) wood units, respectively. The median emPHasis‐10 score was 14 (8–24), whereas the median 6‐minute walk distance was 447 (385–517) m. Univariate linear regression analysis showed that the emPHasis‐10 score was associated with 6‐minute walk distance (β=−0.476 [95% CI −0.604, −0.348], P<0.001) and home oxygen therapy (β=0.214 [95% CI, 0.072, 0.356], P=0.003) but not with hemodynamic parameters. Multiple regression analysis revealed that a higher emPHasis‐10 score was associated with lower 6‐minute walk distance (β=−0.475 [95% CI, −0.631 to −0.319], P<0.001). Conclusions Health‐related quality of life was associated with exercise capacity and the use of home oxygen therapy, but not with hemodynamic parameters, in patients with chronic thromboembolic pulmonary hypertension and normalized hemodynamics after balloon pulmonary angioplasty. Improvements in exercise capacity may lead to further improvements in quality of life.
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Affiliation(s)
- Hayato Sakamoto
- Department of Rehabilitation Kyorin University Hospital Tokyo Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine Kyorin University Hospital Tokyo Japan
| | - Kazuki Tobita
- Department of Rehabilitation Kyorin University Hospital Tokyo Japan
| | - Kaori Takeuchi
- Department of Cardiovascular Medicine Kyorin University Hospital Tokyo Japan
| | - Hanako Kikuchi
- Department of Cardiovascular Medicine Kyorin University Hospital Tokyo Japan
| | - Takumi Inami
- Department of Cardiovascular Medicine Kyorin University Hospital Tokyo Japan
| | - Yuichi Tamura
- Pulmonary Hypertension Center International University of Health and Welfare Mita Hospital Tokyo Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine Kyorin University Hospital Tokyo Japan
| | - Shin Yamada
- Department of Rehabilitation Kyorin University Hospital Tokyo Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine Kyorin University Hospital Tokyo Japan
| | - Toru Satoh
- Department of Cardiovascular Medicine Kyorin University Hospital Tokyo Japan
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Shi Y, Dong X, Hu X, Weng L, Liu Y, Lai J, Tian Z, Zhao J, Li M, Peng J, Wang Q, Zeng X. Cross-cultural validation of the Chinese version of the EmPHasis-10 questionnaire in connective tissue disease patients with pulmonary arterial hypertension and its relationship with risk stratification. BMC Pulm Med 2022; 22:264. [PMID: 35790938 PMCID: PMC9258076 DOI: 10.1186/s12890-022-02056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUNDS The EmPHasis-10 questionnaire is a disease-specific quality of life (QoL) measurement in patients with pulmonary hypertension. We report the results of cross-cultural validation of the Chinese version of the EmPHasis-10 and its relationship with risk stratification in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). METHODS The Emphasis-10 was administered to 75 CTD-PAH patients along with the 36-item Medical Outcomes Study Short Form Survey (SF-36) and EuroQol five dimensions questionnaire (EQ-5D). The diagnosis of PAH was confirmed by right heart catheterization. Demographic and clinical data were obtained. Multivariable logistic regression was conducted based on the low risk profile assessed by a 4-strata risk assessment model (COMPERA 2.0) at follow-up. RESULTS Date from 75 patients with CTD-PAH were analysed. The EmPHasis-10 demonstrated satisfactory reliability (Cronbach α = 0.95) and convergent validity showed by the significant relationship with WHO Functional Class (P = 0.003), SF-36 (P < 0.001) and EQ-5D (P = 0.002). EmPHasis-10 was significantly associated with achieving the low risk profile at 12 months of follow-up (Odds ratio: 0.928, P = 0.029) after adjusting for WHO Functional Class. CONCLUSION EmPHasis-10 has acceptable reliability and validity in CTD-PAH patients and may serve as an additional parameter in risk stratification.
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Grants
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- 2021YFC2501301-6 The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- Z201100005520025 Beijing Municipal Science & Technology Commission
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- 2021-I2M-1-005 CAMS Innovation Fund for Medical Sciences (CIFMS)
- The Chinese National Key Technology R&D Program, Ministry of Science and Technology
- Beijing Municipal Science & Technology Commission
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Affiliation(s)
- Yue Shi
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Xingbei Dong
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Xiaoyun Hu
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1. Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Li Weng
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1. Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1. Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jinzhi Lai
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1. Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1. Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Jinmin Peng
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1. Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
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Saiki C, Kashiwado Y, Yokoyama T, Ayano M, Imabayashi K, Kawano S, Higashioka K, Kimoto Y, Fukata M, Mitoma H, Ono N, Arinobu Y, Akashi K, Horiuchi T, Niiro H. Successful transition from intravenous epoprostenol to oral selexipag and inhaled iloprost in a case of severe pulmonary arterial hypertension associated with systemic lupus erythematosus. Mod Rheumatol Case Rep 2022; 6:183-188. [PMID: 35134204 DOI: 10.1093/mrcr/rxac009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
A 25-year-old woman was admitted to our hospital with severe pulmonary arterial hypertension associated with systemic lupus erythematosus (SLE-PAH). Her mean pulmonary arterial pressure was 56 mmHg, and her SLE Disease Activity Index-2 K score was 14 on admission. In addition to a strong immunosuppressive regimen, which included steroid pulse therapy followed by high-dose oral prednisolone (1 mg/kg) and intravenous cyclophosphamide, an upfront combination of vasodilator therapy, including oral tadalafil, macitentan, and intravenous epoprostenol, was administered in the early phase. Two months later, her mean pulmonary arterial pressure was 29 mmHg, and her other haemodynamic markers showed significant improvement. She refused to start life-long intravenous epoprostenol therapy and so was switched to oral selexipag and inhaled iloprost. The transition was successful, and she has experienced no exacerbations of SLE-PAH during the 10 months since the onset of pulmonary arterial hypertension. To the best of our knowledge, this is the first report of intravenous epoprostenol being switched to alternative oral and inhaled therapy in a patient with SLE-PAH. In combination with adequate immunosuppressive therapy, it is probably easier to make this transition in patients with SLE-PAH than in those with pulmonary arterial hypertension of a different aetiology. Continuous infusion of epoprostenol can have potentially life-threatening complications and a detrimental effect on the quality of life. Our alternative treatment strategy was successful, and we hope that it will prove beneficial in other cases.
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Affiliation(s)
- Chihiro Saiki
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Yusuke Kashiwado
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Taku Yokoyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masahiro Ayano
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Keisuke Imabayashi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Shotaro Kawano
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Kazuhiko Higashioka
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Yasutaka Kimoto
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Oita, Japan
| | - Mitsuhiro Fukata
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroki Mitoma
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Nobuyuki Ono
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Yojiro Arinobu
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Oita, Japan
| | - Hiroaki Niiro
- Department of Medical Education, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Physical Activity and Its Association with Traditional Outcome Measures in Pulmonary Arterial Hypertension. Ann Am Thorac Soc 2021; 19:572-582. [PMID: 34473938 DOI: 10.1513/annalsats.202105-560oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Rationale Limitation of physical activity is a common presenting complaint for patients with pulmonary arterial hypertension (PAH). Physical activity is thought to be determined by cardiopulmonary function, yet there are limited data that investigate this relationship. Objective We aimed to study the relationship between right ventricular function and daily activity and its impact on health-related quality of life (HRQoL) in PAH. Methods Baseline data for 55 patients enrolled in PHANTOM, an ongoing multicenter randomized controlled trial of anastrozole in PAH were used. Post-menopausal women and men were eligible and underwent six-minute walk testing, echocardiography and completed HRQoL questionnaires. Each patient wore an accelerometer for 7-days. Multivariable linear regression models were used to study the association between tricuspid annular plane systolic excursion (TAPSE) and vector magnitude counts, and between daily activity and HRQoL. Principal component analysis and K-means clustering were used to identify activity-based phenotypes. K-nearest neighbors' classification was applied to an independent cross-sectional cohort from the University of Pennsylvania. Results The mean age of patients in PHANTOM was 61 years. 67% were women with idiopathic PAH as the most common etiology. A 0.4 cm increase in TAPSE was associated with an increase in daily vector magnitude counts (ß:34000, 95%CI:900-67000, p=0.004) after adjustment for age, sex, body mass index, etiology of PAH and wear time. A 1-standard deviation increase in vector magnitude counts was associated with higher six-minute walk distance (ß: 56.1 meters, 95%CI:28.6-83.7, p<0.001) and lower emPHasis-10 scores (ß:-3.3, 95%CI:0.3-6.4, p=0.03). Three activity phenotypes, low, medium, and high, were identified. The most active phenotype had greater six-minute walk distances (p=0.001) and lower emPHasis-10 scores (p=0.009) after adjustment for age, sex, body mass index, WHO functional class and parenteral prostacyclin use. Phenotypes of physical activity were reproduced in the second cohort and were independently associated with six-minute walk distance. Conclusion Better right ventricular systolic function was associated with increased levels of activity in PAH. Increased daily activity was associated with greater six-minute walk distance and better HRQoL. Distinct activity-based phenotypes may be helpful in risk stratification of PAH patients or provide novel endpoints for clinical trials.
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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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9
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Hidayati F, Gharini PPR, Hartopo AB, Anggrahini DW, Dinarti LK. The effect of oral sildenafil therapy on health-related quality of life in adults with pulmonary arterial hypertension related to uncorrected secundum atrial septal defect: a quasi experimental study. Health Qual Life Outcomes 2020; 18:278. [PMID: 32795300 PMCID: PMC7427875 DOI: 10.1186/s12955-020-01498-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessment of health-related quality of life (HRQoL) are often measured as an important patient-reported outcome (PRO) in clinical studies. Pulmonary arterial hypertension (PAH) is a common complication of atrial septal defect (ASD). This study aimed to compare the HRQoL of PAH related uncorrected secundum ASD at pre and post therapy with oral sildenafil therapy. METHODS We conducted quasi experimental study at Sardjito General Hospital Yogyakarta since April 2016 to August 2017. Adults with PAH related uncorrected secundum ASD, listed on Congenital Heart Disease and Pulmonary Hypertension (COHARD-PH) registry, and met the inclusion and exclusion criteria were recruited as subject. Interview was done at pre and 12 weeks post oral sildenafil therapy 3 × 20 mg using the EQ-5D-3L questionnaire. Statistical analysis was done using Wilcoxon test and paired T-test to determine the differences of EQ-5D utility and EQ-VAS score at pre and post therapy. RESULTS A total of 18 adult patients with PAH related to uncorrected secundum ASD were enrolled in this study (83.33% female; mean age 38.72 ± 10.81 years old). The most frequent reported problems pre therapy were pain/discomfort (83%) and anxiety/depression (78%). Wilcoxon test showed the median of EQ-5D utility score were increased after sildenafil therapy (before = 0.604, after = 0.664; Z = - 2703; p:0.007), respectively. Meanwhile, the paired T-test results showed an increase of EQ-VAS mean difference 6.67 ± 8.75 (p:0.005; 95% CI 2.32-11.02) after sildenafil therapy. CONCLUSION The administration of oral sildenafil therapy 3 × 20 mg during 12 weeks in adult patients with PAH related uncorrected secundum ASD gives better HRQoL.
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Affiliation(s)
- Fera Hidayati
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia.
| | - Putrika P R Gharini
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Anggoro Budi Hartopo
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Dyah Wulan Anggrahini
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Lucia Kris Dinarti
- Cardiology and Vascular Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Helgeson SA, Menon D, Helmi H, Vadlamudi C, Moss JE, Zeiger TK, Burger CD. Psychosocial and Financial Burden of Therapy in USA Patients with Pulmonary Arterial Hypertension. Diseases 2020; 8:diseases8020022. [PMID: 32545763 PMCID: PMC7349780 DOI: 10.3390/diseases8020022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/16/2022] Open
Abstract
Abstract: Pulmonary arterial hypertension (PAH) is a devastating disease with significant morbidity and mortality. There are many psychosocial and financial implications of this disease; however, little is known how this affects the treatment of PAH patients. A questionnaire-based prospective cohort study was performed on 106 PAH patients from a Pulmonary Hypertension Center and the Pulmonary Hypertension Association national conference in 2018. The demographic, treatment, psychosocial, employment, financial impact on treatment data was obtained. The majority of patients had cardiopulmonary symptoms despite treatment. The symptoms affected their social and work lives, with about one in three applying for disability because of their PAH. The majority of PAH patients had insurance coverage, but still noted a significant financial burden of the disease, with nearly a half who needed financial assistance to pay for their PAH medications. Thirty (28.3%; 95% CI, 20.6-37.5%) patients mentioned they changed their medication regimen, with some skipping doses outright (28 [26.4%; 95% CI, 19-35.6%]) in order to save money. PAH continues to cause significant psychosocial and financial burden on patients despite advances in medications. This impact ranged from dissatisfaction with quality of life, to unemployment, to altering their medication regimen to save money.
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Affiliation(s)
- Scott A. Helgeson
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (C.V.); (J.E.M.); (T.K.Z.); (C.D.B.)
- Correspondence:
| | - Divya Menon
- Department of Pulmonary and Critical Care Medicine, Tufts Medical Center, Boston, MA 02111, USA;
| | - Haytham Helmi
- Department of Emergency Medicine, University of Florida, Jacksonville, FL 32224, USA;
| | - Charitha Vadlamudi
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (C.V.); (J.E.M.); (T.K.Z.); (C.D.B.)
| | - John E. Moss
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (C.V.); (J.E.M.); (T.K.Z.); (C.D.B.)
| | - Tonya K. Zeiger
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (C.V.); (J.E.M.); (T.K.Z.); (C.D.B.)
| | - Charles D. Burger
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (C.V.); (J.E.M.); (T.K.Z.); (C.D.B.)
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Rohm I, Grün K, Müller LM, Bäz L, Förster M, Schrepper A, Kretzschmar D, Pistulli R, Yilmaz A, Bauer R, Jung C, Berndt A, Schulze PC, Franz M. Cellular inflammation in pulmonary hypertension: Detailed analysis of lung and right ventricular tissue, circulating immune cells and effects of a dual endothelin receptor antagonist. Clin Hemorheol Microcirc 2020; 73:497-522. [PMID: 31156142 DOI: 10.3233/ch-180529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Growing evidence suggests that inflammation is crucially involved in the pathogenesis of pulmonary hypertension (PH) and consecutive right heart failure. The present study analyzed the inflammatory response in lung and right ventricle in a rat model of PH and evaluated the effects of the dual endothelin receptor antagonist (ERA) Macitentan. PH was induced by monocrotalin (60 mg/kg body weight s.c.) in Sprague-Dawley rats (PH, n = 10) and compared to healthy controls (CON, n = 10) as well as monocrotalin-induced, macitentan-treated rats (THER, n = 10). Detection of Dendritic cells (DCs), regulatory T cells (Tregs) and others as well as RT-PCR based inflammatory gene expression analysis were performed. Circulating DCs and Tregs were quantified by flow cytometry in the rat model and in PH patients (n = 70) compared to controls (n = 52). Inflammatory cells were increased in lung and right ventricular tissue, whereas DCs and Tregs were decreased in blood. Expression of 17 genes in the lung and 20 genes in the right ventricle were relevantly (>2.0 fold) regulated in the PH group. These effects were, at least in part, attenuated in response to Macitentan treatment. In humans as well as rats, immune cells showed significant correlations to clinical, echocardiographic, and haemodynamic parameters. PH is accompanied by a distinct inflammatory response in lung and right but not left ventricular tissue attenuated by Macitentan. Correlations of circulating DCs as well as tissue resident immune cells with parameters reflecting right ventricular function raise the idea of both, promising biomarkers and novel treatment strategies.
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Affiliation(s)
- Ilonka Rohm
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Katja Grün
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Linda Marleen Müller
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Laura Bäz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Martin Förster
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Andrea Schrepper
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Rudin Pistulli
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Atilla Yilmaz
- Department of Internal Medicine II, Division of Cardiology, Elisabeth Klinikum Schmalkalden, Schmalkalden, Germany
| | - Reinhard Bauer
- Institute of Molecular Cell Biology, Center for Molecular Biomedicine, Jena University Hospital, Jena, Germany
| | - Christian Jung
- Department of Internal Medicine, Division of Cardiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Alexander Berndt
- Institute of Pathology, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
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Takeyasu R, Tamura Y, Abe K, Goda A, Satoh T, Suda R, Tanabe N, Tsujino I, Yamazaki T, Tatsumi K. Psychometric Validation of a Japanese Version of the emPHasis-10 Questionnaire, a Patient-Reported Outcome Measure for Pulmonary Hypertension - Multicenter Study in Japan. Circ Rep 2020; 2:255-259. [PMID: 33693238 PMCID: PMC7921356 DOI: 10.1253/circrep.cr-20-0014] [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: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The emPHasis-10 questionnaire is a disease-specific patient-reported outcome assessment of quality of life (QOL) in pulmonary hypertension (PH). The aim of this study was to psychometrically validate a linguistically validated Japanese version of the emPHasis-10. Methods and Results: Japanese patients with PH (age ≥18 years) and no change in functional status, or initiation or change in PH-specific treatment during the past 3 months were recruited from 5 institutions from August 2018 to July 2019. A set of questionnaires was administered twice. The validity and reliability of the emPHasis-10 were assessed using the data of 76 patients. On concurrent validity analysis, a moderate-to-strong correlation was seen with the total score of all 5 external criteria (the Minnesota Living with Heart Failure modified for PH [MLHFQ-PH], Hospital Anxiety and Depression Scale, Dyspnea-12 questionnaire, European Quality of Life-5 Dimensions questionnaire [EQ-5D], and 6-min walk test), with a notably strong correlation with the MLHFQ-PH (0.77) and EQ-5D (-0.64). On known-group validity, a linear increasing trend of the emPHasis-10 score was observed across 4 World Health Organization functional status groups (Jonckheere-Terpstra test, 1-sided, P<0.001). Intraclass correlation coefficient for test-retest reliability was 0.86, and the Cronbach's α for internal consistency was 0.89. Conclusions: The Japanese emPHasis-10 questionnaire is psychometrically valid to evaluate QOL in Japanese PH patients in a clinical setting.
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Affiliation(s)
- Rika Takeyasu
- Graduate School of Public Health, International University of Health and Welfare Tokyo Japan
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Tokyo Japan
| | - Yuichi Tamura
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Tokyo Japan
- Department of Cardiology, International University of Health and Welfare School of Medicine Narita Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University Fukuoka Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University School of Medicine Tokyo Japan
| | - Toru Satoh
- Department of Cardiovascular Medicine, Kyorin University School of Medicine Tokyo Japan
| | - Rika Suda
- Department of Respirology, Graduate School of Medicine, Chiba University Chiba Japan
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University Chiba Japan
- Department of Respirology, Pulmonary Hypertension Center, Saiseikai Narashino Hospital Narashino Japan
| | - Ichizo Tsujino
- Internal Medicine I, Hokkaido University Hospital Sapporo Japan
| | - Tsutomu Yamazaki
- Innovation and Research Support Center, International University of Health and Welfare Tokyo Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University Chiba Japan
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Quality of Life is Related to Haemodynamics in Precapillary Pulmonary Hypertension. Heart Lung Circ 2020; 29:142-148. [DOI: 10.1016/j.hlc.2018.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/10/2018] [Indexed: 01/08/2023]
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Abstract
Historically, pulmonary arterial hypertension (PAH) has been considered a disease of young adults, but over the last three decades, the average age at diagnosis has increased, presenting clinicians with some unique challenges. Clinical symptoms of PAH, including shortness of breath and reduced functional capacity, are not specific for the disease and may be present in older patients because of their age or as a result of comorbid conditions. Eliminating other causes for these symptoms can delay PAH diagnosis and initiation of PAH-specific treatment compared with younger patients. Currently, there are no specific guidelines relating to PAH in older patients and existing guidelines for identifying patients at potential risk of PAH may not be appropriate for patients aged over 65 years. Even though older patients tend to be diagnosed with more advanced symptoms, and evidence suggests that they are less responsive to PAH-specific therapies, treatment is often less aggressive than in younger patients. Even after adjusting for age, survival rates remain disproportionately lower in the older vs. younger PAH populations. Specific guidelines for diagnosis and treatment of older patients with PAH are needed to improve care and outcomes in this growing population. This review aims to assess the challenges associated with diagnosing and managing PAH in older patients, based on literature searches, authors' experiences, and expert opinions.
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Affiliation(s)
- Olivier Sitbon
- Hôpital Universitaire de Bicêtre, Université Paris-Sud, Paris, France
| | - Luke Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, W12 0HS, UK
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15
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Hirashiki A, Adachi S, Okumura N, Nakano Y, Shimokata S, Shimizu A, Arai H, Toba K, Murohara T, Kondo T. Medium-term health-related quality of life in patients with pulmonary arterial hypertension treated with goal-oriented sequential combination therapy based on exercise capacity. Health Qual Life Outcomes 2019; 17:103. [PMID: 31200710 PMCID: PMC6570916 DOI: 10.1186/s12955-019-1178-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/10/2019] [Indexed: 11/14/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) remains a life-threatening condition, despite modern therapies. We prospectively investigated the therapeutic health-related quality of life (HRQOL) effects of goal-oriented sequential combination therapy based on exercise capacity in patients newly diagnosed with PAH. Methods To examine the changes in HRQOL in PAH patients, we treated 30 patients newly diagnosed with PAH with goal-oriented sequential combination therapy based on exercise capacity. We monitored exercise capacity by cardiopulmonary exercise testing and observed the benefit of using a peak VO2 cut-off of 15 mL/kg/min to guide combination therapy. First-line treatment was an endothelin receptor antagonist (ERA); second-line treatment was the addition of a phosphodiesterase-5 inhibitor (PDE-5I). At baseline and at 3, 6, and 12 months, HRQOL was evaluated by using the eight-item Medical Outcomes Survey Short Form Health Survey. Results At 12 months, 100% of PAH patients were receiving an ERA, and 82% an ERA + PDE-5I. The mean physical component summary (PCS) score was 33.5 at baseline, 41.2 at 3 months, 40.8 at 6 months, and 42.0 at 12 months, and the mean mental component summary (MCS) scores were 45.6, 47.0, 50.0, and 50.1, respectively. PCS score was significantly greater at 3 months than at baseline (P = 0.035). MCS score was comparable at 3 months and at baseline, but was significantly greater at 6 and 12 months than at baseline (P = 0.033, P = 0.028, respectively). Thus, PCS score improved soon after initiation of therapy, and MCS score improved later. Conclusions Together, these results suggest that goal-oriented sequential combination therapy based on exercise capacity improves HRQOL in patients with PAH.
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Affiliation(s)
- Akihiro Hirashiki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8560, Japan. .,Department of Cardiology, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, Morioka, 474-8511, Japan.
| | - Shiro Adachi
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya, 466-8560, Japan
| | - Naoki Okumura
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya, 466-8560, Japan
| | - Yoshihisa Nakano
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8560, Japan
| | - Shigetake Shimokata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8560, Japan
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, Morioka, 474-8511, Japan
| | - Hidenori Arai
- Department of Cardiology, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, Morioka, 474-8511, Japan
| | - Kenji Toba
- Department of Cardiology, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, Morioka, 474-8511, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8560, Japan
| | - Takahisa Kondo
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya, 466-8560, Japan
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Reis A, Santos M, Furtado I, Cruz C, Sa-Couto P, Queirós A, Almeida L, Rocha N. Disability and its clinical correlates in pulmonary hypertension measured through the World Health Organization Disability Assessment Schedule 2.0: a prospective, observational study. ACTA ACUST UNITED AC 2019; 45:e20170355. [PMID: 31166372 PMCID: PMC6733722 DOI: 10.1590/1806-3713/e20170355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 08/12/2018] [Indexed: 11/22/2022]
Abstract
Objective: To characterise the degree of disability in pulmonary hypertension (PH) patients based on the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Method: A prospective and observational study of patients with documented PH (N = 46). Patients completed the WHODAS 2.0 questionnaire during a scheduled routine clinical visit, and their demographic and clinical characteristics were retrieved from electronic medical records (EMR). In subsequent visits, selected clinical variables were registered to assess disease progression. Results: WHODAS 2.0 scores were indicative of mild to moderate disability for the domains of mobility (22.0 ± 23.2), life activities (23.7 ± 25.5), and participation in society (17.2 ± 15.9), as well as total WHODAS 2.0 score (15.3 ± 15.2). For the domains of cognition (9.1 ± 14.1), self-care (8.3 ± 14.4), and interpersonal relationships (11.7 ± 15.7), scores were lower. Disability scores were, generally, proportional to the PH severity. The main baseline correlates of disability were World Health Organisation (WHO) functional class, fatigue, dyspnoea, 6-minute walking distance (6MWD), and N-terminal pro b-type natriuretic peptide (NTproBNP). Baseline WHODAS 2.0 scores showed significant associations with disease progression. However, this effect was not transversal to all domains, with only a few domains significantly associated with disease progression variables. Conclusions: This PH population shows mild disability, with higher degree of disability in the domains of mobility and life activities. This study is the first one to assess disability in PH using WHODAS 2.0. Further studies should apply this scale to larger PH populations with suitable representations of more severe PH forms.
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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
| | - 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
| | - Pedro Sa-Couto
- . Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Alexandra Queirós
- . School of Health, University of Aveiro, Aveiro, Portugal.,. Institute of Electronics and Telematics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | - Luís Almeida
- . MedInUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nelson Rocha
- . Institute of Electronics and Telematics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal.,. Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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McGoon MD, Ferrari P, Armstrong I, Denis M, Howard LS, Lowe G, Mehta S, Murakami N, Wong BA. The importance of patient perspectives in pulmonary hypertension. Eur Respir J 2019; 53:13993003.01919-2018. [PMID: 30545977 PMCID: PMC6351339 DOI: 10.1183/13993003.01919-2018] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 12/19/2022]
Abstract
The assessment of objective measurement of cardiopulmonary status has helped us achieve better clinical outcomes for patients and develop new therapies through to the point of market access; however, patient surveys indicate that more can be done to improve holistic care and patient engagement. In this multidisciplinary review, we examine how clinical teams can acknowledge and embrace the individual patient's perspective, and thus improve the care for individual patients suffering from pulmonary hypertension by cultivating the importance and relevance of health-related quality of life in direct clinical care. At the individual level, patients should be provided with access to accredited specialist centres which provide a multidisciplinary approach where there is a culture focused on narrative medicine, quality of life, shared decision making and timely access to palliative care, and where there is participation in education. On a larger scale, we call for the development, expansion and promotion of patient associations to support patients and carers, lobby for access to best care and treatments, and provide input into the development of clinical trials and registries, focusing on the patients’ perspective. Analysis and discussion on the importance of patients' perspectives in pulmonary hypertensionhttp://ow.ly/edOt30mgYoI
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Affiliation(s)
- Michael D McGoon
- Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Pisana Ferrari
- Pulmonary Hypertension Association Europe, Vienna, Austria
| | | | | | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gabi Lowe
- Jenna Lowe Trust, Republic of South Africa
| | - Sanjay Mehta
- London Health Sciences Centre, Division of Respirology, Dept of Medicine, Schulich School of Medicine, Western University and Pulmonary Hypertension Association Canada, London, ON, Canada
| | | | - Brad A Wong
- Pulmonary Hypertension Association, Silver Spring, MD, USA
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Ivarsson B, Hesselstrand R, Rådegran G, Kjellström B. Health-related quality of life, treatment adherence and psychosocial support in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. Chron Respir Dis 2018; 16:1479972318787906. [PMID: 30011997 PMCID: PMC6302968 DOI: 10.1177/1479972318787906] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension
(CTEPH) share similar quality of life impairment. The aim of the present study was to
investigate health-related quality of life (HRQoL) and its relation to the perception of
treatment and psychosocial support among PAH and CTEPH patients. All adult PAH or CTEPH
patients in the Swedish Pulmonary Arterial Hypertension Register were invited to
participate in a national cohort survey. The survey included the EuroQol 5-dimensions
(EQ-5D) instrument that measures an individual’s HRQoL; the Beliefs about Medicines
Questionnaire-Specific Scale that assesses the perception of PAH-specific treatment; the
Mastery scale that evaluates the feeling of control and ability to cope with the disease;
and the Social Network and Support Scale that maps the social support network. Of the 440
invited patients, 74% responded. Mean age was 66 ± 14 years, 58% were female and 69%
diagnosed with PAH. Patients with PAH were younger, more often female and had a lower
EQ-5D index (0.67 ± 0.29 vs. 0.73 ± 0.25, p = 0.050) than patients with
CTEPH. Patients with a low EQ-5D index had more concerns about treatment
(p = 0.004), lower coping ability (p < 0.001), less
emotional support (p = 0.003) and less accessible social network
(p = 0.002). In conclusion, patients with an impaired HRQoL also
reported negative effects on their social support network, ability to handle stressors and
concerns about treatment.
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Affiliation(s)
- Bodil Ivarsson
- 1 Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,2 Department of Cardiothoracic Surgery/THAI, Skåne University Hospital, Lund, Sweden
| | - Roger Hesselstrand
- 1 Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,3 Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Göran Rådegran
- 1 Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,4 The Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Barbro Kjellström
- 5 Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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19
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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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Chia KSW, Wong PKK, Faux SG, McLachlan CS, Kotlyar E. The benefit of exercise training in pulmonary hypertension: a clinical review. Intern Med J 2017; 47:361-369. [DOI: 10.1111/imj.13159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/27/2016] [Accepted: 06/08/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Karen S. W. Chia
- Department of Medicine; University of New South Wales Rural Clinical School; Coffs Harbour New South Wales Australia
- Department of Medicine; Coffs Harbour Health Campus; Coffs Harbour New South Wales Australia
| | - Peter K. K. Wong
- Department of Medicine; University of New South Wales Rural Clinical School; Coffs Harbour New South Wales Australia
- Department of Medicine; Coffs Harbour Health Campus; Coffs Harbour New South Wales Australia
- Mid-North Coast Arthritis Clinic; Coffs Harbour New South Wales Australia
| | - Steven G. Faux
- Department of Rehabilitation, Sacred Heart Rehabilitation; St Vincent's Health; Sydney New South Wales Australia
- Department of Medicine; University of New South Wales; Sydney New South Wales Australia
- Department of Medicine; St Vincent's Hospital; Sydney New South Wales Australia
| | - Craig S. McLachlan
- Department of Medicine; University of New South Wales Rural Clinical School; Coffs Harbour New South Wales Australia
| | - Eugene Kotlyar
- Department of Medicine; University of New South Wales; Sydney New South Wales Australia
- Department of Medicine; St Vincent's Hospital; Sydney New South Wales Australia
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21
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Mehta S, Sastry BKS, Souza R, Torbicki A, Ghofrani HA, Channick RN, Delcroix M, Pulido T, Simonneau G, Wlodarczyk J, Rubin LJ, Jansa P, Hunsche E, Galiè N, Perchenet L, Sitbon O. Macitentan Improves Health-Related Quality of Life for Patients With Pulmonary Arterial Hypertension. Chest 2017; 151:106-118. [DOI: 10.1016/j.chest.2016.08.1473] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/29/2016] [Accepted: 08/24/2016] [Indexed: 01/22/2023] Open
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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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24
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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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Okumus G, Aslan GK, Arseven O, Ongen G, Issever H, Kiyan E. The role of an activity monitor in the objective evaluation of patients with pulmonary hypertension. CLINICAL RESPIRATORY JOURNAL 2016; 12:119-125. [PMID: 27149246 DOI: 10.1111/crj.12495] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/02/2016] [Accepted: 04/28/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients with pulmonary hypertension (PH) show no symptoms at rest, but symptoms are triggered by physical activities. OBJECTIVES The primary aim of our study was to assess physical activity of patients with PH by using an activity monitor. The secondary aim was to evaluate the correlation between the activity monitor parameters and 6-min walk distance (6MWD), activity of daily living (ADL), quality of life, WHO functional class and PH classification. METHODS Thirty-eight patients with pulmonary arterial hypertension (PAH) and seven patients with chronic thromboembolic PH were included in the study. Physical activity was assessed using a SenseWear arm band. A 6-min walk test was performed. Daily living activities were assessed using the 'nottingham extended activity of daily living index' (NEADL). For quality of life assessments, 'Minnesota living with heart failure' (MLHF) and 'Short form-36' (SF-36) surveys were used. RESULTS Physical activity, exercise capacity, quality of life and contribution to ADL were lower in patients with PH. These data were associated with the 6MWD, quality of life and ADL index scores. We also found weak and moderate correlations between activity monitor data and SF-36 sub-group scores, MLHF and NEADL scores (P < 0.05). For the group with PAH, idiopathic PAH patients had more exercise capacity and total energy expenditure compared with patients with scleroderma-associated PAH. CONCLUSION Correlation between activity monitor data and 6MWD, most of SF-36 sub-group scores, MLHF scores and NEADL index scores suggest that activity monitor can be used in the evaluation of patients with PH.
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Affiliation(s)
- Gulfer Okumus
- Department of Chest Disease, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Goksen Kuran Aslan
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Orhan Arseven
- Department of Chest Disease, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gul Ongen
- Department of Chest Disease, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halim Issever
- Department of Public Health, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esen Kiyan
- Department of Chest Disease, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Kukkonen M, Puhakka A, Halme M. Quality of life among pulmonary hypertension patients in Finland. Eur Clin Respir J 2016; 3:26405. [PMID: 26787306 PMCID: PMC4718930 DOI: 10.3402/ecrj.v3.26405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/27/2015] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of the study was to examine pulmonary hypertension (PH) patients’ quality of life (QOL) for the first time in Finland. Methods This was a non-interventional, cross-sectional study. The SF-36v2 questionnaire was sent to the PH patients who had been referred to or followed up on at the Helsinki University Central Hospital's pulmonary clinic for idiopathic pulmonary arterial hypertension, associated pulmonary arterial hypertension (APAH), or chronic thromboembolic PH (CTEPH). The patients were on pulmonary arterial hypertension (PAH) – specific drugs, were at least 18 years old, and had signed an informed consent. Results There were 62 patients who fulfilled the inclusion criteria, and 53% of respondents rated their health as moderate. Similarly, 55% of respondents rated their health status approximately the same compared to their situation 1 year ago. QOL was impaired in all other subscales, except for the mental health and mental component score. A majority of patients suffered from PH symptoms, which worsened their QOL. The greatest impact on their QOL was associated with a high World Health Organization (WHO) functional class (FC), poor performance in a 6-min walking test (6MWT), symptoms, oxygen therapy, elevated pro-brain natriuretic peptide, pericardial effusion, APAH etiology, and being retired from work. Conclusions The respondents had a reduced QOL, compared to the general population, in all other subscales, except for mental health. APAH patients had the worst QOL. Good results in functional capacity measures (WHO FC, 6MWT) were associated with a better QOL. Patients’ QOL can be improved by reducing the symptoms of PAH.
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Affiliation(s)
- Merja Kukkonen
- Department of Pulmonary Diseases, Helsinki University Central Hospital, Helsinki, Finland;
| | - Airi Puhakka
- Actelion Pharmaceuticals Sverige AB filial Finland, Espoo, Finland
| | - Maija Halme
- Department of Pulmonary Diseases, Helsinki University Central Hospital, Helsinki, Finland
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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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Talwar A, Sahni S, Kim EJ, Verma S, Kohn N. Dyspnea, depression and health related quality of life in pulmonary arterial hypertension patients. J Exerc Rehabil 2015; 11:259-65. [PMID: 26535216 PMCID: PMC4625654 DOI: 10.12965/jer.150230] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/01/2015] [Indexed: 01/22/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare and devastating disease which is characterized by worsening dyspnea and exercise tolerance. These patients are often found to have concomitant, depression, anxiety and impaired health-related quality of life (HRQOL). The interrelationship of dyspnea, depression and HRQOL in these patients is not well studied. Retrospective analysis was performed on 46 PAH patients (mean age 51.73). Patients completed Medical Outcomes Study Short - Form 36 V2 (SF-36) to measure HRQOL, Modified Medical Research Council (mMRC) Dyspnea Scale and Zung Depression Scale (ZDS). Physical Health Composite Scores (PCS) and Mental Health Composite Scores (MCS) were derived from SF-36. Spearman’s correlation was computed to determine degree of correlation between pairs of scales. 46 patients (12 males, 34 females; median age 51.4 yr) with confirmed PAH were considered for the study of which 36 patients (9 males, 27 females, median age 50.1 yr), were eligible for further analysis. MMRC Dyspnea Scale Score was 1.0 (Q1 to Q3:1.0 to 2.0). Median MCS was 52.1 (Q1 to Q3:41.7 to 57.1) and PCS was 37.9 (Q1 to Q3: 30.7 to 49.6). There was a significant negative correlation between dyspnea and PCS (r =−0.660, P<0.0001) and MCS (r =−0.342, P<0.0411). The ZDS was available for 17 of these patients; their median score was 42.0 (Q1 to Q3: 33.0 to 46.0). There was a significant correlation between the ZDS and PCS (r =−0.578, P<0.0150,) MCS (r =−0.752, P<0.0005). Patients with PAH suffer from diminished HRQOL correlating with their dyspnea and underlying depression.
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Affiliation(s)
- Arunabh Talwar
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, New Hyde Park, NY, USA ; Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Sonu Sahni
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, New Hyde Park, NY, USA ; Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Eun Ji Kim
- North Shore-Long Island Jewish Health System, Department of Medicine, Manhasset, NY, USA
| | - Sameer Verma
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, New Hyde Park, NY, USA ; Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Nina Kohn
- Feinstein Institute for Medical Research, Manhasset, NY, USA
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29
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Torres DDFM, Zin WA, Lopes AJ, Vigário PDS, Garcia MI, Waetge D, Bandeira MLDS, Bessa LGP, Guimarães FS. Association Between Hemodynamic Profile, Physical Capacity and Quality of Life in Pulmonary Hypertension. Arq Bras Cardiol 2015; 104:387-93. [PMID: 25742419 PMCID: PMC4495453 DOI: 10.5935/abc.20150012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 10/02/2014] [Indexed: 01/19/2023] Open
Abstract
Background No studies have described and evaluated the association between hemodynamics,
physical limitations and quality of life in patients with pulmonary
hypertension (PH) without concomitant cardiovascular or respiratory
disease. Objective To describe the hemodynamic profile, quality of life and physical capacity of
patients with PH from groups I and IV and to study the association between
these outcomes. Methods Cross-sectional study of patients with PH from clinical groups I and IV and
functional classes II and III undergoing the following assessments:
hemodynamics, exercise tolerance and quality of life. Results This study assessed 20 patients with a mean age of 46.8 ± 14.3 years.
They had pulmonary capillary wedge pressure of 10.5 ± 3.7 mm Hg,
6-minute walk distance test (6MWDT) of 463 ± 78 m, oxygen consumption
at peak exercise of 12.9 ± 4.3 mLO2.kg-1.min-1 and scores of quality
of life domains < 60%. There were associations between cardiac index (CI)
and ventilatory equivalent for CO2 (r=-0.59, p <0.01), IC and ventilatory
equivalent for oxygen (r=-0.49, p<0.05), right atrial pressure (RAP) and
'general health perception' domain (r=-0.61, p<0.01), RAP and 6MWTD
(r=-0.49, p<0.05), pulmonary vascular resistance (PVR) and 'physical
functioning' domain (r=-0.56, p<0.01), PVR and 6MWTD (r=-0.49, p<0.05)
and PVR index and physical capacity (r=-0.51, p<0.01). Conclusion Patients with PH from groups I and IV and functional classes II and III
exhibit a reduction in physical capacity and in the physical and mental
components of quality of life. The hemodynamic variables CI, diastolic
pulmonary arterial pressure, RAP, PVR and PVR index are associated with
exercise tolerance and quality of life domains.
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Affiliation(s)
| | - Walter Araujo Zin
- Laboratório de Fisiologia da Respiração, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Agnaldo José Lopes
- Laboratório de Função Pulmonar, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Patrícia dos Santos Vigário
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | - Marcelo Iorio Garcia
- Serviço de Cardiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniel Waetge
- Serviço de Pneumologia, Ambulatório de Hipertensão Pulmonar, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcelo Luiz da Silva Bandeira
- Serviço de Cardiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luiz Gustavo Pignataro Bessa
- Serviço de Cardiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernando Silva Guimarães
- Laboratório de Fisiologia da Respiração, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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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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A Predictive Model of the Effects of Depression, Anxiety, Stress, 6-Minute-Walk Distance, and Social Support on Health-Related Quality of Life in an Adult Pulmonary Hypertension Population. CLIN NURSE SPEC 2015; 29:22-8. [DOI: 10.1097/nur.0000000000000099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Rival G, Lacasse Y, Martin S, Bonnet S, Provencher S. Effect of Pulmonary Arterial Hypertension-Specific Therapies on Health-Related Quality of Life. Chest 2014; 146:686-708. [DOI: 10.1378/chest.13-2634] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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M M Vanhoof J, Delcroix M, Vandevelde E, Denhaerynck K, Wuyts W, Belge C, Dobbels F. Emotional symptoms and quality of life in patients with pulmonary arterial hypertension. J Heart Lung Transplant 2014; 33:800-8. [PMID: 24854567 DOI: 10.1016/j.healun.2014.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/05/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited evidence exists on the nature and degree of emotional problems in pulmonary arterial hypertension (PAH) and their association with patients' health-related quality of life (HRQOL). METHODS This cross-sectional study examined the presence of depression, anxiety, and stress symptoms, and their association with disease-specific and generic HRQOL. A total of 101 patients (73% women) with PAH (age, 55.4 ± 16.4 years; 42.6% in New York Heart Association [NYHA] class II) completed the Depression, Anxiety, and Stress Scale, the generic Medical Outcomes Study Short-Form 36-Item (SF-36) Health Survey, and the disease-specific Minnesota Living With Heart Failure Questionnaire (MLHFQ) HRQOL instrument. The association between emotional problems and HRQOL was determined using multivariable linear regression analyses, controlling for demographic and disease-related characteristics. RESULTS Of the patients, 32.6%, 48%, and 27.6% experienced depressive, anxiety or stress symptoms, respectively. HRQOL was >1 standard deviation below population norms for the SF-36 Physical Component Summary. Depressive symptoms, NYHA class, and being disabled explained 46% of the total variance of the MLHFQ. Emotional problems did not contribute to the SF-36 Physical Component Summary but explained part of the variance of the physical sub-scales of the SF-36 role limitations due to physical problems, bodily pain, and general health. CONCLUSIONS The high presence of emotional problems warrants regular screening and appropriate psychotherapeutic and/or pharmacological treatment. Which strategies could improve PAH patients' HRQOL remains to be investigated.
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Affiliation(s)
- Jasper M M Vanhoof
- Health Services and Nursing Research, Department of Public Health and Primary Care
| | - Marion Delcroix
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Ellen Vandevelde
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | | | - Wim Wuyts
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Catharina Belge
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Fabienne Dobbels
- Health Services and Nursing Research, Department of Public Health and Primary Care.
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Yorke J, Armstrong I. The assessment of breathlessness in pulmonary arterial hypertension: Reliability and validity of the Dyspnoea-12. Eur J Cardiovasc Nurs 2013; 13:506-14. [DOI: 10.1177/1474515113514891] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Breathlessness is a cardinal symptom of pulmonary arterial hypertension (PAH); yet no breathlessness instrument has been previously tested for reliability and validity for this population. Using a cross-sectional design, we tested the psychometric properties of the Dyspnoea-12 (D-12), for the assessment of breathlessness in PAH. Pearson’s correlations with World Health Organization functional class (WHO FC), Minnesota Living with Heart failure – pulmonary hypertension modified version (MLHF-PH), Hospital Anxiety and Depression scale (HADS) and 6-minute walk distance test (6MWD) were conducted. Participants ( n = 176) were mostly female (70.5%), mean age 54.3±14 years; diagnosed with idiopathic PAH (48.9%), congenital heart disease (27.8%) and connective tissue disease (23.3%); and most were WHO FC II (32.4%) and III (52.3%). The D-12 showed excellent internal consistency for the total and two-component scores for physical and emotional (Cronbach’s α 0.95, 0.93 and 0.94, respectively). D-12 total score was significantly associated with MLHF-PH ( r = 0.70), HADS (anxiety r = 0.54 and depression r = 0.68), WHO FC ( r = 0.49), and 6MWD ( r = -0.26). In patients with PAH, the D-12 - a short patient reported measure of breathlessness severity that taps the physical and emotional components, is a reliable and valid instrument.
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Affiliation(s)
| | - Iain Armstrong
- Pulmonary Vascular Unit, Royal Hallamshire Hospital, Sheffield, UK
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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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Bourge RC, Tapson VF, Safdar Z, Benza RL, Channick RN, Rosenzweig EB, Shapiro S, White RJ, McSwain CS, Gotzkowsky SK, Nelsen AC, Rubin LJ. Rapid transition from inhaled iloprost to inhaled treprostinil in patients with pulmonary arterial hypertension. Cardiovasc Ther 2013; 31:38-44. [PMID: 22970909 PMCID: PMC3561685 DOI: 10.1111/1755-5922.12008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Inhaled treprostinil is a prostacyclin analog approved for the treatment of pulmonary arterial hypertension (PAH) that may provide a more convenient treatment option for patients receiving inhaled iloprost while maintaining the clinical benefit of inhaled prostacyclin therapy. Aims In this open-label safety study, 73 PAH patients were enrolled with primarily World Health Organization Class II (56%) or III (42%) symptoms. At baseline, most patients (93%) were receiving 5 μg of iloprost per dose but 38% of patients reported a dosing frequency below the labeled rate of 6–9 times daily. Patients initiated inhaled treprostinil at 3 breaths four times daily (qid) at the immediate next scheduled iloprost dose. The primary objective was to assess the safety of rapid transition from iloprost to inhaled treprostinil; clinical status and quality of life were also assessed. Results Most patients (84%) achieved the target treprostinil dose of 9 breaths qid and remained on study until transition to commercial therapy (89%). The most frequent adverse events (AEs) were cough (74%), headache (44%), and nausea (30%), and five patients prematurely discontinued study drug due to AE (n = 3), disease progression (n = 1), or death (n = 1). At week 12, the time spent on daily treatment activities was reduced compared to baseline, with a mean total savings of 1.4 h per day. Improvements were also observed at week 12 for 6-min walk distance (+16.0; P < 0.001), N-terminal pro-B-type natriuretic peptide (−74 pg/mL; P = 0.001), and the Cambridge Pulmonary Hypertension Outcome Review (all domains P < 0.001). Conclusions Pulmonary arterial hypertension patients can be safely transitioned from inhaled iloprost to inhaled treprostinil while maintaining clinical status.
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Affiliation(s)
- Robert C Bourge
- University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Halank M, Einsle F, Lehman S, Bremer H, Ewert R, Wilkens H, Meyer FJ, Grünig E, Seyfarth HJ, Kolditz M, Wieder G, Höffken G, Köllner V. Exercise capacity affects quality of life in patients with pulmonary hypertension. Lung 2013; 191:337-43. [PMID: 23681593 DOI: 10.1007/s00408-013-9472-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/27/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND The objective of this prospective study was to evaluate the impact of exercise capacity, mental disorders, and hemodynamics on quality-of-life (QoL) parameters in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS Sixty-three patients with invasively diagnosed PAH (n = 48) or CTEPH (n = 15) underwent a broad panel of assessments, including cardiopulmonary exercise testing (CPET), 6-minute walking distance (6-MWD), World Health Organization functional class (WHO-FC), and assessment of hemodynamics. QoL was evaluated by the 36-item Medical Outcome Study Short Form Health Survey Questionnaire (SF-36). Exercise capacity, hemodynamics, age, gender, and mental disorders (anxiety and depression) were assessed for association with QoL subscores by uni- and multivariate regression analyses. RESULTS Exercise capacity, WHO-FC, oxygen therapy, symptoms of right heart failure, right atrial pressure, and mental disorders were significantly associated with QoL (p < 0.05). In the stepwise backward selection multivariate analysis, depression remained an independent parameter in seven of eight subscales of the SF-36. Furthermore, peak oxygen uptake (peakVO2) during CPET, 6-MWD, anxiety, long-term oxygen therapy, right heart failure, and age remained independent factors for QoL. Hemodynamic parameters at rest did not independently correlate with any domain of the SF-36 QoL subscores. CONCLUSIONS Mental disorders, exercise capacity, long-term oxygen therapy, right heart failure, and age play important role in the quality of life in patients with PAH and CTEPH.
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Affiliation(s)
- Michael Halank
- Department of Internal Medicine I, Carl Gustav Carus University Hospital, Technical University of Dresden, Fetscherstrasse 74, 01309, Dresden, Germany.
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Health-Related Quality of Life in a National Cohort of Patients With Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2012.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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Health-related quality of life in a national cohort of patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. Arch Bronconeumol 2013; 49:181-8. [PMID: 23452896 DOI: 10.1016/j.arbres.2012.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) experience impaired health-related quality of life (HRQL). The objective of this study was to evaluate HRQL in a nation-wide sample. PATIENTS AND METHODS This is a prospective, multicenter, non-interventional study of HRQL including 139 (89%) PAH and 17 (11%) CTEPH patients (women 70.5%; mean age, 52.2) recruited from 21 Spanish hospitals. 55% had idiopathic PAH, 34% other PAH and 11% CTEPH. HRQL was measured using the Short Form 36 Health Survey (SF-36) and EuroQoL-5D (baseline and after 6 months). RESULTS HRQL in the patients with PAH or CTEPH was impaired. The physical component of SF-36 and the EuroQol-5D correlated with the functional class (FC). Mean EuroQol-5D visual analogical scale (EQ-5D VAS) scores were 73.5±18.4, 62.9±20.7 and 51.3±16.0 (P<.0001) in patients with FC I, II and III, respectively. Every increase of one FC represented a loss of 4.0 on the PCS SF-36 and a loss of 9.5 on the EQ-5D VAS. Eight patients who died or received a transplant during the study period presented poorer initial HRQL compared with the rest of the population. No significant changes in HRQL were observed in survivors after 6 months of follow-up. CONCLUSIONS HRQL is impaired in this population, especially in PAH/CTEPH patients near death. HRQL measurements could help predict the prognosis in PAH and CTPH and provide additional information in these patients.
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Lammers AE, Adatia I, Jesús del Cerro M, Díaz G, Heath Freudenthal A, Freudenthal F, Harikrishnan S, Ivy D, Lopes AA, Usha Raj J, Sandoval J, Stenmark K, Haworth SG. Clasificación funcional de la hipertensión pulmonar en niños: Informe del task force pediátrico del Pulmonary Vascular Research Institute (PVRI), Panamá 2011. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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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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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45
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Ganderton L, Jenkins S, McKenna SP, Gain K, Fowler R, Twiss J, Gabbay E. Validation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) for the Australian and New Zealand population. Respirology 2012; 16:1235-40. [PMID: 21810146 DOI: 10.1111/j.1440-1843.2011.02030.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Individuals with pulmonary arterial hypertension (PAH) experience severely impaired quality of life. A disease-specific patient reported outcome measure for PAH (the Cambridge Pulmonary Hypertension Outcome Review--CAMPHOR) has recently been developed and validated in the UK, USA and Canada. It has demonstrated reliability and validity in PAH populations in these countries. The aim of this study was to assess the reliability and validity of the CAMPHOR in an Australian and New Zealand (NZ) PAH population. METHODS Semistructured interviews were conducted with a cohort of 15 PAH patients (aged 68.9±10.0 years; 11 women) to determine the relevance of the CAMPHOR and ensure the terminology and language used was understandable and appropriate for our PAH population. The test-retest reliability, internal consistency and construct validity of the CAMPHOR were then examined in an Australian and NZ PAH population (n=61, aged 56.9±14.5 years; 48 women). RESULTS Data from the patient interviews confirmed that the CAMPHOR is appropriate for use in our PAH population. The three CAMPHOR scales (symptoms, activity limitations and quality of life) had excellent test-retest reliability (correlation coefficients (r(s))=0.86-0.94, P<0.01) and internal consistency (Cronbach's alpha coefficients=0.89-0.92). The CAMPHOR also demonstrated the ability to distinguish between individuals with PAH who differed according to World Health Organisation functional class. CONCLUSIONS We have shown the CAMPHOR to be valid and reliable in an Australian and NZ PAH population and recommend its use in clinical practice.
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Affiliation(s)
- Louise Ganderton
- School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University Royal Perth Hospital Lung Institute of Western Australia
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Matura LA, McDonough A, Carroll DL. Cluster analysis of symptoms in pulmonary arterial hypertension: a pilot study. Eur J Cardiovasc Nurs 2012; 11:51-61. [PMID: 22357779 DOI: 10.1177/1474515111429649] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary artery pressures leading to right heart failure and death. AIMS The aim of this study was to use cluster analysis to describe the symptom profile in PAH and differences in the health outcomes of health status, health-related quality of life (HRQoL) and psychological states in the cluster groups. METHODS A cross-sectional descriptive design was used. A convenience sample completed a socio-demographic and clinical data form, a PAH Symptom Severity and Interference Scale, the Medical Outcomes Study Short Form (SF-36), the United States Cambridge Pulmonary Hypertension Outcome Review (US CAMPHOR) and the Short Form of the Profile of Mood States (POMS). RESULTS Of the 151 participants, the mean age was 53.5 ± 15.1 with the majority female (n = 128, 85%). Fifty-eight (41%) were disabled and 67 (44%) were Functional Class IV. The most prevalent symptoms were shortness of breath with exertion (n = 149, 99%) and fatigue (n = 144, 93%). Three clusters emerged: Cluster 1 diffuse symptoms (n = 93), Cluster 2 severe cardiopulmonary symptoms (n = 32) and Cluster 3 moderate cardiopulmonary symptoms (n = 26). Overall, on the SF-36 the participants had poor general health, reduced physical function, role physical, vitality, and a low composite score for physical health. On the POMS the sample had limited vigor and increased fatigue. Cluster 2 Severe Cardiopulmonary Symptoms had worse SF-36, US CAMPHOR and POMS scores than the other cluster groups. CONCLUSIONS Patients with PAH are experiencing a constellation of symptoms that are interfering with their life and emerging clusters were present.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania, School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104-4217, USA.
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KOWAL-BIELECKA OTYLIA, AVOUAC JEROME, PITTROW DAVID, HUSCHER DOERTE, BEHRENS FRANK, DENTON CHRISTOPHERP, FOELDVARI IVAN, HUMBERT MARC, MATUCCI-CERINIC MARCO, NASH PETER, OPITZ CHRISTIANF, RUBIN LEWISJ, SEIBOLD JAMESR, STRAND VIBEKE, FURST DANIELE, DISTLER OLIVER. Analysis of the Validation Status of Quality of Life and Functional Disability Measures in Pulmonary Arterial Hypertension Related to Systemic Sclerosis: Results of a Systematic Literature Analysis by the Expert Panel on Outcomes Measures in Pulmonary Arterial Hypertension Related to Systemic Sclerosis (EPOSS). J Rheumatol 2011; 38:2419-27. [DOI: 10.3899/jrheum.110344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective.We aimed to assess the current validity status of the Health Assessment Questionnaire–Disability Index (HAQ-DI) and the 36-item Medical Outcomes Study Short Form Health Survey (SF-36).Methods.Studies using HAQ-DI and/or SF-36 in patients with pulmonary arterial hypertension (PAH) associated with systemic sclerosis (PAH-SSc) were identified through a systematic literature review and assessed according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) consensus group criteria.Results.Both HAQ-DI and SF-36 were considered credible (having face validity) and feasible. Based on expert opinion, neither HAQ-DI nor SF-36 was specific for PAH-SSc since their results may be influenced by other aspects of SSc (judged “unclear” with respect to the content validity criterion). In the overall SSc population, there was significant albeit weak correlation between physical component SF-36 scores and pulmonary artery systolic pressure (PASP) by echocardiography (Kendall tau b = −0.2, p < 0.01). Although HAQ-DI also correlated with PASP by echocardiography, there were no significant correlations in SSc patients with PAH proven by right heart catheterization between changes in HAQ-DI over time and changes in other PAH measures including 6-min walk distance (r = −0.04, p = 0.86), expert global assessment (r = 0.06, p = 0.97), and New York Heart Association functional class (r = 0.38, p = 0.39), indicating lack of construct validity for HAQ-DI in PAH-SSc. No studies enabling assessment of criterion validity or discrimination of HAQ-DI or SF-36 in PAH-SSc could be identified.Conclusion.Further validation of HAQ and SF-36 in PAH-SSc is needed. Alternatively, more specific assessments for functional disability or quality of life in PAH-SSc might be required.
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Vis JC, Duffels MG, Mulder P, de Bruin-Bon RHACM, Bouma BJ, Berger RMF, Hoendermis ES, van Dijk APJ, Mulder BJM. Prolonged beneficial effect of bosentan treatment and 4-year survival rates in adult patients with pulmonary arterial hypertension associated with congenital heart disease. Int J Cardiol 2011; 164:64-9. [PMID: 21723630 DOI: 10.1016/j.ijcard.2011.06.064] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 05/20/2011] [Accepted: 06/10/2011] [Indexed: 10/18/2022]
Abstract
Pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) due to systemic to pulmonary shunting is associated with a high risk of morbidity and mortality. In this study we evaluated 4 years treatment effect of bosentan on exercise capacity and quality of life and survival rates in 64 adult patients with PAH associated with CHD, including patients with Down syndrome (DS). All patients were evaluated at baseline and during follow-up with laboratory tests, 6-minute walk test, quality of life questionnaires, and Doppler echocardiography. In total, 13 patients (20%) died during 4-years of follow-up; 4 patients with DS and 9 patients without DS. Mean follow-up of all patients treated with bosentan was 3.5 ± 1.2 year. We analyzed treatment efficacy separately within patients without DS (n=34) and patients with DS (n=30). Mean 6-minute walking distance (6 MWD) in patients without DS significantly increased at 6 months from 417 ± 108 to 458 ± 104 m (+41 m; p=0.002) and significant improvement continued to exist during at least 2.5 years of follow-up (p=0.003). Moreover, stroke volume increased significantly (p=0.02). In the patients with DS, 6-MWD, stroke volume and quality of life remained stable during treatment. In this study we demonstrate a prolonged beneficial effect of bosentan treatment on exercise capacity, stroke volume and quality of life in patients without DS. However the mortality rate of 20% of patients after 4 years of follow-up remains high.
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Affiliation(s)
- Jeroen C Vis
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
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Lammers AE, Adatia I, Cerro MJD, Diaz G, Freudenthal AH, Freudenthal F, Harikrishnan S, Ivy D, Lopes AA, Raj JU, Sandoval J, Stenmark K, Haworth SG. Functional classification of pulmonary hypertension in children: Report from the PVRI pediatric taskforce, Panama 2011. Pulm Circ 2011; 1:280-285. [PMID: 21874157 PMCID: PMC3161406 DOI: 10.4103/2045-8932.83445] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The members of the Pediatric Task Force of the Pulmonary Vascular Research Institute (PVRI) were aware of the need to develop a functional classification of pulmonary hypertension in children. The proposed classification follows the same pattern and uses the same criteria as the Dana Point pulmonary hypertension specific classification for adults. Modifications were necessary for children, since age, physical growth and maturation influences the way in which the functional effects of a disease are expressed. It is essential to encapsulate a child's clinical status, to make it possible to review progress with time as he/she grows up, as consistently and as objectively as possible. Particularly in younger children we sought to include objective indicators such as thriving, need for supplemental feeds and the record of school or nursery attendance. This helps monitor the clinical course of events and response to treatment over the years. It also facilitates the development of treatment algorithms for children. We present a consensus paper on a functional classification system for children with pulmonary hypertension, discussed at the Annual Meeting of the PVRI in Panama City, February 2011.
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Chen H, De Marco T, Kobashigawa EA, Katz PP, Chang VW, Blanc PD. Comparison of cardiac and pulmonary-specific quality-of-life measures in pulmonary arterial hypertension. Eur Respir J 2011; 38:608-16. [PMID: 21273391 DOI: 10.1183/09031936.00161410] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studies systematically comparing the performance of health-related quality-of-life (HRQoL) instruments in pulmonary arterial hypertension (PAH) are lacking. We sought to address this by comparing cardiac and respiratory-specific measures of HRQoL in PAH. We prospectively assessed HRQoL in 128 patients with catheterisation-confirmed PAH at baseline and at 6, 12 and post-24 month follow-up visits. Cardiac-specific HRQoL was assessed using the Minnesota Living with Heart Failure Questionnaire (LHFQ); respiratory-specific HRQoL was assessed using the Airways Questionnaire 20 (AQ20); and general health status was assessed using the 36-item Short Form physical component summary (SF-36 PCS). The LHFQ and AQ20 were highly intercorrelated. Both demonstrated strong internal consistency and converged with the SF-36 PCS. Both discriminated patients based on World Health Organization (WHO) functional class, 6-min walking distance (6MWD) and Borg dyspnoea index (BDI), with the exception of a potential floor effect associated with low 6MWD. The LHFQ was more responsive than the AQ20 to changes over time in WHO functional class, 6MWD and BDI. In multivariate analyses, the LHFQ and AQ20 were each longitudinal predictors of general health status, independent of functional class, 6MWD and BDI. In conclusion, both cardiac-specific and respiratory-specific measures appropriately assess HRQoL in most patients with PAH. Overall, the LHFQ demonstrates stronger performance characteristics than the AQ20.
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Affiliation(s)
- H Chen
- Dept of Medicine, University of California, San Francisco, CA 94143-0924, USA.
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