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Lunardi M, Louvard Y, Lefèvre T, Stankovic G, Burzotta F, Kassab GS, Lassen JF, Darremont O, Garg S, Koo BK, Holm NR, Johnson TW, Pan M, Chatzizisis YS, Banning AP, Chieffo A, Dudek D, Hildick-Smith D, Garot J, Henry TD, Dangas G, Stone G, Krucoff MW, Cutlip D, Mehran R, Wijns W, Sharif F, Serruys PW, Onuma Y. Definitions and Standardized Endpoints for Treatment of Coronary Bifurcations. EUROINTERVENTION 2023; 19:e807-e831. [PMID: 35583108 PMCID: PMC10687650 DOI: 10.4244/eij-e-22-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Bifurcation Academic Research Consortium (Bif-ARC) project originated from the need to overcome the paucity of standardization and comparability between studies involving bifurcation coronary lesions. This document is the result of a collaborative effort between academic research organizations and the most renowned interventional cardiology societies focused on bifurcation lesions in Europe, the United States, and Asia. This consensus provides standardized definitions for bifurcation lesions; the criteria to judge the side branch relevance; the procedural, mechanistic, and clinical endpoints for every type of bifurcation study; and the follow-up methods. Considering the complexity of bifurcation lesions and their evaluation, detailed instructions and technical aspects for site and core laboratory analysis of bifurcation lesions are also reported. The recommendations included within this consensus will facilitate pooled analyses and the effective comparison of data in the future, improving the clinical relevance of trials in bifurcation lesions, and the quality of care in this subset of patients.
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Affiliation(s)
- Mattia Lunardi
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Massy, France
| | | | - Goran Stankovic
- Department of Cardiology, University Clinical Center of -Serbia and Faculty of Medicine, University of Belgrade, -Belgrade, -Serbia
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ghassan S Kassab
- California Medical Innovation Institute, San Diego, California, USA
| | - Jens F Lassen
- Department of Cardiology B, Odense Universitets Hospital and University of Southern Denmark, Odense C, Denmark
| | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, United Kingdom
| | - Manuel Pan
- IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Yiannis S Chatzizisis
- Cardiovascular Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Alaide Chieffo
- Division of Cardiology, San Raffaele Hospital, Milan, Italy
| | - Dariusz Dudek
- Second Department of Cardiology Jagiellonian University Medical College, Krakow, Poland
| | | | - Jérome Garot
- Institut Cardiovasculaire Paris Sud, Massy, France
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, Ohio, USA
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregg Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mitchell W Krucoff
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Baim Institute for Clinical Research and Harvard Medical School, Boston, Massachusetts, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Wijns
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
- The Lambe Institute for Translational Medicine and CURAM, National University of Ireland Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
- International Centre for Circulatory Health, NHLI, Imperial College, London, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
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Harikrishnan S, Salim R, Ganapathi S, Sharma M, Prasad D, Phlilip G, Jeemon P. Development and validation of heart failure-specific quality-of-life measurement tool in India. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100329. [PMID: 38511185 PMCID: PMC10946013 DOI: 10.1016/j.ahjo.2023.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 03/22/2024]
Abstract
Objective To develop and validate a sensitive tool for assessment of quality of life (QoL) in heart failure (HF) patients in Indian settings. Methods The authors conducted literature review, in depth interviews, clinical observations and designed the first draft of the QoL tool. The tool was validated using content and face validity by a panel of experts. For internal consistency reliability, the questionnaire was administered among 270 HF patients. Test-retest reliability was assessed in 20 HF patients. Principal component factor analysis with varimax rotation was employed to assess the dimensionality and to reduce the number of items. Cronbach's alpha, and Intra-class correlation coefficients (ICCs) were employed to investigate reliability of questionnaire. The responsiveness data were collected 6 months after the baseline data collection from 30 HF patients. IBM® SPSS® Statistics Version 21 was used for statistical analysis. Results The principal component factor analysis revealed mainly 5 domains. The final tool included 25 items. Cronbach's alpha (α) for the overall tool was 0.915. Intra-class correlation coefficients (ICCs) based on test-retest was 0.734. The final tool showed good responsiveness to changes with a mean ± SD of the change in response of 46 ± 12.4 and a standardized mean response of 3.7 within six-months. Conclusion The HF specific QoL tool developed for Indian patients is a valid and reliable instrument and it can be applied in daily clinical practice, and research. Short summary We had developed and validated a quality-of-life tool for heart failure patients in India. This is the first ever attempt to develop a measure for heart failure patients in India. We had used a mixed methodology approach to identify all the domains in the tool. The newly developed tool is a valid, reliable, sensitive and responsive tool to measure quality of life in HF patients in India. This tool can be applied in daily clinical practice, research and health system for patients with HF in India.
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Affiliation(s)
- Sivadasanpillai Harikrishnan
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Reethu Salim
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sanjay Ganapathi
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Meenakshi Sharma
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India
| | - Divya Prasad
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Greeva Phlilip
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Panniyammakal Jeemon
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Bouchard K, Gareau A, Greenman PS, Lalande K, Sztajerowska K, Tulloch H. What's love got to do with it? Relationship quality appraisals and quality of life in couples facing cardiovascular disease. Health Psychol Behav Med 2023; 11:2237564. [PMID: 37484832 PMCID: PMC10360988 DOI: 10.1080/21642850.2023.2237564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Changes in couples' relationship quality are common post-cardiac event but it is unclear how relationship quality is linked to patients' and spouses' quality of life (QoL). The purpose of the present study was to examine the association between relationship quality on QoL in patient-spouse dyads within six months of a cardiac event. Methods Participants (N = 181 dyads; 25.9% female patients), recruited from a large cardiac hospital, completed validated questionnaires measuring demographic, relationship (Dyadic Adjustment Scale; DAS) and QoL variables (Heart-QoL & Quality of life of Cardiac Spouses Questionnaire). An Actor-Partner Interdependence Model was used to investigate actor (i.e. responses influencing their own outcome) and partner effects (responses influencing their partner's outcome) of relationship quality and QoL. Results Patients' and spouses' perceptions of relationship quality were in the satisfied range (DAS > 108; 65% of sample) and, as expected, patients reported lower general physical QoL than did their spouse (t(180) = -10.635, p < .001). Patient and spouse relationship quality appraisals were positively associated with their own physical (patient β = .25; spouse β = .05) and emotional/social (patient β = .21; spouse β = .04) QoL. No partner effects were identified. Conclusion High quality relationship appraisals appear to matter for patients' and spouses' QoL after the onset of CVD.
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Affiliation(s)
- Karen Bouchard
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Paul S. Greenman
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Université du Québec en Outaouais, Gatineau, Canada
- Monfort Hospital, Ottawa, Canada
| | - Kathleen Lalande
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Heather Tulloch
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Hwang D, Park SH, Koo BK. Ischemia With Nonobstructive Coronary Artery Disease: Concept, Assessment, and Management. JACC. ASIA 2023; 3:169-184. [PMID: 37181394 PMCID: PMC10167523 DOI: 10.1016/j.jacasi.2023.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 05/16/2023]
Abstract
In daily clinical practice, physicians often encounter patients with angina or those with evidence of myocardial ischemia from noninvasive tests but not having obstructive coronary artery disease. This type of ischemic heart disease is referred to as ischemia with nonobstructive coronary arteries (INOCA). INOCA patients often suffer from recurrent chest pain without adequate management and are associated with poor clinical outcomes. There are several endotypes of INOCA, and each endotype should be treated based on its specific underlying mechanism. Therefore, identifying INOCA and discriminating its underlying mechanisms are important issues and of clinical interest. Invasive physiologic assessment is the first step in the diagnosis of INOCA and discriminating the underlying mechanism; additional provocation tests help physicians identify the vasospastic component in INOCA patients. Comprehensive information acquired from these invasive tests can provide a template for mechanism-specific management for patients with INOCA.
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Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hyeon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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Pigłowska M, Kostka T, Guligowska A. Do Determinants of Quality of Life Differ in Older People Living in the Community and Nursing Homes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:916. [PMID: 36673674 PMCID: PMC9858919 DOI: 10.3390/ijerph20020916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/19/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
Objectives: The aim of the present study was to examine and compare the relationship between nutritional status, physical activity (PA) level, concomitant chronic diseases, and quality of life (QoL) in community-dwelling (CD) older people and nursing home (NH) residents. Material and Methods: One hundred NH residents aged 60 years and above and one hundred sex- and age-matched CD older adults were examined. The QoL was examined with the EuroQol-5D questionnaire. Nutritional status was assessed with the Mini Nutritional Assessment questionnaire (MNA), anthropometric measures, and bioimpedance analysis (BIA). The 7-Day Recall Questionnaire and the Stanford Usual Activity Questionnaire were performed to evaluate the PA energy expenditure level (PA-EE) and the health-related behaviours (PA-HRB), respectively. Results: CD subjects presented a significantly higher self-assessment in the VAS scale in comparison with NH residents (CD: 65.3 ± 19.4 vs. NH 58.2 ± 21.4; p < 0.05), but there were no differences within the five dimensions of QoL. In NH patients, the VAS scale was not correlated with any of the variables evaluating the nutritional status and body composition, while in the CD group correlated positively with MNA (rS = 0.36; p < 0.001), % of FFM (rS = 0.22; p< 0.05), body density (rS = 0.22; p < 0.05) and negatively with % of FM (rS = −0.22; p < 0.05). In an institutional environment, only concomitant diseases (mainly urinary incontinence) were found as independent determinants for QoL. In the community, independent determinants of QoL besides concomitant diseases (mainly ischaemic heart disease) were nutritional status or PA-HRB. Conclusions: Determinants of QoL are different depending on the living environment the older adults. Proper nutritional status and beneficial PA behaviours, are crucial for higher QoL of CD elderly, while for NH residents, the main determinants of QoL are chronic conditions.
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Varghese TP, Kumar PRAV. Quality of Life and Depression Assessment in Patients with Acute Coronary Syndrome: A Cross-Sectional Study. Cardiovasc Hematol Disord Drug Targets 2022; 22:CHDDT-EPUB-126001. [PMID: 36043780 DOI: 10.2174/1871529x22666220830093651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Acute Coronary Syndrome (ACS) is currently the leading cause of death in industrialized countries. Morbidity after ACS includes physical and mental disorders affecting the patient's whole life situation and Quality of Life (QoL). The main aim of the study was to assess QoL and depression among post-ACS patients. METHODS This was a cross-sectional observational study. A total of 112 patients who fulfilled the inclusion criteria were included in this study. A semi-structured questionnaire was administered to the patients to collect data from the patients. In this study, men and women aged 18 - 80 with ACS; patients diagnosed with Non-ST Segment Elevated Myocardial Infarction (NSTEMI) or STEMI or Angina Pectoris were included. Patients with severe mental, and physical illness and dementia were excluded from the study. QoL and depression assessment was done by RAND 36-Item Health Survey and Hamilton Depression Rating scale, respectively. RESULTS Among 112 post-ACS patients, 78 patients were males, and 38 patients were females. The mean age of the study population was 64.25 ± 9.029 and with most individuals in the category of 61 - 70 years. The majority of study populations were married (71.5%) and lived with their families (92.9%). In this study group, 42.9 % of the population reported at least high school education (SSLC) and 54.5% were full-time employees. Most of the patients (91.1%) were taking the medication regularly, while 55.4% of patients reported regular compliance with the follow-up. This study identified that, among various factors, older age, female gender, lower income, unemployment, low education status, poor compliance with medication, and depressive symptoms led to poor QoL. CONCLUSION This study confirms a negative correlation between depressive symptoms and QoL. This study's results reveal the magnitude of depression that is prevalent in the primary health care clinic that goes undiagnosed and unmanaged. Hence, it is recommended to properly screen depressive symptoms in ACS patients. Therefore, concurrently, better QoL can be achieved by managing both depression and ACS.
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Affiliation(s)
- Treesa P Varghese
- Department of Pharmacy Practice,Yenepoya College of Pharmacy and Research Centre (Yenepoya deemed to be University), Deralakatte, Mangalore, India
| | - P R Anand Vijaya Kumar
- Department of Pharmacology, JSS Academy of Higher education and research Centre (JSSAHER), JSS College of Pharmacy, Ooty, India
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Lunardi M, Louvard Y, Lefèvre T, Stankovic G, Burzotta F, Kassab GS, Lassen JF, Darremont O, Garg S, Koo BK, Holm NR, Johnson TW, Pan M, Chatzizisis YS, Banning A, Chieffo A, Dudek D, Hildick-Smith D, Garot J, Henry TD, Dangas G, Stone GW, Krucoff MW, Cutlip D, Mehran R, Wijns W, Sharif F, Serruys PW, Onuma Y. Definitions and Standardized Endpoints for Treatment of Coronary Bifurcations. J Am Coll Cardiol 2022; 80:63-88. [PMID: 35597684 DOI: 10.1016/j.jacc.2022.04.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/03/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
The Bifurcation Academic Research Consortium (Bif-ARC) project originated from the need to overcome the paucity of standardization and comparability between studies involving bifurcation coronary lesions. This document is the result of a collaborative effort between academic research organizations and the most renowned interventional cardiology societies focused on bifurcation lesions in Europe, the United States, and Asia. This consensus provides standardized definitions for bifurcation lesions; the criteria to judge the side branch relevance; the procedural, mechanistic, and clinical endpoints for every type of bifurcation study; and the follow-up methods. Considering the complexity of bifurcation lesions and their evaluation, detailed instructions and technical aspects for site and core laboratory analysis of bifurcation lesions are also reported. The recommendations included within this consensus will facilitate pooled analyses and the effective comparison of data in the future, improving the clinical relevance of trials in bifurcation lesions, and the quality of care in this subset of patients.
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Affiliation(s)
- Mattia Lunardi
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland; Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Massy, France
| | | | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ghassan S Kassab
- California Medical Innovation Institute, San Diego, California, USA
| | - Jens F Lassen
- Department of Cardiology B, Odense Universitets Hospital and University of Southern Denmark, Odense C, Denmark
| | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, United Kingdom
| | - Manuel Pan
- IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Yiannis S Chatzizisis
- Cardiovascular Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Adrian Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Alaide Chieffo
- Division of Cardiology, San Raffaele Hospital, Milan, Italy
| | - Dariusz Dudek
- Second Department of Cardiology Jagiellonian University Medical College, Krakow, Poland
| | | | - Jérome Garot
- Institut Cardiovasculaire Paris Sud, Massy, France
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, Ohio, USA
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mitchell W Krucoff
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Baim Institute for Clinical Research and Harvard Medical School, Boston, Massachusetts, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Wijns
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland; The Lambe Institute for Translational Medicine and CURAM, National University of Ireland Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland; International Centre for Circulatory Health, NHLI, Imperial College, London, United Kingdom.
| | - Yoshinobu Onuma
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of Ireland Galway, Galway, Ireland
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McRee CW, Brice LR, Farag AA, Iskandrian AE, Hage FG. Evolution of symptoms in patients with stable angina after normal regadenoson myocardial perfusion imaging: The Radionuclide Imaging and Symptomatic Evolution study (RISE). J Nucl Cardiol 2022; 29:612-621. [PMID: 32754894 DOI: 10.1007/s12350-020-02298-8] [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: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Assessment of quality of life in patients with stable angina and normal gated single-photon emission computed tomography myocardial perfusion imaging (MPI) remains undefined. Symptom evolution in response to imaging findings has important implications on further diagnostic testing and therapeutic interventions. METHODS Prospective cohort study was conducted at the University of Alabama at Birmingham enrolling 87 adult participants with stable chest pain from the emergency room, hospital setting, and outpatient clinics. Patients underwent MPI with technetium-99m Sestamibi and had a normal study. Participants filled out Seattle Angina Questionnaires initially and at 3-month follow-up. RESULTS Among the 87 participants (60 ± 12 years; 40% African American, 70% women, 29% diabetes), the mean score increased by an absolute value of 14.2 [95% CI 10.4-18.7, P < .001] in physical limitation, 23.2 [95% CI 17.1-29.4, P < .001] in angina stability, 10.9 [95% CI 7.6-14.1, P < .001] in angina frequency, and 20.6 [95% CI 16.5-24.7, P < .001] in disease perception. There was no significant change in the mean score of treatment satisfaction [- 1.4, 95% CI - 4.7 to 1.8, P = .38]. At 3-month follow-up, 28 of 87 participants (32%) were angina free. CONCLUSIONS Patients with stable chest pain and normal MPI experience significant improvement in functional status, quality of life, and disease perception in the short term.
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Affiliation(s)
- Chad W McRee
- University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Lizbeth R Brice
- University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Ayman A Farag
- University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA
| | - Ami E Iskandrian
- University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA
| | - Fadi G Hage
- University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA.
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Tran AT, Spertus JA, Mena-Hurtado CI, Jones PG, Aronow HD, Safley DM, Malik AO, Peri-Okonny PA, Shishehbor MH, Labrosciano C, Smolderen KG. Association of Disease-Specific Health Status With Long-Term Survival in Peripheral Artery Disease. J Am Heart Assoc 2022; 11:e022232. [PMID: 35132874 PMCID: PMC9245831 DOI: 10.1161/jaha.121.022232] [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: 11/17/2022]
Abstract
Background While peripheral artery disease (PAD) is associated with increased cardiovascular morbidity with mortality remaining high and challenging to predict, accurate understanding of serial PAD‐specific health status around the time of diagnosis may prognosticate long‐term mortality risk. Methods and Results Patients with new or worsening PAD symptoms enrolled in the PORTRAIT Registry across 10 US sites from 2011 to 2015 were included. Health status was assessed by the Peripheral Artery Questionnaire (PAQ) Summary score at baseline, 3‐month, and change from baseline to 3‐month follow‐up. Kaplan‐Meier using 3‐month landmark and hierarchical Cox regression models were constructed to assess the association of the PAQ with 5‐year all‐cause mortality. Of the 711 patients (mean age 68.8±9.6 years, 40.9% female, 72.7% white; mean PAQ 47.5±22.0 and 65.9±25.0 at baseline and 3‐month, respectively), 141 (19.8%) died over a median follow‐up of 4.1 years. In unadjusted models, baseline (HR, 0.90 per‐10‐point increment; 95% CI, 0.84–0.97; P=0.008), 3‐month (HR [95% CI], 0.87 [0.82–0.93]; P<0.001) and change in PAQ (HR [95% CI], 0.92 [0.85–0.99]; P=0.021) were each associated with mortality. In fully adjusted models including combination of scores, 3‐month PAQ was more strongly associated with mortality than either baseline (3‐month HR [95% CI], 0.85 [0.78–0.92]; P<0.001; C‐statistic, 0.77) or change (3‐month HR [95% CI], 0.79 [0.72–0.87]; P<0.001). Conclusions PAD‐specific health status is independently associated with 5‐year survival in patients with new or worsening PAD symptoms, with the most recent assessment being most prognostic. Future work is needed to better understand how this information can be used proactively to optimize care.
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Affiliation(s)
- Andy T Tran
- Department of Medicine University of California Irvine School of Medicine Orange CA
| | - John A Spertus
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Carlos I Mena-Hurtado
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University New Haven CT
| | - Philip G Jones
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Herbert D Aronow
- Department of Medicine Alpert Medical School of Brown University Providence RI
| | - David M Safley
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Ali O Malik
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Poghni A Peri-Okonny
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Mehdi H Shishehbor
- Interventional Cardiovascular Center Case Western Reserve University School of Medicine Cleveland OH
| | - Clementine Labrosciano
- The Queen Elizabeth Hospital Adelaide Medical School University of Adelaide SA Australia
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University New Haven CT.,Department of Psychiatry School of Medicine, Yale University New Haven CT
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10
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Xu DP, Lin LQ, Wu BX, Lin MY, Chen QX. Interim analysis report of kuanxiong aerosol in improving angina and quality of life after percutaneous coronary intervention. WORLD JOURNAL OF TRADITIONAL CHINESE MEDICINE 2022. [DOI: 10.4103/wjtcm.wjtcm_26_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Abstract
Up to half of patients undergoing elective coronary angiography for the investigation of chest pain do not present with evidence of obstructive coronary artery disease. These patients are often discharged with a diagnosis of non-cardiac chest pain, yet many could have an ischaemic basis for their symptoms. This type of ischaemic chest pain in the absence of obstructive coronary artery disease is referred to as INOCA (ischaemia with non-obstructive coronary arteries). This comprehensive review of INOCA management looks at why these patients require treatment, who requires treatment based on diagnostic evaluation, what clinical treatment targets should be considered, how to treat patients using a personalised medicine approach, when to initiate treatment, and where future research is progressing.
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Affiliation(s)
- John F Beltrame
- Adelaide Medical School, University of Adelaide, Queen Elizabeth Hospital Campus, Woodville South, Adelaide, SA, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- Basil Hetzel Institute for Translational Health Research, Queen Elizabeth Hospital, Woodville South, Adelaide, SA, Australia
| | - Rosanna Tavella
- Adelaide Medical School, University of Adelaide, Queen Elizabeth Hospital Campus, Woodville South, Adelaide, SA, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- Basil Hetzel Institute for Translational Health Research, Queen Elizabeth Hospital, Woodville South, Adelaide, SA, Australia
| | - Dione Jones
- Adelaide Medical School, University of Adelaide, Queen Elizabeth Hospital Campus, Woodville South, Adelaide, SA, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Chris Zeitz
- Adelaide Medical School, University of Adelaide, Queen Elizabeth Hospital Campus, Woodville South, Adelaide, SA, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- Basil Hetzel Institute for Translational Health Research, Queen Elizabeth Hospital, Woodville South, Adelaide, SA, Australia
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12
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Eliya Y, Averbuch T, Le N, Xie F, Thabane L, Mamas MA, Van Spall HGC. Temporal Trends and Factors Associated With the Inclusion of Patient-Reported Outcomes in Heart Failure Randomized Controlled Trials: A Systematic Review. J Am Heart Assoc 2021; 10:e022353. [PMID: 34689608 PMCID: PMC8751837 DOI: 10.1161/jaha.121.022353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Patient‐reported outcomes (PROs) are important measures of treatment response in heart failure. We assessed temporal trends in and factors associated with inclusion of PROs in heart failure randomized controlled trials (RCTs). Methods and Results We searched MEDLINE, Embase, and CINAHL for studies published between January 2000 and July 2020 in journals with an impact factor ≥10. We assessed temporal trends using the Jonckheere‐Terpstra test and conducted multivariable logistic regression to explore trial characteristics associated with PRO inclusion. We assessed the quality of PRO reporting using the Consolidated Standards of Reporting Trials (CONSORT) PRO extension. Of 417 RCTs included, PROs were reported in 226 (54.2%; 95% CI, 49.3%–59.1%), with increased reporting between 2000 and 2020 (P<0.001). The odds of PRO inclusion were greater in RCTs that were published in recent years (adjusted odds ratio [aOR] per year, 1.08; 95% CI, 1.04–1.12; P<0.001), multicenter (aOR, 1.89; 95% CI, 1.03–3.46; P=0.040), medium‐sized (aOR, 2.35; 95% CI, 1.26–4.40; P=0.008), coordinated in Central and South America (aOR, 5.93; 95% CI, 1.14–30.97; P=0.035), and tested health service (aOR, 3.12; 95% CI, 1.49–6.55; P=0.003), device/surgical (aOR, 6.66; 95% CI, 3.15–14.05; P<0.001), or exercise (aOR, 4.66; 95% CI, 1.81–12.00; P=0.001) interventions. RCTs reported a median of 4 (interquartile interval , 3–6) of a possible of 11 CONSORT PRO items. Conclusions Just over half of all heart failure RCTs published in high impact factor journals between 2000 and 2020 included PROs, with increased inclusion of PROs over time. Trials that were large, tested pharmaceutical interventions, and coordinated in North America / Europe had lower adjusted odds of reporting PROs relative to other trials. The quality of PRO reporting was modest.
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Affiliation(s)
- Yousif Eliya
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Tauben Averbuch
- Department of Medicine McMaster University Hamilton Ontario Canada
| | - NhatChinh Le
- Department of Medicine McMaster University Hamilton Ontario Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group Keele University Stroke-on-Trent United Kingdom
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.,Department of Medicine McMaster University Hamilton Ontario Canada.,Population Health Research Institute Hamilton Ontario Canada
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13
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The Association Between Physical Performance and Health-Related Quality of Life Based on the EuroQol 5-Dimensional Questionnaire in Patients With Chagas Disease. Value Health Reg Issues 2021; 26:191-196. [PMID: 34757310 DOI: 10.1016/j.vhri.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Chagas disease (CD) is a chronic disease to millions worldwide, and many patients develop heart disease. In addition, they are part of an aging population. These characteristics can be associated with a reduction in physical performance and health-related quality of life (HRQoL). This study evaluated HRQoL, and the relationship between physical performance and HRQoL in patients with chronic CD. METHODS We used the 3-level version of EuroQol 5-dimensional questionnaire (EQ-5D-3L), with the visual analog scale (VAS). Physical performance was measured with 30-s chair-stand test (30sCST) and timed up and go test (TUGT). RESULTS Sixty-three patients were evaluated. The majority were women (68.2%) aged 67.7 ± 9.7 years. Overall EQ-5D-3L utility index was 0.65 ± 0.28, and VAS score was 68.4 ± 25.1. Most patients with intermediate and high performance in 30sCST referred no problems in the domains "mobility," "usual activities," and "pain/feeling ill" (P < .001, P = .01, and P = .025, respectively). In a similar way, most patients with intermediate and high performance in TUGT referred no problems in "mobility" (P < .0001) and "usual activities" (P = .001). Higher performance in both tests was associated with higher overall EQ-5D-3L utility and VAS scores. HRQoL measured by EQ-5D-3L was associated with physical status in a cohort of patients with chronic CD. The results underscore the contribution of physical performance, measured by 2 inexpensive and safe physical tests, to HRQoL in these patients. CONCLUSION Strategies aiming the improvement of HRQoL in patients with CD may focus on mobility skills and force. Future studies evaluating interventions in physical performance should be a priority in these patients.
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14
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Kanwar A, Roger VL, Lennon RJ, Gharacholou SM, Singh M. Poor quality of life in patients with and without frailty: co-prevalence and prognostic implications in patients undergoing percutaneous coronary interventions and cardiac catheterization. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:591-600. [PMID: 32821905 DOI: 10.1093/ehjqcco/qcaa065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022]
Abstract
AIMS We hypothesize that poor quality of life (QOL) is highly prevalent in frail older adults and is associated with worse prognosis. METHODS AND RESULTS Predismissal standardized tests for frailty and QOL were prospectively administered to patients included in two cohorts. In Cohort 1, 629 patients ≥65 years who underwent percutaneous coronary intervention (PCI) from 2005 to 2008, frailty (Fried criteria), and QOL [SF-36 and Seattle Angina Questionnaires (SAQ)] were ascertained. Cohort 2 included 921 patients ≥55 years who underwent cardiac catheterization (535 had PCI) from 2014 to 2018 and frailty was determined by Rockwood criteria and QOL by single-item, self-reported health questionnaire. In Cohort 1, 19% were frail and 20% patients in Cohort 2 were frail with a frailty index >0.30. The median SAQ for physical limitation (58.9 vs. 82.2, P < 0.001), physical (29.5 vs. 43.9, P < 0.001), and mental (49.2 vs. 57.4, P < 0.001) component scores of SF-36 in Cohort 1 were lower and self-rating of fair/poor health (56% vs 18%, P < 0.001) in Cohort 2 was significantly higher in frail patients. As compared to patients without frailty, frail patients were five times more likely (59% vs. 11%, P < 0.001) in Cohort 1 and seven times more likely (56% vs. 8%) in Cohort 2 to be classified with poor QOL. Age- and gender-adjusted 3-year all-cause death and death or myocardial infarction (MI) was significantly higher for patients undergoing PCI with frailty; [hazard ratio (95% confidence interval) death, 4.20 (2.63-6.68, P < 0.001) and death or MI hazard ratio (HR) 2.72 (1.91-3.87, P < 0.001)] and with poor QOL [HR death 2.47 (1.59-3.84, P < 0.001)] and death or MI 1.61 (1.16-2.24, P < 0.001). There was no significant interaction between frailty and QOL (P = 0.64) and only modest attenuation was observed when considered together indicating their independent prognostic influence. CONCLUSION In elderly patients undergoing cardiac catheterization or PCI, poor QOL is seen more frequently in frail patients. Both frailty and poor QOL had significant and independent association with long-term survival.
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Affiliation(s)
- Amrit Kanwar
- Department of Internal Medicine, Loma Linda University, Loma Linda, California
| | - Veronique L Roger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Ryan J Lennon
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | - Mandeep Singh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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15
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Tran AT, Fonarow GC, Arnold SV, Jones PG, Thomas LE, Hill CL, DeVore AD, Butler J, Albert NM, Spertus JA. Risk Adjustment Model for Preserved Health Status in Patients With Heart Failure and Reduced Ejection Fraction: The CHAMP-HF Registry. Circ Cardiovasc Qual Outcomes 2021; 14:e008072. [PMID: 34615366 PMCID: PMC8530961 DOI: 10.1161/circoutcomes.121.008072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/30/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Health status outcomes are increasingly being promoted as measures of health care quality, given their importance to patients. In heart failure (HF), an American College of Cardiology/American Heart Association Task Force proposed using the proportion of patients with preserved health status as a quality measure but not as a performance measure because risk adjustment methods were not available. METHODS We built risk adjustment models for alive with preserved health status and for preserved health status alone in a prospective registry of outpatients with HF with reduced ejection fraction across 146 US centers between December 2015 and October 2017. Preserved health status was defined as not having a ≥5-point decrease in the Kansas City Cardiomyopathy Questionnaire Overall Summary score at 1 year. Using only patient-level characteristics, hierarchical multivariable logistic regression models were developed for 1-year outcomes and validated using data from 1 to 2 years. We examined model calibration, discrimination, and variability in sites' unadjusted and adjusted rates. RESULTS Among 3932 participants (median age [interquartile range] 68 years [59-75], 29.7% female, 75.4% White), 2703 (68.7%) were alive with preserved health status, 902 (22.9%) were alive without preserved health status, and 327 (8.3%) had died by 1 year. The final risk adjustment model for alive with preserved health status included baseline Kansas City Cardiomyopathy Questionnaire Overall Summary, age, race, employment status, annual income, body mass index, depression, atrial fibrillation, renal function, number of hospitalizations in the past 1 year, and duration of HF (optimism-corrected C statistic=0.62 with excellent calibration). Similar results were observed when deaths were ignored. The risk standardized proportion of patients alive with preserved health status across the 146 sites ranged from 62% at the 10th percentile to 75% at the 90th percentile. Variability across sites was modest and changed minimally with risk adjustment. CONCLUSIONS Through leveraging data from a large, outpatient, observational registry, we identified key factors to risk adjust sites' proportions of patients with preserved health status. These data lay the foundation for building quality measures that quantify treatment outcomes from patients' perspectives.
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Affiliation(s)
- Andy T. Tran
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri–Kansas City, Kansas City, MO
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Suzanne V. Arnold
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri–Kansas City, Kansas City, MO
| | - Philip G. Jones
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri–Kansas City, Kansas City, MO
| | | | | | - Adam D. DeVore
- Duke Clinical Research Institute, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS
| | - Nancy M. Albert
- Nursing Institute and Kaufman Center for Heart Failure-Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland OH
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri–Kansas City, Kansas City, MO
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16
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Stubblefield WB, Jenkins CA, Liu D, Storrow AB, Spertus JA, Pang PS, Levy PD, Butler J, Chang AM, Char D, Diercks DB, Fermann GJ, Han JH, Hiestand BC, Hogan CJ, Khan Y, Lee S, Lindenfeld JM, McNaughton CD, Miller K, Peacock WF, Schrock JW, Self WH, Singer AJ, Sterling SA, Collins SP. Improvement in Kansas City Cardiomyopathy Questionnaire Scores After a Self-Care Intervention in Patients With Acute Heart Failure Discharged From the Emergency Department. Circ Cardiovasc Qual Outcomes 2021; 14:e007956. [PMID: 34555929 PMCID: PMC8628372 DOI: 10.1161/circoutcomes.121.007956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We conducted a secondary analysis of changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 over 30 days in a randomized trial of self-care coaching versus structured usual care in patients with acute heart failure who were discharged from the emergency department. METHODS Patients in 15 emergency departments completed the KCCQ-12 at emergency department discharge and at 30 days. We compared change in KCCQ-12 scores between the intervention and usual care arms, adjusted for enrollment KCCQ-12 and demographic characteristics. We used linear regression to describe changes in KCCQ-12 summary scores and logistic regression to characterize clinically meaningful KCCQ-12 subdomain changes at 30 days. RESULTS There were 350 patients with both enrollment and 30-day KCCQ summary scores available; 166 allocated to usual care and 184 to the intervention arm. Median age was 64 years (interquartile range, 55-70), 37% were female participants, 63% were Black, median KCCQ-12 summary score at enrollment was 47 (interquartile range, 33-64). Self-care coaching resulted in significantly greater improvement in health status compared with structured usual care (5.4-point greater improvement, 95% CI, 1.12-9.68; P=0.01). Improvements in health status in the intervention arm were driven by improvements within the symptom frequency (adjusted odds ratio, 1.62 [95% CI, 1.01-2.59]) and quality of life (adjusted odds ratio, 2.39 [95% CI, 1.46-3.90]) subdomains. CONCLUSIONS In this secondary analysis, patients with acute heart failure who received a tailored, self-care intervention after emergency department discharge had clinically significant improvements in health status at 30 days compared with structured usual care largely due to improvements within the symptom frequency and quality of life subdomains of the KCCQ-12. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02519283.
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Affiliation(s)
- William B Stubblefield
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Cathy A Jenkins
- Department of Biostatistics (C.A.J., D.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Dandan Liu
- Department of Biostatistics (C.A.J., D.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Alan B Storrow
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - John A Spertus
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City and Saint Luke's Mid America Heart Institute, MO (J.A.S.)
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.S.P.)
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI (P.D.L.)
| | - Javed Butler
- Department of Medicine (J.B.), University of Mississippi Medical Center, Jackson
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital (A.M.C.)
| | - Douglas Char
- Division of Emergency Medicine, Department of Internal Medicine, Washington University, Seattle (D.C.)
| | - Deborah B Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX (D.B.D.)
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.)
| | - Jin H Han
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Brian C Hiestand
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (B.C.H.)
| | - Christopher J Hogan
- Division of Trauma/Critical Care, Departments of Emergency Medicine and Surgery, Virginia Commonwealth University Medical Center, Richmond (C.J.H.)
| | - Yosef Khan
- Health Informatics and Analytics, Centers for Health Metrics and Evaluation, American Heart Association (Y.K.)
| | - Sangil Lee
- Department of Emergency Medicine, University of Iowa Carver College of Medicine (S.L.)
| | - JoAnn M Lindenfeld
- Division of Cardiovascular Disease (J.M.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Candace D McNaughton
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Karen Miller
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.)
| | - Jon W Schrock
- Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (J.W.S.)
| | - Wesley H Self
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, NY (A.J.S.)
| | - Sarah A Sterling
- Department of Emergency Medicine (S.A.S.), University of Mississippi Medical Center, Jackson
| | - Sean P Collins
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
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17
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Hejjaji V, Tang Y, Coles T, Jones PG, Reeve BB, Mentz RJ, Spatz ES, Dunlay SM, Caldwell B, Saha A, Tarver ME, Tran A, Patel KK, Henke D, Piña IL, Spertus JA. Psychometric Evaluation of the Kansas City Cardiomyopathy Questionnaire in Men and Women With Heart Failure. Circ Heart Fail 2021; 14:e008284. [PMID: 34465123 DOI: 10.1161/circheartfailure.120.008284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been psychometrically evaluated in multiple heart failure (HF) populations, but the comparability of its psychometric properties between men and women is unknown. METHODS Data from 3 clinical trials (1 in stable HF with preserved ejection fraction, 1 each in stable and acute HF with reduced ejection fraction) and 1 prospective cohort study (stable HF with reduced ejection fraction), incorporating 6773 men and 3612 women with HF, were used to compare the construct validity, internal and test-retest reliability, ability to detect change, predict mortality and hospitalizations and minimally important differences between the 2 sexes. Interactions of the KCCQ overall summary and subdomain scores by sex were independently examined. RESULTS The KCCQ-Overall Summary score correlated well with New York Heart Association functional class in both sexes across patients with stable (correlation coefficient: -0.40 in men versus -0.49 in women) and acute (-0.37 in men versus -0.34 in women) HF. All KCCQ subdomains demonstrated concordant relationships with relevant comparison standards with no significant interactions by sex in 19 of 21 of these construct validity analyses. All KCCQ scores were equally predictive and other psychometric evaluations showed similar results by sex: test-retest reliability (intraclass correlation coefficient 0.94 in men versus 0.92 in women), responsive to change (standardized response mean 1.01 in both sexes), as were the minimally important differences and internal reliability. CONCLUSIONS The psychometric properties of the KCCQ, in terms of validity, prognosis, reliability, and sensitivity to change, are comparable in men and women with HF with preserved ejection fraction and HF with reduced ejection fraction.
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Affiliation(s)
- Vittal Hejjaji
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (V.H., Y.T., P.G.J., A.T., K.K.P., J.A.S.)
| | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (V.H., Y.T., P.G.J., A.T., K.K.P., J.A.S.)
| | - Theresa Coles
- Duke Clinical Research Institute, Durham, NC (T.C., B.B.R., R.J.M., D.H.)
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (V.H., Y.T., P.G.J., A.T., K.K.P., J.A.S.)
| | - Bryce B Reeve
- Duke Clinical Research Institute, Durham, NC (T.C., B.B.R., R.J.M., D.H.)
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, NC (T.C., B.B.R., R.J.M., D.H.)
| | - Erica S Spatz
- Yale University School of Medicine, New Haven, CT (E.S.S.)
| | - Shannon M Dunlay
- Mayo Clinic College of Medicine, Rochester, MN (S.M.D.). Center for Devices and Radiological Health, US FDA, White Oak, MD
| | | | | | | | - Andy Tran
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (V.H., Y.T., P.G.J., A.T., K.K.P., J.A.S.)
| | - Krishna K Patel
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (V.H., Y.T., P.G.J., A.T., K.K.P., J.A.S.)
| | - Debra Henke
- Duke Clinical Research Institute, Durham, NC (T.C., B.B.R., R.J.M., D.H.)
| | | | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (V.H., Y.T., P.G.J., A.T., K.K.P., J.A.S.)
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18
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Yang L, Zhang Z, Gao H, Wu Y, Wei H, Kong J, Wang R, Cheng J, Tian J. Cultural Adaptation and Validation of Questionnaires for Evaluation of Health-Related Quality of Life with Dysphagia in Different Countries: A Systematic Review. Dysphagia 2021; 37:812-823. [PMID: 34181064 DOI: 10.1007/s00455-021-10330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
Dysphagia can have devastating and long-lasting effects on the patient's health-related quality of life (HRQoL). In recent years, a number of questionnaires for the evaluation of the HRQoL of patients with dysphagia have been developed and have been adapted for use in different countries and cultures. However, problems may arise in the process of cultural adaptation and validation, which can affect the quality of the questionnaires and their measurements. This study was conducted to systematically summarize the cultural adaptation and validation of questionnaires for the evaluation of dysphagia-related HRQoL in different countries, assessing the varieties, measurement properties, and qualities of these questionnaires, with the aim of identifying the status of their adaptation and validation and ways in which they might be improved. Four databases were searched, and relevant articles were screened, with data from eligible reports extracted and reviewed. The methodological quality of the included articles was evaluated using the QualSyst critical appraisal tool. The HRQoL questionnaires for patients with dysphagia were assessed using the quality criteria for the measurement properties of health status questionnaires proposed by Terwee et al. and Timmerman et al. 29 studies published between 2008 and 2020 were included. The questionnaires described in these 29 studies were translated into 19 languages and culturally adapted to 21 countries. The adapted questionnaires were based on the Swallowing quality of life questionnaire (SWAL-QOL) by Mchorney et al., the Dysphagia Handicap Index (DHI) by Silbergleit et al., the M.D. Anderson Dysphagia Inventory (MDADI) by Chen et al., and the Eating Assessment Tool-10 (EAT-10) by Belafsky et al. It was found that the questionnaires were reliable and valid instruments for the assessment of dysphagia-related HRQoL, but the quality criteria for cultural adaptation and validation were not strictly followed, especially in the categories of criterion validity, agreement, responsiveness, and interpretability. In conclusion, although the questionnaires were found to be both reliable and valid, the quality criteria should be considered and strictly followed in the cultural adaptation and validation process in the future.
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Affiliation(s)
- Lin Yang
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Zhigang Zhang
- The First Hospital of Lanzhou University, Lanzhou, China.
- School of Nursing, Lanzhou University, Lanzhou, China.
| | - Huiya Gao
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuchen Wu
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Huaping Wei
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Jiajia Kong
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Rui Wang
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jie Cheng
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
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19
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Thomas M, Jones PG, Arnold SV, Spertus JA. Interpretation of the Seattle Angina Questionnaire as an Outcome Measure in Clinical Trials and Clinical Care: A Review. JAMA Cardiol 2021; 6:593-599. [PMID: 33566062 DOI: 10.1001/jamacardio.2020.7478] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Patient-reported outcomes are increasingly used as end points in clinical trials, assessments in clinical care, and tools for population health, with an increasing role in quality assessment. For patients with coronary artery disease, the Seattle Angina Questionnaire (SAQ) has emerged as the most commonly used measure of disease-specific health status to quantify patients' symptoms of angina and the extent to which their angina affects their functioning and quality of life. This review explains how to interpret the SAQ and describes the construction and face validity of the SAQ, focusing on aligning scores and changes in scores with clinical constructs. Observations The SAQ asks questions similar to those an experienced clinician would ask of a patient with stable ischemic heart disease. Therefore, SAQ scores can be aligned with clinical constructs (eg, scores on the SAQ angina frequency scale of 0-30 points indicate daily angina, 31-60 points indicate weekly angina, 61-99 points indicate monthly angina, and 100 points indicate no angina), and changes in scores can be described by aligning them with changes in question responses. After clinical thresholds are defined, it is important for clinical trials to not simply report mean differences between treatment arms but to also report the distributions of patients who have had clinically important benefits so that a number needed to treat can be generated. Conclusions and Relevance The widespread use of the SAQ is a consequence of its well-established validity, reproducibility, prognostic importance, and sensitivity to clinical change. Nevertheless, interpreting the SAQ can be challenging because of lack of familiarity with the clinical importance of its domains, either cross-sectionally or longitudinally. This review provides an overview of the interpretability of the SAQ as a foundation for its use as an end point in clinical trials, a tool to support more patient-centered care, and a means of facilitating population health strategies to provide a better foundation for the integration of patient experiences with clinical care.
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Affiliation(s)
- Merrill Thomas
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City
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20
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Almeida Lins WM, Tura BR, Kasal DA. The Association Between Physical Performance and Health-Related Quality of Life Based on the EuroQol 5-Dimensional Questionnaire in Patients With Chagas Disease. Value Health Reg Issues 2021; 25:112-117. [PMID: 33873130 DOI: 10.1016/j.vhri.2021.01.005] [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: 04/20/2020] [Revised: 11/30/2020] [Accepted: 01/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Chagas disease (CD) is a chronic disease to millions worldwide, and many patients develop heart disease. In addition, they are part of an aging population. These characteristics can be associated with a reduction in physical performance and health-related quality of life (HRQoL). This study evaluated HRQoL, and the relationship between physical performance and HRQoL in patients with chronic CD. METHODS We used the 3-level version of EuroQol 5-dimensional questionnaire (EQ-5D-3L), with the visual analog scale (VAS). Physical performance was measured with 30-s chair-stand test (30sCST) and timed up and go test (TUGT). RESULTS Sixty-three patients were evaluated. The majority were women (68.2%) aged 67.7 ± 9.7 years. Overall EQ-5D-3L utility index was 0.65 ± 0.28, and VAS score was 68.4 ± 25.1. Most patients with intermediate and high performance in 30sCST referred no problems in the domains "mobility," "usual activities," and "pain/feeling ill" (P < .001, P = .01, and P = .025, respectively). In a similar way, most patients with intermediate and high performance in TUGT referred no problems in "mobility" (P < .0001) and "usual activities" (P = .001). Higher performance in both tests was associated with higher overall EQ-5D-3L utility and VAS scores. HRQoL measured by EQ-5D-3L was associated with physical status in a cohort of patients with chronic CD. The results underscore the contribution of physical performance, measured by 2 inexpensive and safe physical tests, to HRQoL in these patients. CONCLUSION Strategies aiming the improvement of HRQoL in patients with CD may focus on mobility skills and force. Future studies evaluating interventions in physical performance should be a priority in these patients.
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Affiliation(s)
| | - Bernardo Rangel Tura
- Research Division, National Institute of Cardiology, Ministry of Health, Rio de Janeiro, Brazil
| | - Daniel Arthur Kasal
- Research Division, National Institute of Cardiology, Ministry of Health, Rio de Janeiro, Brazil; State University of Rio de Janeiro, Internal Medicine Department, Rio de Janeiro, Brazil.
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21
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Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care. J Am Coll Cardiol 2020; 76:2379-2390. [DOI: 10.1016/j.jacc.2020.09.542] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022]
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22
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Moazzami K, Wittbrodt MT, Alkhalaf M, Lima BB, Nye JA, Mehta PK, Quyyumi AA, Vaccarino V, Bremner JD, Shah AJ. Association Between Mental Stress-Induced Inferior Frontal Cortex Activation and Angina in Coronary Artery Disease. Circ Cardiovasc Imaging 2020; 13:e010710. [PMID: 32772572 PMCID: PMC7422935 DOI: 10.1161/circimaging.120.010710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The inferior frontal lobe is an important area of the brain involved in the stress response, and higher activation with acute mental stress may indicate a more severe stress reaction. However, it is unclear if activation of this region with stress correlates with angina in individuals with coronary artery disease. METHODS Individuals with stable coronary artery disease underwent acute mental stress testing using a series of standardized speech/arithmetic stressors in conjunction with high resolution positron emission tomography imaging of the brain. Blood flow to the inferior frontal lobe was evaluated as a ratio compared with whole brain flow for each scan. Angina was assessed with the Seattle Angina Questionnaire's angina frequency subscale at baseline and 2 years follow-up. RESULTS We analyzed 148 individuals with coronary artery disease (mean age [SD] 62 [8] years; 69% male, and 35.8% Black). For every doubling in the inferior frontal lobe activation, angina frequency was increased by 13.7 units at baseline ([Formula: see text], 13.7 [95% CI, 6.3-21.7]; P=0.008) and 11.6 units during follow-up ([Formula: see text], 11.6 [95% CI, 4.1-19.2]; P=0.01) in a model adjusted for baseline demographics. Mental stress-induced ischemia and activation of other brain pain processing regions (thalamus, insula, and amygdala) accounted for 40.0% and 13.1% of the total effect of inferior frontal lobe activation on angina severity, respectively. CONCLUSIONS Inferior frontal lobe activation with mental stress is independently associated with angina at baseline and during follow-up. Mental stress-induced ischemia and other pain processing brain regions may play a contributory role.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.).,Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Matthew T Wittbrodt
- Department of Psychiatry and Behavioral Sciences (M.T.W., J.D.B.), Emory University School of Medicine, Atlanta, GA
| | - Mhmtjamil Alkhalaf
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Bruno B Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.).,Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Jonathon A Nye
- Department of Radiology and Imaging Sciences (J.A.N., J.D.B.), Emory University School of Medicine, Atlanta, GA
| | - Puja K Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.)
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences (M.T.W., J.D.B.), Emory University School of Medicine, Atlanta, GA.,Department of Radiology and Imaging Sciences (J.A.N., J.D.B.), Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Decatur, GA (J.D.B., A.J.S.)
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.).,Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Decatur, GA (J.D.B., A.J.S.)
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23
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Angermann CE, Assmus B, Anker SD, Asselbergs FW, Brachmann J, Brett M, Brugts JJ, Ertl G, Ginn G, Hilker L, Koehler F, Rosenkranz S, Zhou Q, Adamson PB, Böhm M. Pulmonary artery pressure‐guided therapy in ambulatory patients with symptomatic heart failure: the
CardioMEMS E
uropean
M
onitoring
S
tudy for
H
eart
F
ailure (
MEMS‐HF
). Eur J Heart Fail 2020; 22:1891-1901. [DOI: 10.1002/ejhf.1943] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/27/2020] [Accepted: 06/20/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Christiane E. Angermann
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg University Hospital Würzburg Würzburg Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany
- Department of Medicine I, Cardiology/Angiology University Hospital Giessen Germany
| | - Stefan D. Anker
- Division of Cardiology & Metabolism and Department of Cardiology & Berlin‐Brandenburg Center for Regenerative Therapies, and German Center for Cardiovascular Research, partner site Berlin Charité Universitätsmedizin Berlin Berlin Germany
| | - Folkert W. Asselbergs
- Division Heart & Lungs, Department of Cardiology University Medical Centre Utrecht Utrecht The Netherlands
| | - Johannes Brachmann
- Medical Centre Coburg GmbH II, Medical Clinic Cardiology, Angiology, Pulmonology Coburg Germany
| | | | - Jasper J. Brugts
- Erasmus MC University Medical Centre, Thoraxcenter Rotterdam The Netherlands
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg University Hospital Würzburg Würzburg Germany
| | | | - Lutz Hilker
- Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg‐Western Pommerania Karlsburg Germany
| | - Friedrich Koehler
- Division of Cardiology and Angiology, Medical Department, Campus Charité Mitte, Centre for Cardiovascular Telemedicine Charité Universitätsmedizin Berlin Berlin Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine University of Cologne Heart Center, and Cologne Cardiovascular Research Center (CCRC) Cologne Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I University Heart Center Freiburg – Bad Krozingen, University of Freiburg Freiburg Germany
- Department of Cardiology University Hospital Basel Basel Switzerland
| | | | - Michael Böhm
- Internal Medicine III Cardiology, Angiology, Intensive Care Saarland University Medical Centre Homburg Germany
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24
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Cedars AM, Ko JM, John AS, Vittengl J, Stefanescu‐Schmidt AC, Jarrett RB, Kutty S, Spertus JA. Development of a Novel Adult Congenital Heart Disease-Specific Patient-Reported Outcome Metric. J Am Heart Assoc 2020; 9:e015730. [PMID: 32419592 PMCID: PMC7428986 DOI: 10.1161/jaha.119.015730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
Abstract
Background Patient-reported outcome metrics (PROs) quantify important outcomes in clinical trials and can be sensitive measures of patient experience in clinical practice. Currently, there is no validated disease-specific PRO for adults with congenital heart disease (ACHD). Methods and Results We conducted a preliminary psychometric validation of a novel ACHD PRO. ACHD patients were recruited prospectively from 2 institutions and completed a series of questionnaires, a physician health assessment, and a 6-minute walk test. Participants returned to complete the same questionnaires and assessment 3 months±2 weeks later. We tested the internal consistency and test-retest reliability by comparing responses among clinically stable patients at the 2 study visits. We assessed convergent and divergent validity by comparison of ACHD PRO responses to existing validated questionnaires. We assessed responsiveness by comparison with patient-reported clinical change. One hundred three patients completed 1 study visit and 81 completed both. The ACHD PRO demonstrated good internal consistency in each of its 5 domains (Cronbach's α: 0.87; 0.74; 0.74; 0.90; and 0.89, respectively) and in the overall summary score (0.92). Test-retest reliability was good with an intraclass correlation ≥0.73 for all domains and 0.78 for the Summary Score. The ACHD PRO accurately assessed domain concepts based on comparison with validated standards. Preliminary estimates of responsiveness suggest sensitivity to clinical status. Conclusions These studies provide initial support for the validity and reliability of the ACHD PRO. Further studies are needed to assess its sensitivity to changes in clinical status.
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Affiliation(s)
- Ari M. Cedars
- Division of CardiologyDepartment of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Jong Mi Ko
- Division of CardiologyDepartment of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Anitha S. John
- Department of CardiologyChildren’s National Medical CenterWashingtonDC
| | | | | | - Robin B. Jarrett
- Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTX
| | - Shelby Kutty
- Department of Pediatric CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - John A. Spertus
- Department of CardiologyMid‐America Heart InstituteKansas CityKS
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25
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The Effect of an Empowerment Program on the Perceived Risk and Physical Health of Patients With Coronary Artery Disease. Holist Nurs Pract 2020; 34:163-170. [PMID: 32282492 DOI: 10.1097/hnp.0000000000000370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was conducted to assess the effect of an empowerment program on the perceived risk and physical health of patients with coronary artery disease. This randomized clinical trial recruited 84 patients with coronary artery disease admitted to post-cardiac care unit (CCU) wards in Tehran Heart Center in 2017. The study subjects were selected and assessed according to inclusion criteria and assigned to intervention and control groups by block randomization. Both groups completed questionnaires for demographic details and disease history, perceived risk in cardiac patients, and physical health. The Magic Empowerment Program was performed for the intervention group as 3 workshops on 3 successive days. Intervention continued after patients' discharge from the hospital through phone calls once a week for 8 weeks. The perceived risk in cardiac patients and physical health questionnaires were completed for both groups. Postintervention results showed significant differences between the 2 groups in total score of perceived risk (P = .001) and its subscales. The Empowerment Program changed patients' attitudes toward risk-motivating behavior change and improving physical health.
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26
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Butler J, Khan MS, Mori C, Filippatos GS, Ponikowski P, Comin-Colet J, Roubert B, Spertus JA, Anker SD. Minimal clinically important difference in quality of life scores for patients with heart failure and reduced ejection fraction. Eur J Heart Fail 2020; 22:999-1005. [PMID: 32239794 DOI: 10.1002/ejhf.1810] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/25/2020] [Accepted: 06/07/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS While the associations of health-related quality of life scores in heart failure (HF) [e.g. the Kansas City Cardiomyopathy Questionnaire (KCCQ)] with clinical outcomes are well established, their interpretation in the context of what magnitudes of change are clinically important to patients is less clear. The main objective of this study was to correlate the changes in the KCCQ and Patient Global Assessment (PGA) in patients with HF with reduced ejection fraction (HFrEF) to determine minimal clinically important difference (MCID). METHODS AND RESULTS We analysed data from 459 patients of the FAIR-HF trial. Both KCCQ and PGA were assessed at 4 and 24 weeks after enrolment. An anchor-based approach was used to calculate MCID at week 4 and 24. PGA was chosen as the clinical anchor against which changes in the KCCQ scores were calibrated. For each category of change in PGA, the corresponding differences were calculated by the mean scores of various domains of KCCQ along with 95% confidence intervals (CIs). There was fair correlation between PGA and changes in overall summary scores (OSS) (r = 0.31; P < 0.001), clinical summary scores (CSS) (r = 0.36; P < 0.001) and physical limitation scores (PLS) (r = 0.31; P < 0.001) from baseline to week 4. KCCQ OSS, CSS and PLS MCID for 'little improvement' at week 4 were 3.6 (1.0-6.2), 4.5 (1.8-7.2) and 4.7 (1.4-8.0) points, respectively. OSS, CSS and PLS MCID for 'little improvement' at week 24 were 4.3 (0.2-8.4), 4.5 (0.5-8.5) and 4.0 (-0.9-9.0) points, respectively. CONCLUSION The MCID threshold for KCCQ score was generally consistent and numerically lower than the threshold of 5-point change considered for clinical outcome prognosis and were stable between 4 and 24 weeks. This suggests that even changes smaller than the traditional 5-point improvements in KCCQ may be clinically meaningful. Also, these results can aid in the clinical interpretation of patient-reported outcomes, and better endpoint selection in future studies.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MO, USA
| | | | | | - Gerasimos S Filippatos
- Medical School, University of Cyprus, Nicosia, Cyprus.,National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | | | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital and IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | | | - John A Spertus
- Department of Cardiology, University of Missouri-Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany
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27
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Belkin M, Wussler D, Mueller C. Health-Related Quality of Life in Heart Failure With Preserved Ejection Fraction. JACC. HEART FAILURE 2020; 8:245. [PMID: 32131028 DOI: 10.1016/j.jchf.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
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28
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Backman WD, Levine SA, Wenger NK, Harold JG. Shared decision-making for older adults with cardiovascular disease. Clin Cardiol 2020; 43:196-204. [PMID: 31580493 PMCID: PMC7021653 DOI: 10.1002/clc.23267] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 08/30/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022] Open
Abstract
Shared decision-making is appropriate for clinical decisions involving multiple reasonable options, which occur frequently in the cardiovascular care of older adults. The process includes the communication of relevant factual information between the patient and the clinician, elicitation of patient preferences, and a mutual agreement on the best course of action to meet the patient's personal goals. For older adults, there are common challenges and considerations with regard to shared decision-making, some of which (eg, cognitive impairment) may be biologically linked to cardiovascular disease. There are tools designed to facilitate the shared decision-making process, known as decision aids, which are broadly effective although have shortcomings when applied to older adults. Novel approaches in clinical research and health systems changes will go some way toward improving shared decision-making for older adults, but the greatest scope for improvement may be within the grass roots areas of communication skills, interdisciplinary teamwork, and simply asking our patients what matters most.
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Affiliation(s)
- Warren D. Backman
- Veterans Affairs New England Geriatric Research Education and Clinical CenterBostonMassachusetts
- Section of GeriatricsBoston University and Boston Medical CenterBostonMassachusetts
| | - Sharon A. Levine
- Division of Palliative Care and Geriatric MedicineMassachusetts General HospitalBostonMassachusetts
| | - Nanette K. Wenger
- Division of CardiologyEmory University School of MedicineAtlantaGeorgia
- Emory Heart and Vascular CenterAtlantaGeorgia
- Emory Women's Heart CenterAtlantaGeorgia
| | - John Gordon Harold
- Cedars‐Sinai Smidt Heart Institute and UCLA David Geffen School of MedicineLos AngelesCalifornia
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29
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Liu J, Legg JC, Mo M, Zhang X. Considerations in testing treatment effects on transient event driven health status changes measured by patient reported outcomes. Stat Med 2019; 38:5497-5511. [PMID: 31631355 DOI: 10.1002/sim.8376] [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: 05/03/2019] [Accepted: 08/28/2019] [Indexed: 11/10/2022]
Abstract
Many treatments and drugs are intended to reduce the occurrence of negative events of interest, control the severity of the events, accelerate recovery from the events, or a combination of these effects. While assessing the clinical effect is typically the primary objective of a trial, testing the treatment effect on the health status of patients based on patient reported outcome (PRO) can be a useful component in determining the value of a treatment. Analysis of PROs in this setting, however, face the following challenges: the PRO value immediately after the event occurrence is often not captured, and the effect of the event on health status measured by the PRO is transient as subjects recover over time. Therefore, traditional statistical methods used to assess treatment effects suffer from low power for PROs. In this manuscript, we apply a kernel smoothing technique to estimate before- and after-event PRO values. We also propose new test outcomes based on observed and estimated PRO values and evaluate tests that focus on the tail distributions. We demonstrate that the tail distribution tests using the new outcomes can achieve high power under certain conditions.
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Affiliation(s)
- Jingyuan Liu
- MOE Key Laboratory of Econometrics, Department of Statistics, School of Economics, Wang Yanan Institute for Studies in Economics and Fujian Key Laboratory of Statistical Science, Xiamen University, Xiamen, China
| | - Jason C Legg
- Global Biostatistical Science, Amgen, Newbury Park, California
| | - May Mo
- Global Biostatistical Science, Amgen, Newbury Park, California
| | - Xuwen Zhang
- MOE Key Laboratory of Econometrics, Department of Statistics, School of Economics, Wang Yanan Institute for Studies in Economics and Fujian Key Laboratory of Statistical Science, Xiamen University, Xiamen, China
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30
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Castro RRT, Joyce E, Lakdawala NK, Stewart G, Nohria A, Givertz MM, Desai A, Lewis EF, Stevenson LW. Patients report more severe daily limitations than recognized by their physicians. Clin Cardiol 2019; 42:1181-1188. [PMID: 31571248 PMCID: PMC6906987 DOI: 10.1002/clc.23269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patient limitations guide selection of heart failure therapies, for which indications often specify New York Heart Association Class. OBJECTIVES To determine the extent of patient-reported limitations during daily activities and compare to New York Heart Association class assigned by providers during the same visit, and to left ventricular ejection fraction (LVEF) group. METHODS AND RESULTS While waiting for their appointment, 948 patients on return visits to an ambulatory HF clinic completed a written questionnaire assessing specific activity limitations, which were compared to physician-assigned NYHA class during the same visit. Patient-reported limitation to perform daily activity ranged from 25% for bathing to 61% for yardwork or housework and 71% for jogging or hurrying. Most patients who did not report limitations to perform daily life activities were correctly classified as NYHA I by the physicians (76%), but 12% of the 376 patients classified as NYHA I reported limitations to showering or bathing and 73% reported limitations while doing yardwork or house work. Limitation to walking was reported by 172 patients (50%) classified as class II. Limitations to walking one block were most common in patients with LVEF ≥40% compared to patients with LVEF <40%, and least commonly, in HF with better EF (improved from 31 ± 13 to 52 ± 7). CONCLUSIONS Activity limitations are commonly reported by ambulatory HF patients, but underestimated by physicians. It is not clear how this should guide therapy validated for NYHA class but focused activity questions may merit wider use to track limitations and improvement in ambulatory HF.
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Affiliation(s)
- Renata R T Castro
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil.,School of Medicine, Universidade Iguaçu, Rio de Janeiro, Brazil
| | - Emer Joyce
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Neal K Lakdawala
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Garrick Stewart
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anju Nohria
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael M Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Akshay Desai
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eldrin F Lewis
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lynne W Stevenson
- Cardiomyopathy & Advanced Heart Disease Training, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
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Zhang Z, Jones P, Weintraub WS, Mancini GBJ, Sedlis S, Maron DJ, Teo K, Hartigan P, Kostuk W, Berman D, Boden WE, Spertus JA. Predicting the Benefits of Percutaneous Coronary Intervention on 1-Year Angina and Quality of Life in Stable Ischemic Heart Disease: Risk Models From the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). Circ Cardiovasc Qual Outcomes 2019; 11:e003971. [PMID: 29752388 DOI: 10.1161/circoutcomes.117.003971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 02/16/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is a therapy to reduce angina and improve quality of life in patients with stable ischemic heart disease. However, it is unclear whether the quality of life after PCI is more dependent on the PCI or other patient-related factors. To address this question, we created models to predict angina and quality of life 1 year after PCI and medical therapy. METHODS AND RESULTS Using data from the 2287 stable ischemic heart disease patients randomized in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) to PCI plus optimal medical therapy (OMT) versus OMT alone, we built prediction models for 1-year Seattle Angina Questionnaire angina frequency, physical limitation, and quality of life scores, both as continuous outcomes and categorized by clinically desirable states, using multivariable techniques. Although most patients improved regardless of treatment, marked variability was observed in Seattle Angina Questionnaire scores 1 year after randomization. Adding PCI conferred a greater mean improvement (about 2 points) in Seattle Angina Questionnaire scores that were not affected by patient characteristics (P values for all interactions >0.05). The proportion of patients free of angina or having very good/excellent physical limitation (physical function) or quality of life at 1 year was 57%, 58%, 66% with PCI+OMT and 50%, 55%, 59% with OMT alone group, respectively. However, other characteristics, such as baseline symptoms, age, diabetes mellitus, and the magnitude of myocardium subtended by narrowed coronary arteries were as, or more, important than revascularization in predicting symptoms (partial R2=0.07 versus 0.29, 0.03 versus 0.22, and 0.05 versus 0.24 in the domain of angina frequency, physical limitation, and quality of life, respectively). There was modest/good discrimination of the models (C statistic=0.72-0.82) and excellent calibration (coefficients of determination for predicted versus observed deciles=0.83-0.97). CONCLUSIONS The health status outcomes of stable ischemic heart disease patients treated by OMT+PCI versus OMT alone can be predicted with modest accuracy. Angina and quality of life at 1 year is improved by PCI but is more strongly associated with other patient characteristics. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00007657.
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Affiliation(s)
- Zugui Zhang
- Christiana Care Health System, Newark, DE (Z.Z.)
| | - Philip Jones
- Mid-America Heart Institute/University of Missouri-Kansas City (P.J., J.A.S.)
| | | | | | - Steven Sedlis
- New York Veterans Affairs Medical Center and New York University (S.S.)
| | | | - Koon Teo
- McMaster University, Hamilton, ON, Canada (K.T.)
| | - Pamela Hartigan
- Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven (P.H.)
| | | | | | - William E Boden
- Veterans Affairs New England Healthcare System, Massachusetts Veterans Epidemiology, Research, and Informatics Center, Boston (W.E.B.)
| | - John A Spertus
- Mid-America Heart Institute/University of Missouri-Kansas City (P.J., J.A.S.)
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Ding Q, Funk M, Spatz ES, Whittemore R, Lin H, Lipska KJ, Dreyer RP, Spertus JA, Krumholz HM. Association of Diabetes Mellitus With Health Status Outcomes in Young Women and Men After Acute Myocardial Infarction: Results From the VIRGO Study. J Am Heart Assoc 2019; 8:e010988. [PMID: 31441351 PMCID: PMC6755841 DOI: 10.1161/jaha.118.010988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Diabetes mellitus increases the risk of mortality after acute myocardial infarction (AMI). However, little is known about the association of diabetes mellitus with post-AMI health status outcomes (symptoms, functioning, and quality of life) in younger adults. Methods and Results We investigated the association between diabetes mellitus and health status during the first 12 months after AMI, using data from 3501 adults with AMI (42.6% with diabetes mellitus) aged 18 to 55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study. Health status was measured with Seattle Angina Questionnaire (SAQ), 12-item Short-Form Health Survey, and EuroQol-Visual Analogue Scale at baseline hospitalization, 1-month, and 12-months post-AMI. At baseline, patients with diabetes mellitus had significantly worse SAQ-angina frequency (81±22 versus 86±19), SAQ-physical limitations (77±28 versus 85±23), SAQ-quality of life (55±25 versus 57±23), 12-item Short-Form Health Survey mental (44±13 versus 46±12)/physical functioning (41±12 versus 46±12), and EuroQol-Visual Analogue Scale (61±22 versus 66±21) than those without diabetes mellitus. Over time, both groups (with and without diabetes mellitus) improved considerably and the differences in health status scores progressively narrowed (except for 12-item Short-Form Health Survey physical functioning). In the linear-mixed effects models, adjusted for sociodemographics, cardiovascular risk factors, comorbidities, clinical characteristics, psychosocial factors, healthcare use, and AMI treatment, diabetes mellitus was associated with worse health status at baseline but not after discharge, and the association did not vary by sex. Conclusions At baseline, young adults with diabetes mellitus had poorer health status than those without diabetes mellitus. After AMI, however, they experienced significant improvements and diabetes mellitus was not associated with worse angina, SAQ-physical limitations, mental functioning, and quality of life, after adjustment for baseline covariates. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00597922.
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Affiliation(s)
- Qinglan Ding
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Yale School of Nursing West Haven CT.,College of Health and Human Sciences Purdue University West Lafayette IN
| | | | - Erica S Spatz
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | | | - Haiqun Lin
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Yale School of Public Health New Haven CT
| | - Kasia J Lipska
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Department of Internal Medicine Section of Endocrinology Yale School of Medicine New Haven CT
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - John A Spertus
- Health Outcomes Research Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City Kansas City MO
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT
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Baik D, Reading M, Jia H, Grossman LV, Masterson Creber R. Measuring health status and symptom burden using a web-based mHealth application in patients with heart failure. Eur J Cardiovasc Nurs 2019; 18:325-331. [PMID: 30681003 PMCID: PMC6433527 DOI: 10.1177/1474515119825704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Symptoms of heart failure markedly impair a patient's health status. The aim of this study was to identify predictors of health status in a sample of racially and ethnically diverse patients with heart failure using a web-based mobile health application, mi.Symptoms. METHODS We conducted a cross-sectional study at an urban academic medical center. Patients with heart failure self-reported symptoms using validated symptom instruments (e.g. patient-reported outcome measurement information system) by way of the mobile health application, mi.Symptoms. The primary study outcome was health status, measured with the Kansas City cardiomyopathy questionnaire clinical summary score. Data were analyzed using descriptive statistics and multiple linear regression. RESULTS The mean age of the sample ( n=168) was 58.7 (±12.5) years, 37% were women, 36% were Black, 36% identified as Hispanic/Latino, 48% were classified as New York Heart Association class III, and 44% reported not having enough income to make ends meet. Predictors of better health status in heart failure included higher physical function ( β=0.89, p=0.001) and ability to participate in social roles and activities ( β=0.58, p=0.002), and predictors of poorer health status were New York Heart Association class IV ( β=-11.68, p=0.006) and dyspnea ( β=-0.77, p<0.001). The predictors accounted for 73% of the variance in health status. CONCLUSION Patient-centered interventions should focus on modifiable risk factors that reduce dyspnea, improve functional status, and enhance engagement in social roles to improve the health status of patients with heart failure.
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Affiliation(s)
- Dawon Baik
- 1 School of Nursing, Columbia University, USA
| | - Meghan Reading
- 2 Department of Healthcare Policy and Research, Weill Cornell Medicine, USA
| | - Haomiao Jia
- 1 School of Nursing, Columbia University, USA
| | - Lisa V Grossman
- 3 Department of Biomedical Informatics, Columbia University, USA
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Yee D, Novak E, Platts A, Nassif ME, LaRue SJ, Vader JM. Comparison of the Kansas City Cardiomyopathy Questionnaire and Minnesota Living With Heart Failure Questionnaire in Predicting Heart Failure Outcomes. Am J Cardiol 2019; 123:807-812. [PMID: 30587373 DOI: 10.1016/j.amjcard.2018.11.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 01/06/2023]
Abstract
Patient-reported outcome measures (PROMs) are relevant independent outcomes in heart failure (HF) care and are predictive of subsequent hospitalization and death in HF. The Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) are the 2 most widely adopted PROMs specific to HF. We compared their prognostic abilities in a prospective cohort of HF patients. A prospective cohort of subjects from a single-center registry was analyzed with regard to baseline KCCQ and MLHFQ scores and the outcomes of death, transplant, or left ventricular assist device implantation and hospitalization. A total of 516 subjects with reduced left ventricular ejection fraction (HFrEF) and 151 subjects with preserved left ventricular ejection fraction (HFpEF) were included. Discrimination was assessed using c-statistics based on time-to-event analyses and receiver-operator curves. The additive contribution of MLHFQ was assessed through the change in c-statistic, incremental discrimination index, and category-free net reclassification index. Overall, KCCQ was superior to MLHFQ for predicting death/transplant/ventricular assist device (c-statistic 0.702 [0.666 to 0.738] and 0.658 [0.621 to 0.695] respectively, p value for difference <0.001) and hospitalization (c-statistic 0.640 [0.613 to 0.666] and 0.624 [0.597 to 0.651], respectively, p value for difference 0.022). However, this difference was statistically nonsignificant in the HFpEF group alone. When analyzing the additional prognostic information afforded by adding MLHFQ to KCCQ in the overall, HFrEF, and HFpEF groups there was no significant improvement, although adding KCCQ to MLHFQ did significantly improve risk stratification. Scoring based upon the abbreviated KCCQ-12 did not reduce the prognostic accuracy of KCCQ. In conclusion, KCCQ is more prognostic of death/transplant/left ventricular assist device and hospitalization than MLHFQ in a combined cohort of patients with HFrEF and HFpEF, although the effect in HFpEF was less pronounced. KCCQ should be the preferred PROM for patients with HF if prognostication is a desired goal of using the PROMs.
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Affiliation(s)
- Derek Yee
- Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Washington University School of Medicine, St. Louis, Missouri
| | - Anne Platts
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Shane J LaRue
- Washington University School of Medicine, St. Louis, Missouri
| | - Justin M Vader
- Washington University School of Medicine, St. Louis, Missouri.
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35
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Huang X, Yu Y, Li X, Masoudi FA, Spertus JA, Yan X, Krumholz HM, Jiang L, Li J. The China Patient-centred Evaluative Assessment of Cardiac Events (PEACE) prospective heart failure study design. BMJ Open 2019; 9:e025144. [PMID: 30782925 PMCID: PMC6377534 DOI: 10.1136/bmjopen-2018-025144] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION China faces the prospect of a large growth in the prevalence of heart failure (HF). However, there is limited knowledge about outcomes in patients after HF hospitalisations, including patient-reported outcomes (PROs). This paper is to present the study goal, methodology and data collection of the China Patient-centred Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (China PEACE 5p-HF Study). METHODS AND ANALYSIS The China PEACE 5p-HF Study, a prospective cohort study, will enrol 5000 patients with HF during 2016-2018 from 52 diverse hospitals throughout China and the follow-up period will be 12 months. Information on patients' medical history, in-hospital treatment and in-hospital outcomes are being abstracted from medical records. Details of patients' demographics, socioeconomic status, cardiovascular risk factors, access to healthcare services are being collected through comprehensive baseline interviews. Generic and disease-specific health status, depression, stress, anxiety and cognitive function are being administered using validated PRO instruments. Follow-up interviews will capture PROs and hospitalisation events at 1, 6 and 12 months follow-up. Standardised transthoracic echocardiograms and 6 min walk tests are being done in patients who enrolled in hospitals with these facilities at baseline and at 1 and 12 months after discharge. Collection of blood and urine samples are also being conducted at baseline, 1 and 12 months follow-up and stored for future analyses. ETHICS AND DISSEMINATION The National Center for Cardiovascular Diseases/Fuwai Hospital ethics committee approved this study, and all collaborating hospitals received approval from their local ethics committee. Written informed consent will be obtained from all patients. Findings will be disseminated in future peer-reviewed papers and will help to support improvements in the quality of care for HF nationwide. TRIAL REGISTRATION NUMBER NCT02878811.
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Affiliation(s)
- Xinghe Huang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Yu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fredrick A Masoudi
- Division of Cardiology, University of Colorado at Denver—Anschutz Medical Campus, Aurora, Colorado, USA
| | - John A Spertus
- School of Medicine, University of Missouri, Kansas City, Missouri, USA
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
| | - Xiaofang Yan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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36
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Verwijmeren L, Noordzij PG, Daeter EJ, van Zaane B, Peelen LM, van Dongen EPA. Preoperative determinants of quality of life a year after coronary artery bypass grafting: a historical cohort study. J Cardiothorac Surg 2018; 13:118. [PMID: 30453989 PMCID: PMC6245532 DOI: 10.1186/s13019-018-0798-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/26/2018] [Indexed: 01/02/2023] Open
Abstract
Background Health related quality of life (HRQL) is an important patient related outcome measure after cardiac surgery. Preoperative determinants for postoperative HRQL have not yet been identified, but could aid in preoperative decision making. The aim of this article is to identify associations between preoperative determinants and change in HRQL 1 year after coronary artery bypass grafting (CABG). Methods Single centre retrospective cohort study in 658 patients. Change in HRQL was defined as a decrease or increase of ≥5 points on the physical or mental domain of the Short Form 12 (SF-12) questionnaire. Patients were stratified in three groups according to worse, unchanged, or better HRQL. Multinomial logistic regression analysis was used to investigate the association between preoperative risk factors and postoperative change in HRQL. Results Physical HRQL improved in 22.8% of patients, did not change in 61.2% of patients and worsened in 16.0% of patients. Comorbidities associated with change in physical HRQL were a history of stroke, atrial fibrillation, vascular disease or pulmonary disease. Most important risk factor for change in physical HRQL was preoperative HRQL. Higher preoperative SF-12 score decreased the odds for worse physical HRQL and increased the odds for better physical HRQL. Mental HRQL improved in 49.8% of patients, remained unchanged in 34.5% of patients and worsened in 15.7% of patients. Preoperative HRQL was an important risk factor for a change in mental HRQL. Higher preoperative physical HRQL increased the odds for improved mental HRQL. Lower preoperative mental HRQL increased the odds for better mental HRQL. Conclusions One year after CABG the majority of patients experiences equal or improved HRQL compared to before surgery. Most important preoperative risk factor for change in HRQL is preoperative HRQL. Electronic supplementary material The online version of this article (10.1186/s13019-018-0798-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa Verwijmeren
- Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands
| | - Peter Gerben Noordzij
- Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands.
| | - Edgar Jozeph Daeter
- Cardiac Surgery, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands
| | - Bas van Zaane
- Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Linda Margaretha Peelen
- Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.,Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Eric Paulus Adrianus van Dongen
- Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands
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Mack MJ, Abraham WT, Lindenfeld J, Bolling SF, Feldman TE, Grayburn PA, Kapadia SR, McCarthy PM, Lim DS, Udelson JE, Zile MR, Gammie JS, Gillinov AM, Glower DD, Heimansohn DA, Suri RM, Ellis JT, Shu Y, Kar S, Weissman NJ, Stone GW. Cardiovascular Outcomes Assessment of the MitraClip in Patients with Heart Failure and Secondary Mitral Regurgitation: Design and rationale of the COAPT trial. Am Heart J 2018; 205:1-11. [PMID: 30134187 DOI: 10.1016/j.ahj.2018.07.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with heart failure (HF) and symptomatic secondary mitral regurgitation (SMR) have a poor prognosis, with morbidity and mortality directly correlated with MR severity. Correction of isolated SMR with surgery is not well established in this population, and medical management remains the preferred approach in most patients. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial was designed to determine whether transcatheter mitral valve (MV) repair with the MitraClip device is safe and effective in patients with symptomatic HF and clinically significant SMR. STUDY DESIGN The COAPT trial is a prospective, randomized, parallel-controlled, open-label multicenter study of the MitraClip device for the treatment of moderate-to-severe (3+) or severe (4+) SMR (as verified by an independent echocardiographic core laboratory) in patients with New York Heart Association class II-IVa HF despite treatment with maximally tolerated guideline-directed medical therapy (GDMT) who have been determined by the site's local heart team as not appropriate for MV surgery. A total of 614 eligible subjects were randomized in a 1:1 ratio to MV repair with the MitraClip plus GDMT versus GDMT alone. The primary effectiveness end point is recurrent HF hospitalizations through 24 months, analyzed when the last subject completes 12-month follow-up, powered to demonstrate superiority of MitraClip therapy. The primary safety end point is a composite of device-related complications at 12 months compared to a performance goal. Follow-up is ongoing, and the principal results are expected in late 2018. CONCLUSIONS HF patients with clinically significant SMR who continue to be symptomatic despite optimal GDMT have limited treatment options and a poor prognosis. The randomized COAPT trial was designed to determine the safety and effectiveness of transcatheter MV repair with the MitraClip in symptomatic HF patients with moderate-to-severe or severe SMR.
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Affiliation(s)
- Michael J Mack
- Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, TX.
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH
| | - JoAnn Lindenfeld
- Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville, TN
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Ted E Feldman
- Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, IL
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, VA
| | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Donald D Glower
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | - David A Heimansohn
- Department of Cardiothoracic Surgery, St Vincent Heart Center, Indianapolis, IN
| | - Rakesh M Suri
- Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - Saibal Kar
- Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center, and The Cardiovascular Research Foundation, New York, NY
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38
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Dreyer RP, Zheng X, Xu X, Liu S, Li J, Ding Q, Du X, Li X, Zhang H, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Sex differences in health outcomes at one year following acute myocardial infarction: A report from the China Patient-Centered Evaluative Assessment of Cardiac Events prospective acute myocardial infarction study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:273-282. [PMID: 30270637 DOI: 10.1177/2048872618803726] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We examined sex differences in long-term health outcomes following acute myocardial infarction in China, including mortality, major adverse cardiac events and health status (symptoms, functioning, quality of life). METHODS A total of 3415 acute myocardial infarction patients (23.2% women) aged ⩾18 years were enrolled across 10 geographic regions in China (2012-2014) in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) study. Clinical data was abstracted from medical records. Generic (Euro-Quality of Life Scale) and disease-specific (Seattle Angina Questionnaire) health status was obtained through interviews at baseline and one year. RESULTS At one year, women with acute myocardial infarction had a higher risk of death from all causes ( p<0.001), but had similar rates of major adverse cardiac events ( p=0.2). Women had lower mean generic (Euro-Quality of Life Scale utility index score: 0.90±0.13 vs 0.94±0.11) and disease specific health scores indicating poorer functioning (Seattle Angina Questionnaire summary score: 75.3±11.4 vs 78.4±9.7) and higher rates of daily/weekly angina (Seattle Angina Questionnaire angina frequency score ⩽60 vs >60: 9.1% vs 4.7%; all p<0.001). In multivariable analysis, there was a significant association between female sex and mortality (β=0.45, standard error=0.21, p=0.03) but not for major adverse cardiac events (β=-0.02, standard error=0.14, p=0.89). The association between female sex and worse generic health status persisted (β=-0.02, standard error=0.01, p=0.003), but was no longer significant between sexes for disease-specific health status (β=-0.82, standard error=0.58, p=0.154) or daily/weekly angina (odds ratio=1.39; 95% confidence interval 0.88-2.21). CONCLUSION Women in China have higher crude rates of all-cause/cardiovascular death versus men, as well as worse generic/disease specific health status at one-year post-acute myocardial infarction. The association between female sex and worse generic health status persisted following adjustment.
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Affiliation(s)
- Rachel P Dreyer
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,2 Department of Emergency Medicine, Yale School of Medicine, USA
| | - Xin Zheng
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Xiao Xu
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,4 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, USA
| | - Shuling Liu
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA
| | - Jing Li
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Qinglan Ding
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA
| | - Xue Du
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Xi Li
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Haibo Zhang
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Fredrick A Masoudi
- 5 Department of Medicine, University of Colorado Anschutz Medical Campus, USA
| | - John A Spertus
- 6 Saint Luke's Mid America Heart Institute, USA.,7 University of Missouri - Kansas City, USA
| | - Harlan M Krumholz
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,8 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, USA.,9 Department of Health Policy and Management, Yale School of Public Health, USA
| | - Lixin Jiang
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
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Østergaard B, Mahrer-Imhof R, Wagner L, Barington T, Videbæk L, Lauridsen J. Effect of family nursing therapeutic conversations on health-related quality of life, self-care and depression among outpatients with heart failure: A randomized multi-centre trial. PATIENT EDUCATION AND COUNSELING 2018; 101:1385-1393. [PMID: 29567335 DOI: 10.1016/j.pec.2018.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the short-term (3 months) effects of family nursing therapeutic conversations (FNTC) on health-related quality of life, self-care and depression in outpatients with Heart failure (HF). METHODS A randomised multi-centre trial was conducted in three Danish HF clinics. The control group (n = 167) received usual care, and the intervention group (n = 180) received FNTCs as supplement to usual care. Primary outcome was clinically significant changes (6 points) in Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score between groups. Secondary outcomes were changes in self-care behaviour and depression scores. Data were assessed before first consultation and repeated after three months. RESULTS No statistically significant difference was found in the change of KCCQ, self-care and depression scores between the groups. KCCQ scores of patients in the FNTC group changed clinically significant in seven domains, compared to one domain in the control group, with the highest improvement in self-efficacy, social limitation and symptom burden. CONCLUSION FNTC was not superior to standard care of patients with HF regarding health-related quality of life, self-care and depression. IMPLICATION FOR PRACTICE Addressing the impact of the disease on the family, might improve self-efficacy, social limitation and symptom burden in patients with heart failure.
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Affiliation(s)
- Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Romy Mahrer-Imhof
- Nursing Science & Care Ltd, Winterthur Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Lis Wagner
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Torben Barington
- OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jørgen Lauridsen
- COHERE, Department of Business and Economics, University of Southern Denmark, Odense, Denmark
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Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document. Circulation 2018; 137:2635-2650. [DOI: 10.1161/circulationaha.117.029289] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Garcia-Garcia HM, McFadden EP, Farb A, Mehran R, Stone GW, Spertus J, Onuma Y, Morel MA, van Es GA, Zuckerman B, Fearon WF, Taggart D, Kappetein AP, Krucoff MW, Vranckx P, Windecker S, Cutlip D, Serruys PW. Standardized End Point Definitions for Coronary Intervention Trials. Eur Heart J 2018; 39:2192-2207. [DOI: 10.1093/eurheartj/ehy223] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/11/2018] [Indexed: 01/01/2023] Open
Affiliation(s)
- Hector M Garcia-Garcia
- Cardialysis, Rotterdam, The Netherlands
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Andrew Farb
- US Food and Drug Administration, Washington, DC, USA
| | - Roxana Mehran
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, US
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation and Division of Cardiology, Columbia University Medical Center, New York, US
| | - John Spertus
- Mid America Heart Institute, University of Missouri, Kansas City, USA
| | | | | | | | | | | | - David Taggart
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Arie-Pieter Kappetein
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Canter, Rotterdam, The Netherlands
| | - Mitchell W Krucoff
- Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina, US
| | - Pascal Vranckx
- Hartcentrum Hasselt and Faculty of Medicine and Life Sciences University of Hasselt, Hasselt, Belgium
| | | | - Donald Cutlip
- Harvard Clinical Research Institute, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick W Serruys
- Centre for International Cardiovascular Health, Imperial College London UK
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Pimple P, Hammadah M, Wilmot K, Ramadan R, Al Mheid I, Levantsevych O, Sullivan S, Garcia EV, Nye J, Shah AJ, Ward L, Mehta P, Raggi P, Bremner JD, Quyyumi AA, Vaccarino V. Chest Pain and Mental Stress-Induced Myocardial Ischemia: Sex Differences. Am J Med 2018; 131:540-547.e1. [PMID: 29224740 PMCID: PMC5910270 DOI: 10.1016/j.amjmed.2017.11.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/31/2017] [Accepted: 11/05/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Mental stress-induced myocardial ischemia is a frequent phenomenon in patients with coronary artery disease. Women with coronary artery disease tend to have more mental stress-induced myocardial ischemia and more chest pain/anginal symptoms than men, but whether the association between mental stress-induced myocardial ischemia and angina burden differs in women and men is unknown. METHODS This was a cross-sectional study with experimental manipulation of 950 individuals with stable coronary artery disease. Chest pain/angina frequency in the previous 4 weeks was assessed with the Seattle Angina Questionnaire's angina-frequency subscale. Mental stress-induced myocardial ischemia was assessed with myocardial perfusion imaging during mental stress (standardized public speaking task). Presence of mental stress-induced myocardial ischemia was based on expert readers and established criteria. A conventional (exercise or pharmacologic) stress test was used as a control condition. RESULTS Overall, 338 individuals (37%) reported angina; 112 (12%) developed mental stress-induced myocardial ischemia, and 256 (29%) developed conventional stress ischemia. Women who reported angina had almost double the probability to develop mental stress-induced myocardial ischemia (19% vs 10%, adjusted prevalence rate ratio, 1.90; 95% confidence interval, 1.04-3.46), whereas there was no such difference in men (11% vs 11%, adjusted prevalence rate ratio, 1.09; 95% confidence interval, 0.66-1.82). No association was found between angina symptoms and conventional stress ischemia for women or men. Results for ischemia as a continuous variable were similar. CONCLUSIONS In women, but not in men, anginal symptoms may be a marker of vulnerability toward ischemia induced by psychologic stress. These results highlight the psychosocial origins of angina in women and may have important implications for the management and prognosis of women with angina.
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Affiliation(s)
- Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Muhammad Hammadah
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga
| | - Kobina Wilmot
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga
| | - Ronnie Ramadan
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga
| | - Ibhar Al Mheid
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga
| | | | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Ernest V Garcia
- Department of Radiology & Imaging Science, Emory University School of Medicine, Atlanta, Ga
| | - Jonathon Nye
- Department of Radiology & Imaging Science, Emory University School of Medicine, Atlanta, Ga
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga; Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga
| | - Laura Ward
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Puja Mehta
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Ga
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga; Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga.
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Khariton Y, Hernandez AF, Fonarow GC, Sharma PP, Duffy CI, Thomas L, Mi X, Albert NM, Butler J, McCague K, Nassif ME, Williams FB, DeVore A, Patterson JH, Spertus JA. Health Status Variation Across Practices in Outpatients With Heart Failure: Insights From the CHAMP-HF (Change the Management of Patients With Heart Failure) Registry. Circ Cardiovasc Qual Outcomes 2018; 11:e004668. [PMID: 29627798 PMCID: PMC5891827 DOI: 10.1161/circoutcomes.118.004668] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although a key treatment goal for patients with heart failure with reduced ejection fraction is to optimize their health status (their symptoms, function, and quality of life), the variability across outpatient practices in achieving this goal is unknown. METHODS AND RESULTS In the CHAMP-HF (Change the Management of Patients With Heart Failure) registry, associations between baseline practice characteristics and Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) and Symptom Frequency (SF) scores were assessed in 3494 patients across 140 US practices using hierarchical regression after accounting for 23 patient and 11 treatment characteristics. We then calculated an adjusted median odds ratio to quantify the average difference in likelihood that a patient would have excellent (KCCQ-OS, ≥75) health status or minimal (monthly or fewer) symptoms (KCCQ-SF, ≥75) when treated at one practice versus another, at random. The mean (±SD) KCCQ-OS and KCCQ-SF were 64.2±24 and 68.9±25.6, with 40% (n=1380) and 50% (n=1760) having KCCQ scores ≥75, respectively. The adjusted median odds ratio across practices, for KCCQ-OS ≥75, was 1.70 (95% confidence interval, 1.54-1.99; P<0.001) indicating a median 70% higher odds of a patient having good-to-excellent health status when treated at one random practice versus another. In regard to KCCQ-SF, the adjusted median odds ratio for KCCQ-SF ≥75 was 1.54 (95% confidence interval, 1.41-1.76; P=0.001). CONCLUSIONS In a large, contemporary registry of outpatients with chronic heart failure with reduced ejection fraction, we observed significant practice-level variability in patients' health status. Quantifying patients' health status as a measure of quality should be explored as a foundation for improving care. CLINICAL TRIAL REGISTRATION URL: https://www.centerwatch.com. Unique identifier: TX144901.
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Affiliation(s)
- Yevgeniy Khariton
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.).
| | - Adrian F Hernandez
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Gregg C Fonarow
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Puza P Sharma
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Carol I Duffy
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Laine Thomas
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Xiaojuan Mi
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Nancy M Albert
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Javed Butler
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Kevin McCague
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Michael E Nassif
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Fredonia B Williams
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - Adam DeVore
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - J Herbert Patterson
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - John A Spertus
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
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Thomson K, Brouwers C, Damman OC, de Bruijne MC, Timmermans DR, Melles M. How Health Care Professionals Evaluate a Digital Intervention to Improve Medication Adherence: Qualitative Exploratory Study. JMIR Hum Factors 2018; 5:e7. [PMID: 29463494 PMCID: PMC5840481 DOI: 10.2196/humanfactors.8948] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/05/2017] [Indexed: 02/01/2023] Open
Abstract
Background Medication nonadherence poses a serious and a hard-to-tackle problem for many chronic diseases. Electronic health (eHealth) apps that foster patient engagement and shared decision making (SDM) may be a novel approach to improve medication adherence. Objective The aim of this study was to investigate the perspective of health care professionals regarding a newly developed digital app aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example. Methods A Web-based prototype of the eHealth app—MIK—was codesigned with patients and health care professionals. After user tests with patients, we performed semistructured interviews and user tests with 12 physicians from 6 different hospitals to examine how the functionalities offered by MIK could assist physicians in their consultation and how they could be integrated into daily clinical practice. Qualitative thematic analysis was used to identify themes that covered the physicians’ evaluations. Results On the basis of the interview data, 3 themes were identified, which were (1) perceived impact on patient-physician collaboration; (2) perceived impact on the patient’s understanding and self-management regarding medication adherence; and (3) perceived impact on clinical decisions and workflow. Conclusions The eHealth app MIK seems to have the potential to improve the consultation between the patient and the physician in terms of collaboration and patient engagement. The impact of eHealth apps based on the concept of SDM for improving medication-taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth apps aimed at improving self-management by means of patient engagement and SDM.
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Affiliation(s)
- Karen Thomson
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Corline Brouwers
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Danielle Rm Timmermans
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Ko JM, Tecson KM, Rashida VA, Sodhi S, Saef J, Mufti M, White KS, Ludbrook PA, Cedars AM. Clinical and Psychological Drivers of Perceived Health Status in Adults With Congenital Heart Disease. Am J Cardiol 2018; 121:377-381. [PMID: 29198985 DOI: 10.1016/j.amjcard.2017.10.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
The factors having the greatest impact on self-reported health status in adults with congenital heart disease (ACHD) remain incompletely studied. We conducted a single-site, cross-sectional study of ACHD patients followed at the Center for ACHD at Washington University School of Medicine, including retrospectively gathered clinical data and psychometric and health status assessments completed at the time of enrollment. To identify primary drivers of perceived health status, we investigated the impact of the demographic, clinical, and psychological variables on self-reported health status as assessed using the Rand 36-Item Short Form Health Survey. Variables with significant associations within each domain were considered jointly in multivariable models constructed via stepwise selection. There was domain-specific heterogeneity in the variables having the greatest effect on self-reported health status. Depression was responsible for the greatest amount of variability in health status in all domains except physical functioning. In the physical functioning domain, depression remained responsible for 5% of total variability, the third most significant variable in the model. In every domain, depression more strongly influenced health status than did any cardiac-specific variable. In conclusion, depression was responsible for a significant amount of heterogeneity in all domains of self-perceived health status. Psychological variables were better predictors of health status than clinical variables.
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Pokharel Y, Khariton Y, Tang Y, Nassif ME, Chan PS, Arnold SV, Jones PG, Spertus JA. Association of Serial Kansas City Cardiomyopathy Questionnaire Assessments With Death and Hospitalization in Patients With Heart Failure With Preserved and Reduced Ejection Fraction: A Secondary Analysis of 2 Randomized Clinical Trials. JAMA Cardiol 2017; 2:1315-1321. [PMID: 29094152 PMCID: PMC5814994 DOI: 10.1001/jamacardio.2017.3983] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/12/2017] [Indexed: 12/21/2022]
Abstract
Importance While there is increasing emphasis on incorporating patient-reported outcome measures in routine care for patients with heart failure (HF), how best to interpret longitudinally collected patient-reported outcome measures is unknown. Objective To examine the strength of association between prior, current, or a change in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores with death and hospitalization in patients with HF with preserved (HFpEF) and reduced (HFrEF) ejection fractions. Design, Setting, and Participants Secondary analyses of the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial of 1372 patients with HFpEF, conducted between August 2006 and January 2012, and the HF-ACTION trial that included 1669 patients with HFrEF, conducted between April 2003 and February 2007. Exposures Prior, current, and change in KCCQ Overall Summary scores (KCCQ-os) in 5-point increments (higher scores indicate better health status). Main Outcomes and Measures Time to cardiovascular death/first HF hospitalization (primary outcome) and all-cause death (secondary outcome). Results Of 1767 eligible TOPCAT participants, 882 were women (49.9%), and the mean (SD) age was 71.5 (9.7) years. Of 2130 eligible HF-ACTION participants, 599 were women (28.1%), and the mean age was 58.6 (12.7) years. Each 5-point difference in prior or current KCCQ-os scores was associated with a 6% (95% CI, 4%-8%; P < .001) to 9% (95% CI, 7%-11%; P < .001) lower risk for subsequent cardiovascular death/first HF hospitalization in patients with HFpEF and 6% (95% CI, 4%-9%; P < .001) to 8% (95% CI, 5%-10%; P < .001) lower risk for subsequent cardiovascular death/first HF hospitalization in patients with HRpEF and HFrEF in unadjusted analyses. Results were similar for change in KCCQ-os. In models with the prior and current KCCQ-os, only the current KCCQ-os was significantly associated with 10% (95% CI, 7%-12%; P < .001) and 7% (95% CI, 3%-11%; P < .001) lower risk for subsequent cardiovascular death/first HF hospitalization in patients with HFpEF and HFrEF, respectively. Similar results were observed when the current and Δ KCCQ-os were considered together, when adjusted for important patient and treatment characteristics, when including 3 sequential KCCQ-os scores, and when examining all-cause death as the outcome. Conclusions and Relevance In serial health status evaluations of patients with HF, the most recent KCCQ score was most strongly associated with subsequent death and cardiovascular hospitalization in HFpEF and HFrEF. Measuring serial patient-reported outcome measures in the clinical care of patients with HF can provide an updated assessment of prognosis. Trial Registration clinicaltrials.gov Identifier: NCT00094302 (TOPCAT) and NCT00047437 (HF-ACTION).
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Affiliation(s)
- Yashashwi Pokharel
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Yevgeniy Khariton
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Yuanyuan Tang
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Michael E. Nassif
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Paul S. Chan
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Suzanne V. Arnold
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Philip G. Jones
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - John A. Spertus
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
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Jayaram NM, Khariton Y, Krumholz HM, Chaudhry SI, Mattera J, Tang F, Herrin J, Hodshon B, Spertus JA. Impact of Telemonitoring on Health Status. Circ Cardiovasc Qual Outcomes 2017; 10:e004148. [PMID: 29237746 PMCID: PMC5776725 DOI: 10.1161/circoutcomes.117.004148] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/08/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although noninvasive telemonitoring in patients with heart failure does not reduce mortality or hospitalizations, less is known about its effect on health status. This study reports the results of a randomized clinical trial of telemonitoring on health status in patients with heart failure. METHODS AND RESULTS Among 1521 patients with recent heart failure hospitalization randomized in the Tele-HF trial (Telemonitoring to Improve Heart Failure Outcomes), 756 received telephonic monitoring and 765 usual care. Disease-specific health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) within 2 weeks of discharge and at 3 and 6 months. Repeated measures linear regression models were used to assess differences in KCCQ scores between patients assigned to telemonitoring and usual care over 6 months. The baseline characteristics of the 2 treatment arms were similar (mean age, 61 years; 43% female and 39% black). Over the 6-month follow-up period, there was a statistically significant, but clinically small, difference between the 2 groups in their KCCQ overall summary and subscale scores. The average KCCQ overall summary score for those receiving telemonitoring was 2.5 points (95% confidence interval, 0.38-4.67; P=0.02) higher than usual care, driven primarily by improvements in symptoms (3.5 points; 95% confidence interval, 1.18-5.82; P=0.003) and social function (3.1 points; 95% confidence interval, 0.30-6.00; P=0.03). CONCLUSIONS Telemonitoring results in statistically significant, but clinically small, improvements in health status when compared with usual care. Given that the KCCQ was a secondary outcome, the benefits should be confirmed in future studies. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00303212.
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Affiliation(s)
- Natalie M Jayaram
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Yevgeniy Khariton
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Harlan M Krumholz
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Sarwat I Chaudhry
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Jennifer Mattera
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Fengming Tang
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Jeph Herrin
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Beth Hodshon
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - John A Spertus
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.).
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Cedars A, Opotowsky AR. Sustaining Happiness in Adult Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2016; 7:635-7. [DOI: 10.1177/2150135116660262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Ari Cedars
- Department of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Alexander R. Opotowsky
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Loisance DY. Quality of life in advanced chronic heart failure: a relevant or a misleading parameter? Eur J Cardiothorac Surg 2016; 50:273-4. [PMID: 27107042 DOI: 10.1093/ejcts/ezw082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Y Loisance
- Department of Cardiothoracic Surgery, CHU Henri Mondor, Creteil, France
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