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Mendes JL, Dos Santos CM, Sousa-Pinto B. Assessment of patient-reported outcomes measures in heart failure: a systematic review. Heart Fail Rev 2024; 29:853-867. [PMID: 38630207 DOI: 10.1007/s10741-024-10404-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 06/19/2024]
Abstract
Heart failure (HF) is a prevalent global disease, particularly impacting developed countries. With the world's aging population, HF's impact on the quantity and quality of life is expected to grow. This review aims to ascertain the frequency, characteristics, and properties of all patient-reported outcomes measures (PROMs) studied in HF patients. We searched Ovid/Medline and Web of Science for original articles about PROMs performed in adults with HF. Using pre-established quality criteria for measurement properties, an overall rating was assigned to evaluate and compare different instruments. The quality of evidence was assessed with the COSMIN risk of bias checklist. Of 4283 records identified, we reviewed 296 full-text documents and included 64 papers, involving 30,185 participants. Thirty different PROMs were identified, with 14 specifically designed for HF being the most commonly used. Minnesota Living with Heart Failure (MLHF) and Kansas City Cardiomyopathy Questionnaire (KCCQ) were evaluated 16 and 13 times, respectively, demonstrating good psychometric properties. The MacNew Heart Disease Health-Related Quality of Life Questionnaire, a common heart disease-specific instrument, exhibited negative performances across various psychometric measures. Evidence for generic instruments was scant and unremarkable and they proved to be less responsive in HF populations. MLHF and KCCQ emerged as the most commonly used and well-supported PROMs, with robust overall evidence. They are comprehensive and accurate instruments, particularly suitable for application in clinical practice and research. Future research should explore how computer-adapted instruments can enhance precision, reduce respondent burden, and improve communication between clinicians and patients, thereby promoting more efficient and patient-centered services.
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Affiliation(s)
- João Lázaro Mendes
- Internal Medicine Department, Unidade Local de Saúde de Viseu Dão-Lafões, Viseu, Portugal.
| | | | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
- Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Center for Health Technology and Services Research, Porto, Portugal
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Greffin K, Muehlan H, van den Berg N, Hoffmann W, Ritter O, Oeff M, Speerfork S, Schomerus G, Schmidt S. Measuring context that matters: validation of the modular Tele-QoL patient-reported outcome and experience measure. Qual Life Res 2023; 32:3223-3234. [PMID: 37458961 PMCID: PMC10522723 DOI: 10.1007/s11136-023-03469-z] [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] [Accepted: 06/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE A setting-sensitive instrument for assessing Quality of Life (QoL) in Telemedicine (TM) was unavailable. To close this gap, a content-valid "add-on" measure was developed. In parallel, a brief index was derived featuring six items that summarise the main content of the multidimensional assessment. After pre- and pilot-testing, the psychometric performance of the final measures was investigated in an independent validation study. METHODS The questionnaires were applied along with other standardised instruments of similar concepts as well as associated, yet disparate concepts for validation purposes. The sample consisted of patients with depression or heart failure, with or without TM (n = 200). Data analyses were aimed at calculating descriptive statistics and testing the psychometric performance on item, scale, and instrument level, including different types of validity and reliability. RESULTS The proposed factor structure of the multidimensional Tele-QoL measure has been confirmed. Reliability coefficients for internal consistency, split-half, and test-retest reliability of the subscales and index reached sufficient values. The Tele-QoL subscales and the index demonstrated Rasch scalability. Validity of both instruments can be assumed. Evidence for discriminant construct validity was provided. Known-groups validity was indicated by respective score differences for various classes of disease severity. CONCLUSION Both measures show convincing psychometric properties. The final multidimensional Tele-QoL assessment consists of six outcome scales and two impact scales assessing (un-)intended effects of TM on QoL. In addition, the Tele-QoL index provides a short alternative for outcome assessment. The Tele-QoL measures can be used as complementary modules to existing QoL instruments capturing healthcare-related aspects of QoL from the patients' perspective.
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Affiliation(s)
- Klara Greffin
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Greifswald, Germany.
| | - Holger Muehlan
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Oliver Ritter
- Department of Cardiology, Nephrology and Pulmonology, Campus Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Michael Oeff
- Brandenburg City Hospital, Brandenburg an der Havel, Germany
| | - Sven Speerfork
- Clinic of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Georg Schomerus
- Clinic of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Silke Schmidt
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Greifswald, Germany
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Horn N, Gärtner L, Rastan AJ, Andrási TB, Lenz J, Böning A, Salzmann-Djufri M, Puvogel U, Genovese M, Kus S, Rief W, Salzmann S. Preoperative optimization of cardiac valve patients' expectations: Study protocol of the randomized controlled ValvEx-trial. Front Cardiovasc Med 2023; 10:1105507. [PMID: 36937912 PMCID: PMC10018216 DOI: 10.3389/fcvm.2023.1105507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Complete recovery after surgery depends on psychological factors such as preoperative information, expectations, and surgery-associated anxiety. Prior studies have shown that even a short preoperative psychological intervention aiming at optimized expectations (EXPECT) can improve postoperative outcomes in coronary artery bypass patients. However, this intervention may benefit only a small subgroup of heart surgery patients since implementing preoperative psychological interventions into the daily clinical routine is difficult due to the additional time and appointments. It is unclear whether the EXPECT intervention can be shortened and whether heart valve patients would also benefit from interventions that optimize patients' expectations. The multicenter ValvEx trial aims (i) to adapt an effective preoperative psychological intervention (EXPECT) to make it brief enough to be easily integrated into the preoperative routine of heart valve patients and (ii) to examine if the adapted preoperative psychological intervention improves the subjectively perceived illness-related disability (PDI) up to 3 months after surgery. Materials and analysis In two German university hospitals, N = 88 heart valve patients who undergo heart surgery are randomized into two groups [standard of care (SOC) vs. standard of care plus interventional expectation manipulation (SOC and EXPECT)] after baseline assessment. Patients in the EXPECT group additionally to standard of care participate in the preoperative psychological intervention (30-40 min), focusing on optimizing expectations and have two booster-telephone calls (4 and 8 weeks after the surgery, approx. 15 min). Both groups have assessments again on the evening before the surgery, 4 to 6 days, and 3 months after the surgery. Discussion The trial demonstrates excellent feasibility in the clinical routine and a high interest by the patients. Ethics and dissemination The Ethics Committees of the Department of Medicine of the Philipps University of Marburg and the Department of Medicine of the University of Giessen approved the study protocol. Study results will be published in peer-reviewed journals and presented at congresses. Clinical trial registration ClinicalTrials.gov, identifier NCT04502121.
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Affiliation(s)
- Nicole Horn
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
- *Correspondence: Nicole Horn,
| | - Laura Gärtner
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Ardawan J. Rastan
- Department of Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Térezia B. Andrási
- Department of Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Juliane Lenz
- Department of Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, Justus Liebig University, Giessen, Germany
| | | | - Ulrike Puvogel
- Department of Cardiovascular Surgery, Justus Liebig University, Giessen, Germany
| | - Maria Genovese
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Sibel Kus
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Stefan Salzmann
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
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Zamora E, González B, Lupón J, Borrellas A, Domingo M, Santiago‐Vacas E, Cediel G, Codina P, Rivas C, Pulido A, Crespo E, Velayos P, Diaz V, Bayes‐Genis A. Quality of life in patients with heart failure and improved ejection fraction: one-year changes and prognosis. ESC Heart Fail 2022; 9:3804-3813. [PMID: 35916351 PMCID: PMC9773756 DOI: 10.1002/ehf2.14098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/16/2022] [Accepted: 07/20/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The criteria for patients with heart failure (HF) and improved ejection fraction (HFimpEF) are a baseline left ventricular ejection fraction (LVEF) ≤40%, a ≥10-point increase from baseline LVEF, and a second LVEF measurement >40%. We aimed to (i) assess patients with HF and reduced LVEF (HFrEF) at baseline and compare quality of life (QoL) changes between those that fulfilled and those that did not fulfil the HFimpEF criteria 1 year later and (ii) assess the prognostic role of QoL in patients with HFimpEF. METHODS We reviewed data from a prospective registry of real-world outpatients with HF that were assessed for LVEF and QoL at a first visit to the HF clinic and 1 year later. QoL was evaluated with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). The primary prognostic endpoint was the composite of all-cause death or HF hospitalization. RESULTS Baseline and 1-year LVEF and MLWFQ scores were available for 1040 patients with an initial LVEF ≤40% (mean age, 65.2 ± 11.7 years; 75.9% men). The main aetiology was ischaemic heart disease (52.9%), and patients were mostly in New York heart Association Classes II (71.1%) and III (21.6%). At baseline, the mean LVEF was 28.5% ± 7.3, and the mean MLWHFQ score was 30.2 ± 19.5. After 1 year, the mean LVEF increased to 38.0% ± 12.2, and the MLWHFQ scores improved to 17.4 ± 16.0. In 361 patients that fulfilled the HFimpEF criteria (34.7%), significant improvements were observed in both LVEF (from 28.7% ± 6.6 to 50.9% ± 7.6, P < 0.001) and QoL (from 32.9 ± 20.6 to 16.9 ± 16.0, P < 0.001). Patients that did not fulfil the HFimpEF criteria also showed significant improvements in LVEF (from 28.4% ± 7.6 to 31.1% ± 7.9, P < 0.001) and QoL (from 28.7 ± 18.8 to 17.6 ± 15.9, P < 0.001). However, the QoL improvement was significantly higher in the HFimpEF group (-16.0 ± 23.8 vs. -11.1 ± 20.3, P = 0.001), despite the worse mean baseline MLWHFQ score, compared with the non-HFimpEF group (P = 0.001). The 1-year QoL was similar between groups (P = 0.50). The 1-year MLWHFQ score was independently associated with outcomes; the hazard ratio for the composite endpoint was 1.02 (95% CI: 1.01-1.03, P = 0.006). In contrast, the QoL improvement (with a cut-off ≥5 points) was not independently associated with the composite outcome. CONCLUSIONS Patients with HFrEF showed improved QoL after 1 year, regardless of whether they met the HFimpEF criteria. The similar 1-year QoL perception between groups suggested that factors other than LVEF influenced QoL perception. The 1-year QoL was superior to the QoL change from baseline for predicting prognosis in patients with HFimpEF.
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Affiliation(s)
- Elisabet Zamora
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Beatriz González
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Josep Lupón
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Andrea Borrellas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Mar Domingo
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Evelyn Santiago‐Vacas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Germán Cediel
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Pau Codina
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain
| | - Carmen Rivas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Ana Pulido
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Eva Crespo
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Patricia Velayos
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Violeta Diaz
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Antoni Bayes‐Genis
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 761] [Impact Index Per Article: 380.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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6
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 891] [Impact Index Per Article: 445.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Greffin K, Muehlan H, van den Berg N, Hoffmann W, Ritter O, Oeff M, Schomerus G, Schmidt S. Setting-Sensitive Conceptualization and Assessment of Quality of Life in Telemedical Care-Study Protocol of the Tele-QoL Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10454. [PMID: 34639754 PMCID: PMC8507616 DOI: 10.3390/ijerph181910454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
Quality of life (QoL) is a core patient-reported outcome in healthcare research, alongside primary clinical outcomes. A conceptual, operational, and psychometric elaboration of QoL in the context of TM is needed, because standardized instruments to assess QoL do not sufficiently represent essential aspects of intended outcomes of telemedical applications (TM). The overall aim is to develop an instrument that can adequately capture QoL in TM. For that purpose, an extended working model of QoL will be derived. Subsequently, an instrument will be developed and validated that captures those aspects of QoL that are influenced by TM. The initial exploratory study section includes (a) a systematic literature review, (b) a qualitative survey for concept elicitation, and (c) pre-testings using cognitive debriefings with patients and an expert workshop. The second quantitative section consists of an online expert survey and two patient surveys for piloting and validation of the newly developed instrument. The resulting questionnaire will assess central experiences of patients regarding telemedical applications and its impact on QoL more sensitively. Its use as adjunct instrument will lead to a more appropriate evaluation of TM and contribute to the improvement of care tailored to patients' individual needs.
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Affiliation(s)
- Klara Greffin
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
| | - Holger Muehlan
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
| | - Neeltje van den Berg
- Department of Health Care Epidemiology and Community Health, Institute of Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (N.v.d.B.); (W.H.)
| | - Wolfgang Hoffmann
- Department of Health Care Epidemiology and Community Health, Institute of Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (N.v.d.B.); (W.H.)
| | - Oliver Ritter
- Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany;
- Department of Cardiology, Brandenburg City Hospital, 14770 Brandenburg an der Havel, Germany;
| | - Michael Oeff
- Department of Cardiology, Brandenburg City Hospital, 14770 Brandenburg an der Havel, Germany;
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Medicine Leipzig, 04103 Leipzig, Germany;
| | - Silke Schmidt
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
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Ihsen Z, Khadija M, Marwa C, Imtinen BM, Fethia BM, Sofien K, Sondos K. [Study of the factors contributing to poor quality of life in chronic heart failure with reduced ejection fraction]. Ann Cardiol Angeiol (Paris) 2021; 70:231-236. [PMID: 34517976 DOI: 10.1016/j.ancard.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increasing prevalence and poor prognosis associated with chronic heart failure (CHF) have made the improvement of quality of life (QoL) one of the main goals in the treatment of CHF patients. Since little is known about the QoL in Tunisian patients with heart failure (HF), the current study was performed to assess QoL in a sample of Tunisian patients hospitalized with HF and to identify factors related to QoL. METHODS In this prospective study, we evaluated patients with CHF attending the cardiology department of Habib Thameur University Hospital in a four-month period. Echocardiography was performed and patients with left ventricular ejection fraction of 45% or less were selected. QoL assessment was performed with a disease-specific instrument: the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in a sample of 100 selected patients. Relationships between health-related QoL and the studied variables were examined with bivariate correlations and binary logistic regression analysis. RESULTS In the total sample (n = 100), mean age was 62.7 years. The majority were male (77%), married (76%), with a mean of 2.5 comorbidities, and in a New York Heart Association (NYHA) functional class III to IV (61%). Mean LVEF was 36%. Half of the patients had poor QoL on the total MLHFQ scale (median = 41.5) as well as on its physical (median = 17.5) and emotional (median = 11.25) domains. In univariate analysis, the following variables were related to poor QoL with p < 0.005: not being employed, suffering from hypertension, renal failure, anemia, being under a low-salt diet, having no regular physical activity, having the physical symptoms of HF, higher NYHA class and longer QRS duration. In multiple regression analysis, the main independent predictors of poor QoL on the total scale were higher NYHA functional class and renal dysfunction,. The data provided no evidence of an association between LVEF and QoL. CONCLUSION This study has found that higher NHYA functional class and chronic kidney disease are risk factors for impaired QoL, independently of disease severity among patients with heart failure.
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Affiliation(s)
- Zairi Ihsen
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040.
| | - Mzoughi Khadija
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
| | - Chouaieb Marwa
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
| | - Ben Mrad Imtinen
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
| | - Ben Moussa Fethia
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
| | - Kamoun Sofien
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040.
| | - Kraiem Sondos
- Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040
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Validation of the German HeartQoL: a short health-related quality of life questionnaire for cardiac patients. Qual Life Res 2019; 29:1093-1105. [PMID: 31832979 PMCID: PMC7142053 DOI: 10.1007/s11136-019-02384-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 11/05/2022]
Abstract
Purpose The aim of this study was to evaluate psychometric properties of the core disease-specific 14-item German HeartQoL questionnaire. Methods As an extension of the international HeartQol Project, cross-sectional and longitudinal health-related quality of life (HRQL) data were collected from 305 patients with angina (N = 101), myocardial infarction (N = 123), or ischemic heart failure (N = 81) in Austria and Switzerland using German versions of the HeartQoL, the Short Form-36 Health Survey (SF-36), and the Hospital Anxiety and Depression Scale. The underlying factor structure was examined with Mokken Scaling analysis; then convergent, divergent, and discriminative validity, internal consistency reliability, and responsiveness were assessed. Results The highest HRQL scores were reported by patients with myocardial infarction followed by ischemic heart failure and then angina. The two-factor structure was confirmed with strong physical, emotional, and global scale H coefficients (> .50). Divergent and convergent validity (from r = .04 to .78) were shown for each diagnosis; discriminative validity was verified as well (partially: age, sex, and disease severity; largely: SF-36 health status/transition; totally: anxiety and depression). Internal consistency reliability was excellent (Cronbach’s alpha = .91). In terms of responsiveness, physical and global scale scores improved significantly after percutaneous coronary intervention (p < .01) while after cardiac rehabilitation all scale scores improved significantly (p < .001). Conclusions The German HeartQoL questionnaire is a valid and reliable HRQL instrument with these data supporting its potential use in clinical practice and research to assess and compare HRQL in German-speaking patients with ischemic heart disease. The shortness of the tool may prove to be helpful particularly in clinical practice.
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10
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Mogle J, Buck H, Zambroski C, Alvaro R, Vellone E. Cross-Validation of the Minnesota Living With Heart Failure Questionnaire. J Nurs Scholarsh 2017; 49:513-520. [PMID: 28755434 DOI: 10.1111/jnu.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE The Minnesota Living With Heart Failure Questionnaire (MLHFQ) is the leading method for assessing quality of life in patients with heart failure (HF) around the world. However, unique, culture-specific variations in factorial structure have been identified. The current study examined the cross-cultural equivalence of an Italian version of the MLHFQ. DESIGN Cross-sectional assessment as part of an HF study in Italy. Patients (n = 1,192; mean age = 72 years, SD = 11) completed demographics, the MLHFQ, and the Short-Form 12 (SF-12). METHODS A series of exploratory and confirmatory factor analyses were used to develop an appropriate factor model in the current sample. FINDINGS We initially fit a confirmatory factor analysis based on published psychometric work validating the MLHFQ. This did not provide adequate fit, and the sample was then randomly split into equivalent subsets to conduct factor analyses with cross-validation. In the first subsample, an exploratory factor analysis uncovered slight modifications to the proposed factor structure that resulted in much improved model fit. The final model included a higher order factor and three subscales: physical, emotional, and social. A cross-validation confirmatory factor analysis using this structure was conducted in the remaining subset to ensure broader applicability of the results. Correlations with the SF-12 were consistent with previous work using these measures. CONCLUSIONS Some items of the MLHFQ are sensitive to differences across cultures, and factor structures vary based on where the scale is administered. In spite of these differences, the total score remains a valid and reliable indicator of quality of life in HF patients across cultures. CLINICAL RELEVANCE Cultural influences on quality of life are important to consider when assessing patients' well-being in HF.
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Affiliation(s)
- Jacqueline Mogle
- Assistant Professor, College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Harleah Buck
- Associate Professor, Coordinator of Chronic Illness Initiatives, College of Nursing, University of South Florida, Tampa, FL, USA
| | - Cheryl Zambroski
- Associate Professor and Director, College of Nursing, University of South Florida, Tampa, FL, USA
| | - Rosaria Alvaro
- Associate Professor in Nursing Science, Department of Biomedicine and Prevention, University of Rome "Tor Vergata,", Rome, Italy
| | - Ercole Vellone
- Assistant Professor in Nursing Science, Department of Biomedicine and Prevention, University of Rome "Tor Vergata,", Rome, Italy
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11
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Franzén K, Blomqvist K, Saveman BI. Impact of Chronic Heart Failure on Elderly Persons' Daily Life: A Validation Study. Eur J Cardiovasc Nurs 2016; 5:137-45. [PMID: 16290116 DOI: 10.1016/j.ejcnurse.2005.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Revised: 08/26/2005] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Knowledge about how elderly persons perceive the impact of chronic heart failure (CHF) on daily life is important when planning nursing care. For this purpose, disease specific instruments are needed. However, few instruments have been developed or tested specifically on elderly persons. AIM To validate a Swedish version of the Minnesota Living with Heart Failure Questionnaire (LHFQ) on elderly persons with CHF, and use it to describe the impact of CHF on daily life in the same population. METHODS The sample comprised of 357 persons, aged between 65 and 99, diagnosed with CHF. A questionnaire including background data, the LHFQ and the SF-12 was used. RESULTS A factor analysis resulted in four dimensions: physical, emotional, treatment and pleasure. LHFQ showed convergent validity and ability to discriminate between known groups. Cronbach's alpha for the total scale was 0.94. Impairments in the physical dimension were most common, especially fatigue (88%) and shortness of breath (87%). CONCLUSIONS The LHFQ showed satisfying psychometric properties in an elderly Swedish population with CHF and can, with minor alterations, be recommended for research and clinical use. The impact of chronic heart failure on daily life was mostly physical, but other impairments were also common.
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Affiliation(s)
- Kristofer Franzén
- Department of Nursing, Faculty of Medicine, Lund University, P.O. BOX 157, SE-221 00 Lund, Sweden.
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12
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Heo S, Moser DK, Widener J. Gender Differences in the Effects of Physical and Emotional Symptoms on Health-Related Quality of Life in Patients with Heart Failure. Eur J Cardiovasc Nurs 2016; 6:146-52. [PMID: 16919502 DOI: 10.1016/j.ejcnurse.2006.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 05/25/2006] [Accepted: 06/13/2006] [Indexed: 01/01/2023]
Abstract
BACKGROUND Physical and emotional symptoms are common in heart failure. These symptoms are theorized to affect health-related quality of life (HRQOL), but their impact is likely mediated by variables not yet explored. Moreover, gender may affect these relationships. AIM To determine gender differences in the effects of physical and emotional symptom status on HRQOL. METHODS AND RESULTS Data from 51 men and 47 women with heart failure were analyzed using regression analyses. There were no gender differences in physical or emotional symptom status, or HRQOL, but there were differences in the dynamic relationships among the variables. In bivariate analyses, physical and emotional symptom status was related to HRQOL in both men and women. However, in women, physical symptom status was related to HRQOL, while in men depression affected HRQOL in multivariate analyses (p<.001, r(2)=.27; p<.001, r(2)=.40, respectively). Functional status measured by the New York Heart Association functional class mediated the effects of anxiety and depression on HRQOL only in women. CONCLUSION There were gender differences in the dynamic relationships among variables related to HRQOL. These results demonstrate the need for individualized, comprehensive evaluation of patient's HRQOL and symptom status in order to appropriately target interventions.
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Affiliation(s)
- Seongkum Heo
- University of Kentucky, College of Nursing, 527 CON Building, 760 Rose Street, Lexington, KY 40536-0232, USA
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13
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Willemsen D, Cordes C, Bjarnason-Wehrens B, Knoglinger E, Langheim E, Marx R, Reiss N, Schmidt T, Workowski A, Bartsch P, Baumbach C, Bongarth C, Phillips H, Radke R, Riedel M, Schmidt S, Skobel E, Toussaint C, Glatz J. [Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)]. Clin Res Cardiol Suppl 2016; 11 Suppl 1:2-49. [PMID: 26882905 DOI: 10.1007/s11789-015-0077-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.
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Affiliation(s)
- Detlev Willemsen
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland.
| | - C Cordes
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - B Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln, Deutschland
| | | | - E Langheim
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
| | - R Marx
- MediClin Fachklinik Rhein/Ruhr, Essen, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - N Reiss
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - T Schmidt
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - A Workowski
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - P Bartsch
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - C Baumbach
- Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | - C Bongarth
- Klinik Höhenried, Bernried am Starnberger See, Deutschland
| | - H Phillips
- Reha Parcs Steinhof, Erkrath, Deutschland
| | - R Radke
- Christiaan-Barnard-Klinik, Dahlen-Schmannewitz, Dahlen, Deutschland
| | - M Riedel
- Klinik Fallingbostel, Bad Fallingbostel, Deutschland
| | - S Schmidt
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - E Skobel
- Rehaklinik "An der Rosenquelle", Aachen, Deutschland
| | - C Toussaint
- m&i Fachklinik Herzogenaurach, Herzogenaurach, Deutschland
| | - J Glatz
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
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14
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Bilbao A, Escobar A, García-Perez L, Navarro G, Quirós R. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes 2016; 14:23. [PMID: 26887590 PMCID: PMC4756518 DOI: 10.1186/s12955-016-0425-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is one of the most widely used health-related quality of life questionnaires for patients with heart failure (HF). It provides scores for two dimensions, physical and emotional, and a total score. However, there are some concerns about its factor structure and alternatives have been proposed, some including a third factor representing a social dimension. The objectives of the present study were to analyze the internal structure of the MLHFQ and the unidimensionality of the total score, and to compare the different factor structures proposed. Methods The MLHFQ was given to 2565 patients with HF. The structural validity of the questionnaire was assessed by confirmatory factor analysis (CFA), and Rasch analysis. These two approaches were also applied to the alternative structures proposed. Results The CFA results for the hypothesized model of two latent factors and the Rasch analysis confirmed the adequacy of the physical and emotional scales. Rasch analysis for the total score showed only two problematic items. The results of the CFA for other two-factor structures proposed were not better than the results for the original structure. The Rasch analyses applied to the different social factors yielded the best results for Munyombwe’s social dimension, composed of six items. Conclusions Our results support the validity of using the MLHFQ physical, emotional and total scores in patients with HF, for clinical practice and research. In addition, they confirmed the existence of a third factor, and we recommend the use of Munyombwe’s social factor.
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Affiliation(s)
- Amaia Bilbao
- Research Unit, Basurto University Hospital (Osakidetza), Bilbao, Bizkaia, Spain. .,Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain.
| | - Antonio Escobar
- Research Unit, Basurto University Hospital (Osakidetza), Bilbao, Bizkaia, Spain. .,Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain.
| | - Lidia García-Perez
- Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain. .,Evaluation Service, Dirección del Servicio Canario de la Salud, Tenerife, Canary Islands, Spain.
| | - Gemma Navarro
- Epidemiologic Unit, Corporació Parc Tauli Clinic, Sabadell, Barcelona, Spain.
| | - Raul Quirós
- Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain. .,Department of Internal Medicine, Costa del Sol Hospital, Marbella, Málaga, Spain.
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15
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Nolte K, Herrmann-Lingen C, Wachter R, Gelbrich G, Düngen HD, Duvinage A, Hoischen N, von Oehsen K, Schwarz S, Hasenfuss G, Halle M, Pieske B, Edelmann F. Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction: the Ex-DHF-P trial. Eur J Prev Cardiol 2014; 22:582-93. [PMID: 24627449 DOI: 10.1177/2047487314526071] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/08/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite suffering from poor prognosis, progressive exercise intolerance, and impaired quality of life (QoL), effective therapeutic strategies in heart failure with preserved ejection fraction (HFpEF) are sparse. Exercise training (ET) improves physical QoL in HFpEF, but the effects on other aspects of QoL are unknown. METHODS The multicentre, prospective, randomized, controlled Exercise training in Diastolic Heart Failure Pilot study included 64 HFpEF patients (65 ± 7 years, 56% female). They were randomized to supervised endurance/resistance training in addition to usual care (ET, n = 44) or usual care alone (UC, n = 20). At baseline and after 3 months, QoL was assessed (36-item Short-form Health Survey (SF-36), Minnesota Living With Heart Failure Questionnaire (MLWHFQ), and Patient Health Questionnaire (PHQ-9). RESULTS Exercise improved the following SF-36 dimensions: physical functioning (p < 0.001, p = 0.001 vs. UC), bodily pain (p = 0.046), general health perception (p < 0.001, p = 0.016 vs. UC), general mental health (p = 0.002), vitality (p = 0.003), social functioning (p < 0.001) physical (p < 0.001, p = 0.001 vs. UC), and mental component score (p = 0.030). ET did not improve role limitations due to physical and emotional problems. The MLWHFQ total scale (p < 0.001) and the MLWHFQ physical limitation scale (p < 0.001, p = 0.04 vs. UC) also improved with ET. The MLWHFQ emotional limitation scale did not change with ET. With ET, also the PHQ-9 total score improved significantly (p = 0.004, p = 0.735 vs. UC). CONCLUSIONS In patients with HFpEF, exercise training improved emotional status, physical and social dimensions of QoL as well as symptoms of depression from pre to post test. Physical dimensions of QoL and general health perception also improved significantly with exercise in comparison to usual care.
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Affiliation(s)
- Kathleen Nolte
- Department of Cardiology, University of Göttingen, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine, University of Göttingen, Göttingen, Germany German Center for Cardiovascular Research (DZHK) Site Göttingen, Germany
| | - Rolf Wachter
- Department of Cardiology, University of Göttingen, Göttingen, Germany German Center for Cardiovascular Research (DZHK) Site Göttingen, Germany
| | - Götz Gelbrich
- Institute for Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine - Cardiology, Charité - Campus Virchow-Klinikum, University of Berlin, Augustenburger Platz 1, Berlin, Germany
| | - André Duvinage
- Department of Internal Medicine - Cardiology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Nadine Hoischen
- Department of Cardiology, University of Göttingen, Göttingen, Germany
| | - Karima von Oehsen
- Department of Cardiology, University of Göttingen, Göttingen, Germany Department of Psychosomatic Medicine, University of Göttingen, Göttingen, Germany
| | - Silja Schwarz
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Munich, Germany
| | - Gerd Hasenfuss
- Department of Cardiology, University of Göttingen, Göttingen, Germany German Center for Cardiovascular Research (DZHK) Site Göttingen, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Munich, Germany Munich Heart Alliance, Partner Site German Centre for Cardiovascular Research (DZHK), Germany
| | - Burkert Pieske
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Frank Edelmann
- Department of Cardiology, University of Göttingen, Göttingen, Germany German Center for Cardiovascular Research (DZHK) Site Göttingen, Germany
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16
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Tebbe U, Tschöpe C, Wirtz JH, Lokies J, Turgonyi E, Bramlage P, Strunz AM, Lins K, Böhm M. Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure: REFLECT-HF. Clin Res Cardiol 2014; 103:665-73. [PMID: 24535376 DOI: 10.1007/s00392-014-0678-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Germany, care for patients with chronic heart failure (HF) is provided by hospital-based cardiologists (HBC), office-based cardiologists (OBC) and general practitioners (GP). We aimed to compare patient characteristics, diagnostic approaches and therapeutic decisions. METHODS Multi-centre, cross-sectional, observational survey at 48 physicians. Patients (n = 384) were required to have previously diagnosed HF and NYHA class ≥ II and/or a left ventricular ejection fraction of <50 %. A total of 384 patients were included at 5 HBCs, 26 OBCs and 18 GPs. RESULTS A mean of 18.8 % of all patients at HBCs practices had heart failure, compared to a smaller proportion of 13.9 and 6.7 % at OBCs and GPs, respectively. Echo facility was available for all HBCs and OBCs, but for 16.7 % of GPs (p < 0.0001 for trend). Patients at HBCs had a higher NYHA class (65.6 % had class III/IV; p < 0.0001) compared to 36.8 % at OBCs and 39.3 % at GPs. Usage of three guideline-recommended pharmaceutical treatments was more than 80 %: diuretics (83.1 %), renin-angiotensin system blocking agents (91.4 %) and betablockers (90.1 %) with no differences between physician groups. Mineralocorticoid receptor antagonists (MRAs, overall 47.7 %) were more frequently prescribed by OBCs (54.7 %; p = 0.0007 for trend) than HBCs (43.8 %) and GPs (31.0 %). Ivabradin was not frequently used (11.0 % at OBCs, 4.9 % at HBCs and 0 % at GPs; p = 0.0163 for trend). The proportion of patients with CRT (8.6 %), ICD (23.5 %) and CABG (23.1 %) was not statistically different between groups. CONCLUSION REFLECT-HF demonstrates that there are some differences in evidence-based treatment decisions between the three main health services (HBC, OBC and GP) providing care for patients with HF in Germany. Advocating adherence to guideline recommendations and earlier adoption of these evidence-based treatments across all levels of care might further improve patient care.
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Affiliation(s)
- Ulrich Tebbe
- Klinikum Lippe-Detmold, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Röntgenstrasse 18, 32756, Detmold, Germany,
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17
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Bussoni MF, Guirado GN, Roscani MG, Polegato BF, Matsubara LS, Bazan SGZ, Matsubara BB. Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction. Braz J Med Biol Res 2013; 46:803-8. [PMID: 24036912 PMCID: PMC3854427 DOI: 10.1590/1414-431x20132902] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 06/21/2013] [Indexed: 11/22/2022] Open
Abstract
Exercise capacity and quality of life (QOL) are important outcome predictors in
patients with systolic heart failure (HF), independent of left ventricular (LV)
ejection fraction (LVEF). LV diastolic function has been shown to be a better
predictor of aerobic exercise capacity in patients with systolic dysfunction and
a New York Heart Association (NYHA) classification ≥II. We hypothesized that the
currently used index of diastolic function E/e' is associated with exercise
capacity and QOL, even in optimally treated HF patients with reduced LVEF. This
prospective study included 44 consecutive patients aged 55±11 years (27 men and
17 women), with LVEF<0.50 and NYHA functional class I-III, receiving optimal
pharmacological treatment and in a stable clinical condition, as shown by the
absence of dyspnea exacerbation for at least 3 months. All patients had
conventional transthoracic echocardiography and answered the Minnesota Living
with HF Questionnaire, followed by the 6-min walk test (6MWT). In a
multivariable model with 6MWT as the dependent variable, age and E/e' explained
27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis).
No association was found between walk distance and LVEF or mitral annulus
systolic velocity. Only normalized left atrium volume, a sensitive index of
diastolic function, was associated with decreased QOL. Despite the small number
of patients included, this study offers evidence that diastolic function is
associated with physical capacity and QOL and should be considered along with
ejection fraction in patients with compensated systolic HF.
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Affiliation(s)
- M F Bussoni
- Universidade Estadual Paulista, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, BotucatuSP, Brasil
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18
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Evidence on the global measurement model of the Minnesota Living with Heart Failure Questionnaire. Qual Life Res 2013; 22:2675-84. [PMID: 23677481 DOI: 10.1007/s11136-013-0383-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most widely used health-related quality of life measure in both clinical and research settings. Nevertheless, its measurement model has never been confirmed. This study aims to fill that gap with a large international sample. METHODS Data from eight studies (3,847 patients with heart failure) from 21 countries were merged and analysed. Common variables included MLHFQ scores, functional capacity, cardiovascular risk factors and the socio-demographic characteristics of the patient. The measurement model of the MLHFQ was assessed by means of exploratory and confirmatory factor analyses (EFA-CFA). The reliability of MLHFQ scores was evaluated using Cronbach's alpha coefficient and the MLHFQ's ability to differentiate among known groups was assessed through severity levels. RESULTS Findings from the EFA and CFA suggest that the MLHFQ total and domain-specific scores fall within a bifactor model. The physical and emotional scores were supported within the sample, as was the original total score. Furthermore, a third factor was revealed regarding social environment. The reliability coefficient reached 0.9 for almost all physical and total scores. All the MLHFQ mean scores showed the ability to differentiate among functional capacity groups, with most of the effect size coefficients reaching 0.8. CONCLUSIONS Beyond the suitable degree of reliability and validity displayed by the MLHFQ scores in the different country-specific versions, our results confirmed for the first time the unidimensionality of the most commonly used score in HF patients: the total MLHFQ score. Moreover, the social environment domain identified in this study can now be considered when assessing these patients' HRQL, especially as a relevant outcome with regard to disease management.
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19
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Lennie TA, Moser DK, Biddle MJ, Welsh D, Bruckner GG, Thomas DT, Rayens MK, Bailey AL. Nutrition intervention to decrease symptoms in patients with advanced heart failure. Res Nurs Health 2013; 36:120-45. [PMID: 23335263 PMCID: PMC4011634 DOI: 10.1002/nur.21524] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
For a majority of patients with advanced heart failure, there is a need for complementary, non-pharmacologic interventions that could be easily implemented by health care providers to provide palliative care. Three major pathologic pathways underlying heart failure symptoms have been identified: fluid overload, inflammation, and oxidative stress. Prior research has demonstrated that three nutrients-sodium, omega-3 fatty acids, and lycopene-can alter these pathologic pathways. Therefore, the purposes of this study are to test the effects of a 6-month nutrition intervention of dietary sodium reduction combined with supplementation of lycopene and omega-3 fatty acids on heart failure symptoms, health-related quality of life, and time to heart failure rehospitalization or all-cause death. The aims of this double blind-placebo controlled study are (1) to determine the effects of a 6-month nutrition intervention on symptom burden (edema, shortness of air, and fatigue) and health-related quality of life at 3 and 6 months, and time to heart failure rehospitalization or all-cause death over 12 months from baseline; (2) compare dietary sodium intake, inflammation, and markers of oxidative stress between the nutrition intervention group and a placebo group at 3 and 6 months; and (3) compare body weight, serum lycopene, and erythrocyte omega-3 index between the nutrition intervention group and a placebo group at 3 and 6 months. A total of 175 patients with advanced heart failure will be randomized to either the nutrition intervention or placebo group.
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Affiliation(s)
- Terry A Lennie
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
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20
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Fujita B, Franz M, Goebel B, Fritzenwanger M, Figulla HR, Kuethe F, Ferrari M, Jung C. Prognostic relevance of heart rate at rest for survival and the quality of life in patients with dilated cardiomyopathy. Clin Res Cardiol 2012; 101:701-7. [DOI: 10.1007/s00392-012-0447-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/15/2012] [Indexed: 11/28/2022]
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21
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Gouya G, Hammer A, Elhenicky M, Neuhold S, Wolzt M, Hülsmann M, Pacher R. Benefit of specialized clinics for the treatment of patients with heart failure. Eur J Intern Med 2011; 22:428-31. [PMID: 21767764 DOI: 10.1016/j.ejim.2011.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 02/13/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Current guidelines recommend special attention for heart failure (HF) patients in dedicated outpatient units. AIMS AND METHODS In this observational cohort study we sought to determine whether an equivalent benefit is achieved in all HF patients treated in specialized heart failure clinics. Patients were stratified to patients recently referred and those who already receiving long-term care (>1 year). Data were collected at baseline and after 12 months. RESULTS 474 patients were prospectively observed. 130 subjects were recently referred and 344 subjects had received long-term care. During follow-up of recently referred patients, enhancement of neurohumoral pharmacotherapy was achieved in 67% (p<0.001), which was paralleled by a reduction in NT-proBNP (baseline 1779 pg/ml [range 458;4685]; after 12 months 668 pg/ml [range 167;1690]; p<0.001) and improvement in quality of life score, measured by the Minnesota Living with Heart Failure Questionnaire by 8 points [range 0;23]; (at baseline 34 points [range 16;59], and after 12 months 15 points [range 5;42]; p=0.04). In contrast, these parameters were unchanged in long-term care patients. Hospitalization for HF and other cardiovascular causes was higher in patients recently referred, and all-cause mortality was comparable in both groups. CONCLUSIONS This comprehensive analysis of chronic HF patients treated in a specialized HF outpatient clinic confirmed the potential to optimize pharmacotherapy paralleled by improvements in quality of life and NT-proBNP levels in patients referred within the first 12 months. Prolonged management of HF patients after this optimization of maintenance therapy yields little additional benefit.
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Affiliation(s)
- Ghazaleh Gouya
- Department of Clinical Pharmacology, Medical University Vienna, Austria.
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Naveiro-Rilo JC, Diez-Juárez DM, Romero Blanco A, Rebollo-Gutiérrez F, Rodríguez-Martínez A, Rodríguez-García MA. Validation of the Minnesota living with heart failure questionnaire in primary care. Rev Esp Cardiol 2011; 63:1419-27. [PMID: 21144402 DOI: 10.1016/s1885-5857(10)70276-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the applicability, internal consistency and validity of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) when used in primary care, compared with the Short Form-36 (SF-36) health survey. METHODS The two questionnaires were administered to 589 patients with chronic heart failure who were registered with 97 primary care physicians. The applicability, internal consistency and validity of the MLHFQ were evaluated and comparisons were made with the SF-36. RESULTS More than 90% of patients completed the questionnaires. The percentage of uncompleted items was low. Cronbach's alpha ranged from 0.79 to 0.94 for the various MLHFQ dimensions. Exploratory factorial analysis identified two factors that explained 65.8% of the variance. Moderate to good correlations were observed between similar dimensions of the MLHFQ and SF-36 (correlation coefficient -0.43 to -0.73). There were significant associations between scores on the MLHFQ and clinical measures of disease severity. CONCLUSIONS When used in primary care, the MLHFQ had a high level of acceptability and good psychometric properties compared with the SF-36. Consequently, it would be useful for assessing health-related quality of life in patients with chronic heart failure.
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Volz A, Schmid JP, Zwahlen M, Kohls S, Saner H, Barth J. Predictors of readmission and health related quality of life in patients with chronic heart failure: a comparison of different psychosocial aspects. J Behav Med 2010; 34:13-22. [PMID: 20658185 DOI: 10.1007/s10865-010-9282-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 07/12/2010] [Indexed: 01/24/2023]
Abstract
Psychological distress is common in patients with chronic heart failure. The impact of different psychological variables on prognosis has been shown but the comparative effects of these variables remain unclear. This study examines the impact of depression, anxiety, vital exhaustion, Type D personality, and social support on prognosis in chronic heart failure patients. One hundred eleven patients (mean age 57 ± 14 years) having participated in an exercise based ambulatory cardiac rehabilitation program were enrolled in a prospective cohort study. Psychological baseline data were assessed at program entry. Mortality, readmission, and health-related quality of life were assessed at follow up (mean 2.8 ± 1.1 years). After controlling for disease severity none of the psychological variables were associated with mortality, though severe anxiety predicted readmission [HR = 3.21 (95% CI, 1.04-9.93; P = .042)]. Health-related quality of life was independently explained by vital exhaustion, anxiety and either body mass index (physical dimension) or sex (emotional dimension). As psychological variables have a strong impact on health-related quality of life they should be routinely assessed in chronic heart failure patients` treatment.
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Affiliation(s)
- Andreas Volz
- Division of Social and Behavioral Health Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure. ACTA ACUST UNITED AC 2010; 16:645-50. [PMID: 19801939 DOI: 10.1097/hjr.0b013e3283299542] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF. DESIGN All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program. METHODS Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1). RESULTS Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20). CONCLUSION Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.
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Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses. Qual Life Res 2008; 18:71-85. [DOI: 10.1007/s11136-008-9416-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 10/24/2008] [Indexed: 10/21/2022]
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Heo S, Doering LV, Widener J, Moser DK. Predictors and Effect of Physical Symptom Status on Health-Related Quality of Life in Patients With Heart Failure. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.2.124] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Physical symptoms are common and distressing problems for patients with heart failure and may be the strongest predictor of health-related quality of life. Identification of variables predictive of physical symptom status is needed to develop effective interventions to improve health-related quality of life.
Methods A total of 84 patients discharged after being hospitalized for exacerbation of heart failure were followed up for 3 months. The Minnesota Living With Heart Failure Questionnaire and the Dyspnea-Fatigue Index were used to assess health-related quality of life and physical symptom status, respectively. Relationships of health-related quality of life and physical symptom status to baseline demographic, behavioral, biophysiological, and psychological variables were examined with bivariate correlations and stepwise multiple regression analyses.
Results Patients with better physical symptom status and those who worked, were older, and were less anxious at baseline reported better health-related quality of life (F=12.4, P<.001); physical symptom status was the strongest predictor. Patients who had less depression, worked, had higher perceived control, and were younger at baseline reported better physical symptom status (F=14.4, P<.001); depression was the strongest predictor.
Conclusions Physical symptom status is the most important predictor of health-related quality of life, and baseline depression and perceived control are the best predictors of physical symptom status. Interventions targeted to improve psychological status may improve physical symptom status and thereby improve health-related quality of life.
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Affiliation(s)
- Seongkum Heo
- Seongkum Heois an assistant professor at the Indiana University School of Nursing in Indianapolis. Debra K. Moseris a professor and holds the Gill Endowed Chair of Nursing at the University of Kentucky College of Nursing in Lexington. Lynn V. Doeringis an associate professor and section chair in acute care at the University of California, Los Angeles, School of Nursing. Jeanne Wideneris a doctoral student at Ohio State University in Columbus
| | - Lynn V. Doering
- Seongkum Heois an assistant professor at the Indiana University School of Nursing in Indianapolis. Debra K. Moseris a professor and holds the Gill Endowed Chair of Nursing at the University of Kentucky College of Nursing in Lexington. Lynn V. Doeringis an associate professor and section chair in acute care at the University of California, Los Angeles, School of Nursing. Jeanne Wideneris a doctoral student at Ohio State University in Columbus
| | - Jeanne Widener
- Seongkum Heois an assistant professor at the Indiana University School of Nursing in Indianapolis. Debra K. Moseris a professor and holds the Gill Endowed Chair of Nursing at the University of Kentucky College of Nursing in Lexington. Lynn V. Doeringis an associate professor and section chair in acute care at the University of California, Los Angeles, School of Nursing. Jeanne Wideneris a doctoral student at Ohio State University in Columbus
| | - Debra K. Moser
- Seongkum Heois an assistant professor at the Indiana University School of Nursing in Indianapolis. Debra K. Moseris a professor and holds the Gill Endowed Chair of Nursing at the University of Kentucky College of Nursing in Lexington. Lynn V. Doeringis an associate professor and section chair in acute care at the University of California, Los Angeles, School of Nursing. Jeanne Wideneris a doctoral student at Ohio State University in Columbus
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Heo S, Moser DK, Lennie TA, Zambroski CH, Chung ML. A comparison of health-related quality of life between older adults with heart failure and healthy older adults. Heart Lung 2007; 36:16-24. [PMID: 17234473 DOI: 10.1016/j.hrtlng.2006.06.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 03/14/2006] [Accepted: 06/13/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) in older adults with heart failure may be affected by a variety of variables including aging. It is important to determine the unique impact of heart failure to more effectively improve HRQOL in this population. OBJECTIVE The purpose of this study was to compare HRQOL and physical, psychologic, clinical, and sociodemographic status in older adults with and without heart failure. METHODS The HRQOL of 90 older adults with heart failure and 116 healthy older adults was compared. The factors best associated with HRQOL in each group were determined using multiple regression model. RESULTS HRQOL was substantially worse among older adults with heart failure than among healthy older adults. Older adults with heart failure had more severe physical and emotional symptoms, poorer functional status, and worse health perceptions. Physical symptom status was the strongest predictor of HRQOL in both groups. In addition, in older adults with heart failure, physical symptom status, age, and anxiety were related to HRQOL. CONCLUSION The poor HRQOL seen in patients with heart failure is not just a reflection of aging. Comprehensive interventions targeted toward the factors that specifically negatively impact HRQOL are essential in older adults with heart failure.
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Affiliation(s)
- Seongkum Heo
- University of Kentucky, College of Nursing, Lexington, Kentucky 40536-0232, USA
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Use of the “Minnesota Living With Heart Failure” Quality of Life Questionnaire in Spain. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1885-5857(06)60104-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Aplicación en España del cuestionario sobre calidad de vida «Minnesota Living With Heart Failure» para la insuficiencia cardíaca. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77078-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Meyer K, Laederach-Hofmann K. Effects of a Comprehensive Rehabilitation Program on Quality of Life in Patients With Chronic Heart Failure. ACTA ACUST UNITED AC 2003; 18:169-76. [PMID: 14605517 DOI: 10.1111/j.0889-7204.2003.03013.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This evaluation was performed to assess the effects of a new, comprehensive outpatient rehabilitation program on generic and disease-specific quality of life related to exercise tolerance in stable chronic heart failure patients. Fifty-one patients (aged 59+/-11 years; 84% men) were treated for 12 weeks. Patients underwent optimized drug treatment, exercise training, and counseling and education. At baseline and at the end of the program, functional status, exercise capacity, and quality of life were assessed using the Medical Outcomes Study 36-item Short-Form Health Survey and the Minnesota Living with Heart Failure Questionnaire. Left ventricular ejection fraction and New York Heart Association functional class, as well as measures of physical fitness and walking distance covered in 6 minutes, improved significantly (by 11%-20% and by 58% on average, respectively). Physical functioning (effect size, 0.38; p<0.0001), role functioning (effect size, 0.17; p<0.05), and mental component score (effect size, 0.47; p<0.0001) on the questionnaire improved significantly. Disease-specific quality of life improved in sum score (effect size, 0.24; p<0.0001) and physical component score (effect size, 0.35; p<0.0001). The latter was inversely correlated to improvement in peak power output (r= -0.31; p<0.05). In patients with stable chronic heart failure, significant improvements in both generic and disease-specific quality of life related to improved exercise tolerance can be achieved within 12 weeks of comprehensive rehabilitation.
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