Evolución de la calidad de vida relacionada con la salud en pacientes ingresados por insuficiencia cardiaca. Estudio IC-QoL

The role of quality of life data as an endpoint for collecting real-world evidence within geroscience clinical trials

With geroscience research evolving at a fast pace, the need arises for human randomized controlled trials to assess the efficacy of geroprotective interventions to prevent age-related adverse outcomes, disease, and mortality in normative aging cohorts. However, to confirm efficacy requires a long-term and costly approach as time to the event of morbidity and mortality can be decades. While this could be circumvented using sensitive biomarkers of aging, current molecular, physiological, and digital endpoints require further validation. In this review, we discuss how collecting real-world evidence (RWE) by obtaining health data that is amenable for collection from large heterogeneous populations in a real-world setting can help speed up validation of geroprotective interventions. Further, we propose inclusion of quality of life (QoL) data as a biomarker of aging and candidate endpoint for geroscience clinical trials to aid in distinguishing healthy from unhealthy aging. We highlight how QoL assays can aid in accelerating data collection in studies gathering RWE on the geroprotective effects of repurposed drugs to support utilization within healthy longevity medicine. Finally, we summarize key metrics to consider when implementing QoL assays in studies, and present the short-form 36 (SF-36) as the most well-suited candidate endpoint.

Individual Trajectories of Health Status During the First Year of Discharge From Hospitalization for Heart Failure and Their Associations With Death in the Following Years

Background Improving health status is one of the major goals in the management of heart failure (HF). However, little is known about the long-term individual trajectories of health status in patients with acute HF after discharge. Methods and Results We enrolled 2328 patients hospitalized for HF from 51 hospitals prospectively and measured their health status via the Kansas City Cardiomyopathy Questionnaire-12 at admission and 1, 6, and 12 months after discharge, respectively. The median age of the patients included was 66 years, and 63.3% were men. Six patterns of Kansas City Cardiomyopathy Questionnaire-12 trajectories were identified by a latent class trajectory model: persistently good (34.0%), rapidly improving (35.5%), slowly improving (10.4%), moderately regressing (7.4%), severely regressing (7.5%), and persistently poor (5.3%). Advanced age, decompensated chronic HF, HF with mildly reduced ejection fraction, HF with preserved ejection fraction, depression symptoms, cognitive impairment, and each additional HF rehospitalization within 1 year of discharge were associated with unfavorable health status (moderately regressing, severely regressing, and persistently poor) (P<0.05). Compared with the pattern of persistently good, slowly improving (hazard ratio [HR], 1.50 [95% CI, 1.06-2.12]), moderately regressing (HR, 1.92 [1.43-2.58]), severely regressing (HR, 2.26 [1.54-3.31]), and persistently poor (HR, 2.34 [1.55-3.53]) were associated with increased risks of all-cause death. Conclusions One-fifth of 1-year survivors after hospitalization for HF experienced unfavorable health status trajectories and had a substantially increased risk of death during the following years. Our findings help inform the understanding of disease progression from a patient perception perspective and its relationship with long-term survival. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT02878811.

Género y efectividad de la metodología enfermera en pacientes con insuficiencia cardiaca

Estudios recientes demostraron que una intervención enfermera de educación sanitaria en la Insuficiencia Cardiaca (IC) evita descompensaciones. Por otro lado, dado que existen diferencias de género en los patrones de la IC, las intervenciones tendrán también efectos diferentes. Objetivo: determinar la existencia de posibles diferencias según el género de los pacientes, en el efecto de una intervención enfermera respecto al autocuidado. Material y método: Se realizó un estudio cuasi experimental con pacientes atendidos en consulta de IC (129). Seleccionados en dos tiempos, primer trimestre año grupo control (62), y segundo trimestre año grupo intervención (67).Todos se evaluaron tres veces, primera consulta, tres y seis meses. Al grupo intervención se aplicó en cada visita una intervención enfermera que consistía en la educación terapéutica, control y seguimiento de su IC. Resultados: inicio: T.A. sistólica hombres 133.90±0.96(DE 27.77), mujeres 119.64±0.57 (DE18.72). Cuidador 93% hombres, 63% mujeres. Conducta terapéutica 2.07+0.02 (DE0.20) hombres,3.04+0.01 (DE 0.31) mujeres. Final: autocuidado -16.00±2.08 (DE10.99) hombres, -9.68±2.22 (DE12.92) mujeres. Adherencia terapéutica1.32±0.35 (DE1.83) hombres, 2.94±1.87 (DE10.93) mujeres. Mejoría muy similar de los NOC en todos. Conclusiones: en el grupo de estudio, participaron más mujeres que hombres,estos[1] últimos tuvieron mayor co morbilidad, consumo de tabaco y alcohol que lasmujeres y disponían de una cuidadora informal. Con relación al autocuidado y adherencia al tratamiento, en la valoración inicial, no se encontró una diferencia significativa entre ambos géneros, mientras que en la calidad de vida el resultado fue mejor en los hombres. Después de la intervención, se encontró que todos los pacientes mejoraron los resultados en calidad de vida y en el NOC (Nursing outcomesclassification), así como el autocuidado y la adhesión terapéutica en todos los participantes. [2] Es importante destacar que los hombres doblaron la puntuación en autocuidado y las mujeres en adhesión terapéutica.

Dose-dependent relationship of physical and depressive symptoms with health-related quality of life in patients with heart failure

BACKGROUND

Patients with heart failure (HF) have poor health-related quality of life (HRQOL). The vast majority of patients have physical symptoms, and about 30-40% have depressive symptoms. The combined effects of physical and depressive symptoms on HRQOL have not been examined fully in HF.

PURPOSES

To examine the combined effects of physical and depressive symptoms on HRQOL using repeated measures, controlling for covariates (i.e. age, education level, New York Heart Association (NYHA) functional class, financial status, and health perception).

METHODS

Patients (N = 224, 62 ± 12 years old, 67% male, 38% NYHA functional class III/IV) provided data on physical (Symptom Status Questionnaire) and depressive symptoms (Beck Depression Inventory II) at baseline and HRQOL (Minnesota Living with Heart Failure Questionnaire) at baseline and 12 months. Patients were divided into three groups based on presence of physical and depressive symptoms: a) no symptom group, b) one symptom group (dyspnea or fatigue), and c) two symptom group (physical and depressive symptoms). Repeated measures ANOVA was used to analyze the data.

RESULTS

The least squares mean scores of baseline and 12-month HRQOL differed significantly in the three groups after controlling for the covariates (26.4 vs. 36.6 vs. 53.1, respectively, all pairwise p values < 0.001). There was no time-by-group interaction or time main effect.

CONCLUSION

Physical and depressive symptoms have a dose-response relationship with HRQOL. Further research is needed to provide effective interventions to improve physical and depressive symptoms, in turn, HRQOL.