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Avitabile CM, Mota JP, Yeaman KM, Andrieux SJ, Lechtenberg L, Escobar E, Chuo J, Xanthopoulos MS, Faig W, O'Malley SM, Ford E, McBride MG, Paridon SM, Mitchell JA, Zemel BS. Creating a digital approach for promoting physical activity in pediatric pulmonary hypertension: A framework for future interventions. Pulm Circ 2024; 14:e12402. [PMID: 38962181 PMCID: PMC11219287 DOI: 10.1002/pul2.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 07/05/2024] Open
Abstract
Children with pulmonary hypertension (PH) often demonstrate limited exercise capacity. Data support exercise as an effective nonpharmacologic intervention among adults with PH. However, data on exercise training in children and adolescents are limited, and characteristics of the optimal exercise program in pediatric PH have not been identified. Exercise programs may have multiple targets, including muscle deficits which are associated with exercise limitations in both adult and pediatric PH. Wearable accelerometer sensors measure physical activity volume and intensity in the naturalistic setting and can facilitate near continuous data transfer and bidirectional communication between patients and the study team when paired with informatics tools during exercise interventions. To address the knowledge gaps in exercise training in pediatric PH, we designed a prospective, single arm, nonrandomized pilot study to determine feasibility and preliminary estimates of efficacy of a 16-week home exercise intervention, targeting lower extremity muscle mass and enriched by wearable mobile health technology. The exercIse Training in pulmONary hypertEnsion (iTONE) trial includes (1) semistructured exercise prescriptions tailored to the participant's baseline level of activity and access to resources; (2) interval goal setting fostering self-efficacy; (3) real time monitoring of activity via wearable devices; (4) a digital platform enabling communication and feedback between participant and study team; (5) multiple avenues to assess participant safety. This pilot intervention will provide information on the digital infrastructure needed to conduct home-based exercise interventions in PH and will generate important preliminary data on the effect of exercise interventions in youth with chronic cardiorespiratory conditions to power larger studies in the future.
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Affiliation(s)
- Catherine M. Avitabile
- Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Division of CardiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Jena P. Mota
- Division of CardiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kiley M. Yeaman
- Research InstituteChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sybil J. Andrieux
- Research InstituteChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Lara Lechtenberg
- Research InstituteChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Emma Escobar
- Research InstituteChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - John Chuo
- Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Division of NeonatologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Melissa S. Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Division of Pulmonary and Sleep MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Walter Faig
- Biostatistics and Data Management CoreChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Shannon M. O'Malley
- Division of CardiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Elizabeth Ford
- Division of CardiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Michael G. McBride
- Division of CardiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Stephen M. Paridon
- Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Division of CardiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Jonathan A. Mitchell
- Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Division of Gastroenterology, Hepatology, and NutritionChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Babette S. Zemel
- Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Division of Gastroenterology, Hepatology, and NutritionChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
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Zhou H, Wang Y, Li W, Yang L, Liao Y, Xu M, Zhang C, Ma H. Usefulness of the Duke Activity Status Index to Assess Exercise Capacity and Predict Risk Stratification in Patients with Pulmonary Arterial Hypertension. J Clin Med 2023; 12:jcm12082761. [PMID: 37109099 PMCID: PMC10142524 DOI: 10.3390/jcm12082761] [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: 02/13/2023] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Exercise capacity is an important component of risk assessment for pulmonary arterial hypertension (PAH). We investigated the association of the Duke Activity Status Index (DASI) with peak oxygen consumption (peakVO2) and explored whether the DASI can discriminate the high-risk individuals in patients with PAH, according to peakVO2 < 11 mL/min/kg. A total of 89 patients were evaluated using cardiopulmonary exercise testing (CPET) and DASI. The correlation between the DASI and peakVO2 was measured by univariate analysis, and a receiver operating characteristic (ROC) curve analysis was conducted. The DASI was correlated with peakVO2 in the univariate analysis. The ROC curve analysis revealed that the DASI had a discriminative value for identifying the individuals with a high risk in PAH patients (p < 0.001), with an area under ROC curve (AUC) of 0.79 (95% CI: 0.67-0.92). Similar results were observed in patients with PAH associated with congenital heart disease (CHD-PAH), (p = 0.001), with an AUC of 0.80 (95% CI: 0.658-0.947). Therefore, DASI reflects exercise capacity in patients with PAH and has good ability to discriminate patients with a low risk and a high risk, and it may be included in the risk assessment of PAH.
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Affiliation(s)
- Haofeng Zhou
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Yu Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Weiya Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Lifang Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Yingxue Liao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Mingyu Xu
- School of Medicine, South China University of Technology, Guangzhou 510000, China
| | - Caojin Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510000, China
| | - Huan Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510000, China
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Pepe A, Farina E. A mixed-method study on adolescents' well-being during the COVID-19 syndemic emergency. Sci Rep 2023; 13:871. [PMID: 36650194 PMCID: PMC9843112 DOI: 10.1038/s41598-022-24007-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/08/2022] [Indexed: 01/19/2023] Open
Abstract
In this study, we set out to investigate adolescents' levels of perceived well-being and to map how they went about caring for their well-being during the COVID-19 syndemic. Participants were 229 Italian adolescent high school students (48.9% males, mean age = 16.64). The research design was based on an exploratory, parallel, mixed-method approach. A multi-method, student-centered, computer-assisted, semi-structured online interview was used as the data gathering tool, including both a standardized quantitative questionnaire on perceived well-being and an open-ended question about how adolescents were taking charge of their well-being during the COVID-19 health emergency. Main findings reveal general low levels of perceived well-being during the syndemic, especially in girls and in older adolescents. Higher levels of well-being are associated with more affiliative strategies (we-ness/togetherness) whereas low levels of well-being are linked with more individualistic strategies (I-ness/separatedness) in facing the health emergency. These findings identify access to social support as a strategy for coping with situational stress and raise reflection on the importance of balancing the need for physical distancing to protect from infection, and the need for social closeness to maintain good mental health.
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Affiliation(s)
- Alessandro Pepe
- "R.Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy. .,LAB300, University of Milano-Bicocca, Milan, Italy.
| | - Eleonora Farina
- "R.Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy.,LAB300, University of Milano-Bicocca, Milan, Italy
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Avitabile CM, McBride MG, Harris MA, Whitehead KK, Fogel MA, Paridon SM, Zemel BS. Skeletal muscle deficits are associated with worse exercise performance in pediatric pulmonary hypertension. Front Pediatr 2022; 10:1025420. [PMID: 36275051 PMCID: PMC9579321 DOI: 10.3389/fped.2022.1025420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Skeletal muscle deficits are associated with worse exercise performance in adults with pulmonary hypertension (PH) but the impact is poorly understood in pediatric PH. OBJECTIVE To study muscle deficits, physical inactivity, and performance on cardiopulmonary exercise test (CPET) and exercise cardiac magnetic resonance (eCMR) in pediatric PH. METHODS Youth 8-18 years participated in a prospective, cross-sectional study including densitometry (DXA) for measurement of leg lean mass Z-score (LLMZ), handheld dynamometer with generation of dominant and non-dominant handgrip Z-scores, Physical Activity Questionnaire (PAQ), CPET, and optional eCMR. CPET parameters were expressed relative to published reference values. CMR protocol included ventricular volumes and indexed systemic flow at rest and just after supine ergometer exercise. Relationships between LLMZ, PAQ score, and exercise performance were assessed by Pearson correlation and multiple linear regression. RESULTS There were 25 participants (13.7 ± 2.8 years, 56% female, 64% PH Group 1, 60% functional class I); 12 (48%) performed both CPET and eCMR. Mean LLMZ (-0.96 ± 1.14) was associated with PAQ score (r = 50, p = 0.01) and with peak oxygen consumption (VO2) (r = 0.74, p = < 0.001), VO2 at anaerobic threshold (r = 0.65, p < 0.001), and peak work rate (r = 0.64, p < 0.01). Higher handgrip Z-scores were associated with better CPET and eCMR performance. On regression analysis, LLMZ and PAQ score were positively associated with peak VO2, while handgrip Z-score and PAQ score were positively associated with peak work rate. CONCLUSION Muscle mass and strength are positively associated with exercise performance in pediatric PH. Future studies should determine the effect of rehabilitation programs on muscle properties and exercise performance.
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Affiliation(s)
- Catherine M Avitabile
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Michael G McBride
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Matthew A Harris
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kevin K Whitehead
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Mark A Fogel
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Stephen M Paridon
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Babette S Zemel
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Nakazato L, Mendes F, Paschoal IA, Oliveira DC, Moreira MM, Pereira MC. Association of daily physical activity with psychosocial aspects and functional capacity in patients with pulmonary arterial hypertension: a cross-sectional study. Pulm Circ 2021; 11:2045894021999955. [PMID: 33854767 PMCID: PMC8010827 DOI: 10.1177/2045894021999955] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary arterial hypertension impairs exercise tolerance and daily physical activity. Aside from the hemodynamic limitations, physical, cognitive, and emotional factors may play a relevant and as yet unexplored role. We investigated whether there is an association between the physical activity level and psychological disorders, health-related quality of life, and daily activities. We also searched for an association of the physical activity level with clinical factors and functional capacity. This was an analytical, cross-sectional, observational study conducted in a Brazilian University Hospital. Twenty stable pulmonary arterial hypertension subjects wore an accelerometer for a week and completed an activity diary. They answered the quality of life questionnaire (SF-36), as well as the Hospital Anxiety and Depression scale, and the Manchester Respiratory Activities of Daily Living questionnaire. Transthoracic echocardiography, the six-minute walk test, the one-minute sit-to-stand test, and spirometry were performed. For statistical analysis, we used Chi-square tests or Fisher's test as appropriate and the Mann-Whitney test to compare numerical values between two groups. The relationship between the parameters was assessed using the Spearman correlation test. The mean age was 44.3 years, 80% were women, 80% had idiopathic pulmonary arterial hypertension, and 20% had connective tissue disease. The mean daily step count was 4280 ± 2351, and the mean activity time was 41.6 ± 19.3 min. The distance covered (six-minute walk test) was 451.5 m, and the number of movements (one-minute sit-to-stand test) was 23.8. Thirty percent scored positive for anxiety, and 15% for depression (Hospital Anxiety and Depression scale). There was a significant correlation between accelerometer data and walking distance (six-minute walk test), number of movements (one-minute sit-to-stand test), level of daily physical activity (Manchester Respiratory Activities of Daily Living questionnaire), and depression symptoms. Our findings support the hypothesis that other aspects beyond physical and hemodynamic ones might impact the daily physical activity of patients with pulmonary arterial hypertension.
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Affiliation(s)
- Layse Nakazato
- Pulmonary Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Felipe Mendes
- Department of Physical Therapy, University of São Paulo, São Paulo, Brazil
| | - Ilma A. Paschoal
- Pulmonary Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Daniela C. Oliveira
- Cardiovascular Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Marcos M. Moreira
- Pulmonary Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Mônica C. Pereira
- Pulmonary Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
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Von Visger TT, Lee D, Lyons A, Chang YP. Integrated Review of Psychosocial and Behavioral Health Assessments and Interventions in Pulmonary Hypertension. Nurs Res 2021; 70:150-161. [PMID: 33630538 DOI: 10.1097/nnr.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The medical management of patients with pulmonary hypertension (PH) has advanced, with few evidence-based recommendations about psychosocial and behavioral health interventions. There is also a lack of comprehensive understanding of PH psychosocial and behavioral health needs. Some psychosocial and behavioral health interventions have been tested; however, there is a gap in the systematic evaluation of nonpharmacological complementary approaches to augment PH management when addressing psychosocial and behavioral health needs. OBJECTIVES The objectives are to explore psychosocial and behavioral health needs and describe psychosocial and behavioral health interventions for patients with PH. METHODS We conducted an integrative systematic review of publications between January 1, 2010, and January 31, 2020, obtained from electronic databases: EMBASE, PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane, PsycINFO, and Web of Science. The literature searches focused on empirical literature reporting psychosocial needs and psychosocial and behavioral health interventions for adult PH patients. We included peer-reviewed studies published in English. Search terms used in the study were: "hypertension," "pulmonary hypertension," "psychosocial," "depression," "anxiety," "quality of life," "behavioral health," "self-management," "psychosocial intervention," and "psychological distress." Excluded were opinion and discussion publications, reviews, non-PH populations, and pediatric articles. We used the constant comparison method to guide the synthesis of reports applying the Joanna Briggs quality assessment guidelines. RESULTS A total of 44 articles meeting the criteria were included for final consideration. We conducted an integrative systematic review of 27 quantitative studies, narrative synthesis of 10 qualitative studies, and 7 psychosocial and behavioral health intervention studies. PH patients reported psychosocial needs, such as financial, social connections, sexual health, and palliative care needs, as well as levels of psychological distress symptoms. The results from both quantitative and qualitative studies revealed similar overarching psychosocial and behavioral health conceptual categories. Patients described their ongoing needs in PH management by relying on their psychosocial and behavioral health capabilities to adjust to changes at each stage of disease progression. Patients had high levels of psychosocial and behavioral health needs requiring interventions beyond medical treatment. DISCUSSION Pilot studies testing psychosocial and behavioral health interventions reported improvement in levels of anxiety and depression and health-related quality of life. Larger scale studies are needed to advance this knowledge. Psychosocial and behavioral health interventions with cognitive-guided foci have the potential of meeting these unmet needs.
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Zhang J, Yin Y, Wen Y, Shi F, Wang J. Anxiety and Depression in Patients With Pulmonary Arterial Hypertension in Northwest China: A Cross-Sectional Study. Front Psychiatry 2021; 12:758120. [PMID: 35185632 PMCID: PMC8854771 DOI: 10.3389/fpsyt.2021.758120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/27/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a rare life-threatening and incurable disease. Although symptoms of depression and anxiety have been widely reported, these traits and associated factors have not been systematically assessed in Northwest China. METHODS A cross-sectional study was conducted between March 2020 and February 2021. 106 PAH patients in Northwest China were evaluated by Self-rating Anxiety Scale (SAS) and the Self Rating Depression Scale (SDS) questionnaire. RESULTS Overall, the included patients had particularly high depressive symptoms (70.09%), while anxiety among them was 17.55%. Multivariate linear regression revealed that patients with lower age (p = 0.04), female (p < 0.01), smoking (p < 0.01), WHO functional class III/IV (p < 0.01), higher mean pulmonary hypertension (p < 0.01), lower left ventricular ejection fraction (p < 0.01), and lower 6-min walking distance (p < 0.01) had higher anxiety scores. Patients who lived in rural areas (p = 0.01), smoking (p < 0.01), WHO functional class III/IV (p < 0.01), higher mean pulmonary hypertension (p = 0.04), lower 6-min walking distance (p < 0.01), and college degree or above had higher depression scores (p = 0.02). CONCLUSIONS Mental health problems such as depression are common among patients with PAH in Northwest China. Patients' characteristics such as smoking status, WHO functional class, and 6-min walking distance were related to anxiety and depression scores. Thus, early detection of mental health problems such as depression and anxiety should be detected in PAH patients. Meanwhile, interventions against these problems should be used to improve such patients' mental status.
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Affiliation(s)
- Juxia Zhang
- Clinical Educational Department, Gansu Provincial Hospital, Lanzhou, China
| | - Yuhuan Yin
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yujie Wen
- Cardiovascular Department, Gansu Provincial Hospital, Lanzhou, China
| | - Fugui Shi
- Lanzhou Hand and Foot Surgery Hospital, Lanzhou, China
| | - Jiancheng Wang
- Geriatrics Department, Gansu Provincial Hospital, Lanzhou, China
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Waller L, Krüger K, Conrad K, Weiss A, Alack K. Effects of Different Types of Exercise Training on Pulmonary Arterial Hypertension: A Systematic Review. J Clin Med 2020; 9:jcm9061689. [PMID: 32498263 PMCID: PMC7356848 DOI: 10.3390/jcm9061689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) represents a chronic progressive disease characterized by high blood pressure in the pulmonary arteries leading to right heart failure. The disease has been a focus of medical research for many years due to its worse prognosis and limited treatment options. The aim of this study was to systematically assess the effects of different types of exercise interventions on PAH. Electronic databases were searched until July 2019. MEDLINE database was used as the predominant source for this paper. Studies with regards to chronic physical activity in adult PAH patients are compared on retrieving evidence on cellular, physiological, and psychological alterations in the PAH setting. Twenty human studies and 12 rat trials were identified. Amongst all studies, a total of 628 human subjects and 614 rats were examined. Regular physical activity affects the production of nitric oxygen and attenuates right ventricular hypertrophy. A combination of aerobic, anaerobic, and respiratory muscle training induces the strongest improvement in functional capacity indicated by an increase of 6 MWD and VO2peak. In human studies, an increase of quality of life was found. Exercise training has an overall positive effect on the physiological and psychological components of PAH. Consequently, PAH patients should be encouraged to take part in regular exercise training programs.
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Affiliation(s)
- Lena Waller
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University Giessen, 35394 Giessen, Germany; (K.K.); (K.C.); (K.A.)
- Correspondence: ; Tel.: +49-641-99-25212
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University Giessen, 35394 Giessen, Germany; (K.K.); (K.C.); (K.A.)
| | - Kerstin Conrad
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University Giessen, 35394 Giessen, Germany; (K.K.); (K.C.); (K.A.)
| | - Astrid Weiss
- Department of Internal Medicine, Institute of Pulmonary Pharmacotherapy, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), 35392 Giessen, Germany;
| | - Katharina Alack
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University Giessen, 35394 Giessen, Germany; (K.K.); (K.C.); (K.A.)
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Zeng X, Chen H, Ruan H, Ye X, Li J, Hong C. Effectiveness and safety of exercise training and rehabilitation in pulmonary hypertension: a systematic review and meta-analysis. J Thorac Dis 2020; 12:2691-2705. [PMID: 32642177 PMCID: PMC7330286 DOI: 10.21037/jtd.2020.03.69] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Pulmonary hypertension (PH) is a chronic progressive disease characterized by increasing pulmonary vascular resistance, poor prognosis and high disability rate. Although many targeted drugs for PH have been put to clinical use, most patients still have poor exercise tolerance and quality of life. Exercise training is considered to further improve exercise capacity and quality of life in patients with PH, but it has not been fully studied and utilized. The aim of this systematic review and meta-analysis is to evaluate the effectiveness and safety of exercise training in patients with PH. Methods A search was conducted for the meta-analysis using the databases PubMed, Embase, Cochrane Library, including literature published before December 2018. The primary outcome of this meta-analysis was a change in the 6-minute walk distance (6MWD). In addition, peak oxygen uptake (PeakVO2), resting pulmonary arterial systolic pressure (PASPrest), resting heart rate (HRrest), peak exercise heart rate (HRpeak), oxygen uptake anaerobic threshold (VO2 at AT), maximum workload and quality of life (QoL) were also assessed. Results A total of 651 patients in 17 studies were included. A meta-analysis showed that exercise training was associated with significant improvement in the 6MWD [weighted mean difference (WMD): 64.75 m (95% CI: 53.19–76.31 m, P<0.001)], peakVO2 [WMD: 1.78 mL/min/kg (95% CI: 1.27–2.29 mL/min/kg, P<0.001)], HRpeak [WMD: 11.07 beats/min (95% CI: 8.04–14.11 beats/min, P<0.001)] and QoL measured by SF-36 questionnaire subscale scores. Furthermore, exercise training is well tolerated, and no major adverse event occurred related to exercise training. Conclusions Exercise training is associated with a significant improvement in exercise capacity, cardiorespiratory fitness and quality of life among patients with PH and proved to be safe for stable PH patients with optimization of medical therapy. However, more large-scale multicenter studies are needed to confirm the effectiveness and safety of exercise training in patients with PH.
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Affiliation(s)
- Xiaomei Zeng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,General practice Department, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen 518035, China
| | - Haiming Chen
- First Clinical Medical Institute of Guangzhou Medical University, Guangzhou 510182, China
| | - Honglian Ruan
- School of Public Health, Guangzhou Medical University, Guangzhou 511436, China
| | - Xiaojuan Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,General practice Department, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen 518035, China
| | - Jieying Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Cheng Hong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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10
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Shapiro S, Bourge RC, Pozella P, Harris DF, Borg EH, Nelsen AC. Implantable system for treprostinil: a real-world patient experience study. Pulm Circ 2020; 10:2045894020907881. [PMID: 32363029 PMCID: PMC7177997 DOI: 10.1177/2045894020907881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/31/2020] [Indexed: 12/26/2022] Open
Abstract
Parenteral prostanoids are effective for improving outcomes in patients with pulmonary arterial hypertension. However, subcutaneous or intravenous delivery via an external pump places a significant burden on patients. Consequently, the Implantable System for Remodulin© (treprostinil) was developed and is associated with a low rate of complications (United Therapeutics (Research Triangle Park, NC) in collaboration with Medtronic, Inc. (Mounds View, MN)). The current real-world experience study evaluated pulmonary arterial hypertension patients' perceptions of their quality of life, ability to perform activities of daily living, perceptions on the benefits and risks of the implantable system, and their social interactions before and after receiving the implantable system. Pulmonary arterial hypertension patients who had been transitioned from an external infusion pump to the implantable system completed a mix of quantitative and qualitative questions administered online over the course of a six-day period. A total of 20 patients completed the study. All patients reported that their quality of life, confidence out in public, and ability to travel long distances had improved. Over 90% of patients reported that their overall level of independence was better since receiving the implantable system, and most patients indicated that their ability to independently perform specific activities of daily living had improved. Responses to the qualitative questions suggested that the implantable system saved time, improved interpersonal relationships, and increased freedom. Results from this real-world patient experience study suggest this novel delivery system provides improvements in factors that are of substantial importance to patients.
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Affiliation(s)
- Shelley Shapiro
- VA Greater Los Angeles Healthcare System Cardiology Section, David Geffen UCLA School of Medicine, UCLA Medical Center Department of Pulmonary Critical Care, Los Angeles, CA, USA
| | - Robert C Bourge
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patti Pozella
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | | | - Erick H Borg
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | - Andrew C Nelsen
- United Therapeutics Corporation, Research Triangle Park, NC, USA
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11
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Walther CP, Nambi V, Hanania NA, Navaneethan SD. Diagnosis and Management of Pulmonary Hypertension in Patients With CKD. Am J Kidney Dis 2020; 75:935-945. [PMID: 32199709 DOI: 10.1053/j.ajkd.2019.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/07/2019] [Indexed: 12/12/2022]
Abstract
Pulmonary hypertension (PH) is a highly prevalent and important condition in adults with chronic kidney disease (CKD). In this review, we summarize the definition of PH, discuss its pathophysiology and classifications, and describe diagnostic and management strategies in patients with CKD, including those with kidney failure treated by kidney replacement therapy. In the general population, PH is classified into 5 groups based on clinical presentation, pathology, hemodynamics, and management strategies. In this classification system, PH in CKD is placed in a diverse group with unclear or multifactorial mechanisms, although underlying cardiovascular disease may account for most cases. CKD may itself directly incite pulmonary circulatory dysfunction and remodeling through uremic toxins, inflammation, endothelial dysfunction, and altered vasoregulation. Despite several studies describing the higher prevalence of PH in CKD and kidney failure, along with an association with poor outcomes, high-quality evidence is not available for its diagnostic and management strategies in those with CKD. In CKD not requiring kidney replacement therapy, volume management along with treatment of underlying risk factors for PH are critical. In those receiving hemodialysis, options are limited and transition to peritoneal dialysis may be considered if recurrent hypotension precludes optimal volume control.
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Affiliation(s)
- Carl P Walther
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
| | - Vijay Nambi
- Micheal E DeBakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Houston, TX; Sections of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Nicola A Hanania
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.
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12
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Kahraman BO, Savci S, Ozsoy I, Baran A, Acar S, Ozpelit E, Balci A, Sevinc C, Akdeniz B. Effects of neuromuscular electrical stimulation in patients with pulmonary arterial hypertension: a randomized controlled pilot study. J Cardiol 2020; 75:702-708. [PMID: 32001075 DOI: 10.1016/j.jjcc.2019.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/01/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with pulmonary arterial hypertension (PAH) present impairments in muscle strength and exercise capacity. There is growing evidence about the benefits of neuromuscular electrical stimulation (NMES) in patients with respiratory diseases, except in patients with PAH. The aim of this study was to investigate the effects of NMES on muscle strength, and other physical and psychosocial variables in patients with PAH. METHODS Patients with PAH were randomly divided into two groups as NMES and control. The NMES was applied to the bilateral deltoid and quadriceps femoris muscles with 50 Hz for 3 days/week, 8 weeks for the NMES group. Muscle strength, muscle cross-sectional area and thickness, arterial stiffness, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were assessed at baseline and after 8 weeks by blinded assessors. RESULTS There was no significant difference in the demographic and clinical characteristics between the patient groups (p > 0.05). The improvements in muscle strength, muscle cross-sectional area and thickness, pulse wave velocity, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were significantly higher in the NMES group compared to the control group (p < 0.05). CONCLUSIONS This study suggests that NMES intervention is safe and effective for patients with PAH.
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Affiliation(s)
- Buse Ozcan Kahraman
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
| | - Sema Savci
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Ismail Ozsoy
- School of Physical Therapy and Rehabilitation, Kırsehir Ahi Evran University, Kirsehir, Turkey
| | - Agah Baran
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Serap Acar
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Ebru Ozpelit
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ali Balci
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Can Sevinc
- Department of Chest Disease, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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13
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Chandrasekhar M, Rao A, Ruiz G, Groninger H. Palliative Care Issues in Pulmonary Arterial Hypertension #367. J Palliat Med 2019; 22:220-222. [DOI: 10.1089/jpm.2018.0618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Chin KM, Gomberg-Maitland M, Channick RN, Cuttica MJ, Fischer A, Frantz RP, Hunsche E, Kleinman L, McConnell JW, McLaughlin VV, Miller CE, Zamanian RT, Zastrow MS, Badesch DB. Psychometric Validation of the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT) Questionnaire: Results of the SYMPHONY Trial. Chest 2018; 154:848-861. [PMID: 29705220 DOI: 10.1016/j.chest.2018.04.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 03/12/2018] [Accepted: 04/02/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Disease-specific patient-reported outcome (PRO) instruments are important in assessing the impact of disease and treatment. The Pulmonary Arterial Hypertension-Symptoms and Impact Questionnaire is the first instrument for quantifying pulmonary arterial hypertension (PAH) symptoms and impacts developed according to the 2009 US Food and Drug Administration PRO guidance; previous qualitative research in patients with PAH supported its initial content validity. METHODS Content finalization and psychometric validation were conducted by using data from A Study of Macitentan in Pulmonary Arterial Hypertension to Validate the PAH-SYMPACT (SYMPHONY), a single-arm, 16-week trial with macitentan 10 mg in US patients with PAH. Item performance, Rasch analysis, and factor analyses were used to select the final item content of the PRO and to define its domain structure. Internal consistency, test-retest reliability, known-group and construct validity, sensitivity to change, and influence of oxygen on item performance were evaluated. RESULTS Data from 278 patients (79% female; mean age: 60 years) were analyzed. Following removal of redundant/misfitting items, the final questionnaire has 11 symptom items across two domains (cardiopulmonary and cardiovascular symptoms) and 11 impact items across two domains (physical and cognitive/emotional impacts). Differential item function analysis confirmed that PRO scoring is unaffected by oxygen use. For all four domains, internal consistency reliability was high (Cronbach's alpha > 0.80), and scores were highly reproducible in stable patients (intraclass correlation coefficient: 0.84-0.94). Correlations with the Cambridge Pulmonary Hypertension Outcome Review questionnaire and the 36-item Medical Outcomes Study Short Form Survey were moderate to high ([r] = 0.34-0.80). The questionnaire differentiated well between patients with varying disease severity levels and was sensitive to improvements in clinician- and patient-reported disease severity. CONCLUSIONS The Pulmonary Arterial Hypertension-Symptoms and Impact Questionnaire is a brief, disease-specific PRO instrument possessing good psychometric properties that can be administered in clinical practice and clinical studies. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01841762; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Kelly M Chin
- University of Texas Southwestern, Internal Medicine, Pulmonary Hypertension Program, Dallas, TX.
| | | | | | - Michael J Cuttica
- Northwestern University, Medicine, Pulmonary and Critical Care Medicine, Chicago, IL
| | - Aryeh Fischer
- University of Colorado Denver, Medicine, Rheumatology/Pulmonary Sciences & Critical Care Medicine, Aurora, CO
| | | | - Elke Hunsche
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | | | | | | | - Roham T Zamanian
- Stanford University Medical Center, Pulmonary & Critical Care Medicine, Stanford, CA
| | | | - David B Badesch
- University of Colorodo Denver, Cardiology/Pulmonary Sciences & Critical Care Medicine, Aurora, CO
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15
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Abstract
PURPOSE OF REVIEW Developments in the management of pulmonary arterial hypertension have significantly improved prognosis changing this from an acute to a chronic disease. Despite optimal treatment many patients still have a high-symptom burden both because of the disease and the side-effects of therapy, consequently there is an increasing need for a palliative care approach to improve the quality of life for this patient group. This review article will outline the need for palliative care support for patients with pulmonary arterial hypertension, discuss the barriers that currently exist and suggest how this may be improved. RECENT FINDINGS Studies have been conducted which explore the role of palliative care in pulmonary arterial hypertension including physicians attitudes and the current barriers that exist to prevent its implementation. SUMMARY Specialist palliative support is utilized in the minority of patients with pulmonary arterial hypertension despite a need for symptom control. Patients may benefit from the introduction of a palliative care approach as part of their standard care, but to achieve this there needs to be a greater understanding of the role of palliative care by both clinicians and patients and more research into the benefits for patients with pulmonary arterial hypertension.
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16
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Mechanisms underlying the impact of exercise training in pulmonary arterial hypertension. Respir Med 2018; 134:70-78. [DOI: 10.1016/j.rmed.2017.11.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/10/2017] [Accepted: 11/28/2017] [Indexed: 11/23/2022]
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17
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Madden BP, Shaw EJ. Skeletal muscle exercise training in pulmonary arterial hypertension. Int J Cardiol 2017; 246:59-60. [DOI: 10.1016/j.ijcard.2017.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 10/18/2022]
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18
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Tran DL, Lau EM, Celermajer DS, Davis GM, Cordina R. Pathophysiology of exercise intolerance in pulmonary arterial hypertension. Respirology 2017; 23:148-159. [DOI: 10.1111/resp.13141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/15/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Derek L. Tran
- Faculty of Health Sciences; The University of Sydney; Sydney NSW Australia
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences; Macquarie University; Sydney NSW Australia
- Pulmonary Hypertension Service; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Edmund M.T. Lau
- Pulmonary Hypertension Service; Royal Prince Alfred Hospital; Sydney NSW Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
| | - David S. Celermajer
- Pulmonary Hypertension Service; Royal Prince Alfred Hospital; Sydney NSW Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
| | - Glen M. Davis
- Faculty of Health Sciences; The University of Sydney; Sydney NSW Australia
| | - Rachael Cordina
- Pulmonary Hypertension Service; Royal Prince Alfred Hospital; Sydney NSW Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
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González-Saiz L, Fiuza-Luces C, Sanchis-Gomar F, Santos-Lozano A, Quezada-Loaiza CA, Flox-Camacho A, Munguía-Izquierdo D, Ara I, Santalla A, Morán M, Sanz-Ayan P, Escribano-Subías P, Lucia A. Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: The WHOLEi+12 trial. Int J Cardiol 2017; 231:277-283. [DOI: 10.1016/j.ijcard.2016.12.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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20
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Matura LA, Fargo J, Fritz JS, Smith KA, Vaidya A, Pinder D, Archer-Chicko C, Palevsky HI, Pack AI, Sommers MS, Kawut SM. Slow-paced respiration therapy to treat symptoms in pulmonary arterial hypertension. Heart Lung 2016; 46:7-13. [PMID: 27884398 DOI: 10.1016/j.hrtlng.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the feasibility of using slow-paced respiration therapy to treat symptoms in women with pulmonary arterial hypertension (PAH). BACKGROUND People with PAH report increased dyspnea, fatigue and sleep disturbance that can impair health-related quality of life (HRQOL). METHODS Ten women with PAH received 8-weeks of daily, 15 min sessions using slow-paced respiration therapy via the RESPeRATE™ device. Participants had baseline and follow up assessments including plasma norepinephrine and interleukin-6 (IL-6), self-report questionnaires to measure dyspnea, fatigue, depressive symptoms, sleep and HRQOL along with 7-day actigraphy and sleep diaries. RESULTS The mean age was 50 years. Adherence to the intervention was 92%. There was decrease in median IL-6 levels [1.3 ± 0.5 to 1.1 ± 0.4, 95% CI (0.03-0.43)] over the study period. Sleep disturbance decreased, depressive symptoms decreased and HRQOL scores decreased (higher scores indicate worse HRQOL). CONCLUSIONS In this pilot study, slow-paced respiration therapy is feasible in patients with PAH and may improve symptoms and lower IL-6.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
| | | | - Jason S Fritz
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Kerri A Smith
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Anjali Vaidya
- Perelman School of Medicine of the University of Pennsylvania, Division of Cardiovascular Medicine, Philadelphia, PA, USA
| | - Diane Pinder
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Christine Archer-Chicko
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Harold I Palevsky
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Allan I Pack
- Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Marilyn S Sommers
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Steven M Kawut
- Center for Clinical Epidemiology and Biostatistics, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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21
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Gu S, Hu H, Dong H. Systematic Review of Health-Related Quality of Life in Patients with Pulmonary Arterial Hypertension. PHARMACOECONOMICS 2016; 34:751-770. [PMID: 26951248 DOI: 10.1007/s40273-016-0395-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The increasing survival of patients with pulmonary arterial hypertension (PAH) has shifted attention towards the disease burden that PAH imposes on patients and healthcare systems. Most studies emphasize epidemiology and medications, while large observational studies reporting on the health-related quality of life (HRQOL) of patients with PAH are lacking. OBJECTIVE Our objective was to study the HRQOL of patients with PAH and to summarize the factors that influence it. METHODS We conducted systematic literature searches in English (PubMed, Web of Knowledge, ScienceDirect and OVID) and Chinese (China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP and SinoMed) databases to identify studies published from 2000 to 2015 assessing the HRQOL of patients with PAH. Search results were independently reviewed and extracted by two reviewers. RESULTS Of 3392 records identified in the initial search, 20 eligible papers (19 English, 1 Chinese) were finally included. Studies used a range of instruments; the generic 36-item Short Form Survey (SF-36) was the most widely used, and the disease-specific Cambridge Pulmonary Hypertension Outcome Survey (CAMPHOR) was the second mostly widely used. Mean HRQOL scores assessed via the SF-36 (physical component summary [PCS] 25.4-80.1; mental component summary [MCS] 33.2-76.0) and CAMPHOR (symptom scores 3.1-17; total HRQOL 2.8-12.6; activity scores 3.8-18.1) varied across studies, reporting decreased HRQOL in patients. Mental health (depression, anxiety, stress), physical health (exercise capacity, symptoms) and medical therapies were reported to affect HRQOL. CONCLUSION We found that PAH places a substantial burden on patients, particularly in terms of HRQOL; however, the paucity of large observational studies in this area requires the attention of researchers, especially in China.
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Affiliation(s)
- Shuyan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
| | - Huimei Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
- Department of Public Health, Zhejiang Medical College, Hangzhou, Zhejiang Province, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China.
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22
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McCollister D, Shaffer S, Badesch DB, Filusch A, Hunsche E, Schüler R, Wiklund I, Peacock A. Development of the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT®) questionnaire: a new patient-reported outcome instrument for PAH. Respir Res 2016; 17:72. [PMID: 27301413 PMCID: PMC4908719 DOI: 10.1186/s12931-016-0388-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 06/07/2016] [Indexed: 12/03/2022] Open
Abstract
Background Regulators and clinical experts increasingly recognize the importance of incorporating patient-reported outcomes (PROs) in clinical studies of therapies for pulmonary arterial hypertension (PAH). No PAH-specific instruments have been developed to date in accordance with the 2009 FDA guidance for the development of PROs as endpoints in clinical trials. A qualitative research study was conducted to develop a new instrument assessing PAH symptoms and their impacts following the FDA PRO guidance. Methods A cross-sectional study was conducted at 5 centers in the US in symptomatic PAH patients aged 18–80 years. Concept elicitation was based on 5 focus group discussions, after which saturation of emergent concepts was reached. A PRO instrument for PAH symptoms and their impacts was drafted. To assess the appropriateness of items, instructions, response options, and recall periods, 2 rounds of one-on-one cognitive interviews were conducted, with instrument revisions following each round. Additional interviews tested the usability of an electronic version (ePRO). PRO development considered input from an international Steering Committee, and translatability and lexibility assessments. Results Focus groups comprised 25 patients (5 per group); 20 additional patients participated in cognitive interviews (10 per round); and 10 participated in usability interviews. Participants had a mean ± SD age of 53.1 ± 15.8 years, were predominantly female (93 %), and were diverse in race/ethnicity, WHO functional class (FC I/II: 56 %, III/IV: 44 %), and PAH etiology (idiopathic: 56 %, familial: 2 %, associated: 42 %). The draft PRO instrument (PAH-SYMPACT®) was found to be clear, comprehensive, and relevant to PAH patients in cognitive interviews. Items were organized in a draft conceptual framework with 16 symptom items in 4 domains (respiratory symptoms, tiredness, cardiovascular symptoms, other symptoms) and 25 impact items in 5 domains (physical activities, daily activities, social impact, cognition, emotional impact). The recall period is the past 24 h for symptoms, and the past 7 days for impacts. Conclusions The PAH-SYMPACT® was shown to capture symptoms and their impacts relevant to PAH patients, demonstrating content saturation, concept validity, and ePRO usability. Final content and psychometric validation of the instrument will be based on the results of an ongoing Phase IIIb clinical trial in PAH patients. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0388-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deborah McCollister
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, 12401 E. 17th Ave., Box L957, Aurora, CO, 80045, USA.
| | - Shannon Shaffer
- Outcomes Research, Evidera, 7101 Wisconsin Ave, Suite 1400, Bethesda, MD, 20814, USA
| | - David B Badesch
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, 12401 E. 17th Ave., Box L957, Aurora, CO, 80045, USA.,Division of Cardiology, University of Colorado Denver, 12401 E. 17th Ave., Box L957, Aurora, CO, 80045, USA
| | - Arthur Filusch
- Department of Pneumology and Cardiology, HPK - Heidelberg Private Clinic, Im Rossgraben 14, 69123, Heidelberg, Germany
| | - Elke Hunsche
- Global Market Access and Pricing, Actelion Pharmaceuticals Ltd, Gewerbestrasse 16, CH-4123, Allschwil, Switzerland
| | - René Schüler
- Global Market Access and Pricing, Actelion Pharmaceuticals Ltd, Gewerbestrasse 16, CH-4123, Allschwil, Switzerland
| | - Ingela Wiklund
- Outcomes Research, Evidera, 1 Butterwick, London, W6 8DL, UK
| | - Andrew Peacock
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Glasgow, G81 4HX, UK
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Matura LA, McDonough A, Hanlon AL, Carroll DL. Developmental and Initial Validation of the Pulmonary Arterial Hypertension Symptom Inference Scale. J Nurs Meas 2016; 24:40-53. [PMID: 27103243 DOI: 10.1891/1061-3749.24.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension is a chronic illness that produces multiple symptoms and impairs quality of life. PURPOSE The purpose of this study was to describe the initial psychometric properties of the Pulmonary Arterial Hypertension Symptom Interference Scale (PAHSIS). METHODS Participants completed a sociodemographic and clinical data form: the PAHSIS and the Medical Outcomes Study Short Form-36 (SF-36). Data analysis included descriptive statistics, principal component analysis (PCA), and Pearson r correlations. RESULTS PCA revealed a 3-factor solution: Cardiopulmonary, Weary, and Gastric. Correlations between the 3 factors and the SF-36 subscales and composite summary scores ranged from acceptable to high. CONCLUSIONS These findings support the initial validity and reliability of the PAHSIS. Nursing can use the PAHSIS to assess the impact of patient symptoms to deploy effective, targeted interventions.
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Matura LA, Shou H, Fritz JS, Smith KA, Vaidya A, Pinder D, Archer-Chicko C, Dubow D, Palevsky HI, Sommers MS, Kawut SM. Physical Activity and Symptoms in Pulmonary Arterial Hypertension. Chest 2016; 150:46-56. [PMID: 26892602 DOI: 10.1016/j.chest.2016.02.633] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom in patients with pulmonary arterial hypertension (PAH); however, the impact of fatigue on daily physical activity in PAH is unknown. Accelerometry is a validated measure for assessing physical activity. We hypothesized that patients with PAH reporting higher levels of fatigue would have lower daily physical activity measured by accelerometry. METHODS We performed a prospective cohort study of 15 women with PAH. On day 1, subjects completed the Multidimensional Fatigue Inventory (MFI), the United States Cambridge Pulmonary Hypertension Outcome Review (US CAMPHOR), and a 6-min walk test. Subjects wore the accelerometer on their dominant hip and completed an activity diary for 7 days. On day 15, subjects repeated the MFI and the US CAMPHOR, and then wore the accelerometer and completed an activity diary for an additional 7 days. All multivariate analyses were adjusted for age, BMI, and PAH type. RESULTS The mean age was 50.5 years, and 53% had idiopathic or heritable PAH. During the 2 weeks, subjects were mostly sedentary (85% of the time), although 10% of their time was spent performing low-level activity. Lower average daily counts were associated with worse self-reported energy levels, whereas less day-to-day physical activity variability was associated with more self-reported mental fatigue, physical fatigue, and total activity. Higher percentage of activity bouts was also associated with worse energy. CONCLUSIONS Women with PAH may spend most of their time being sedentary, and lower self-reported energy levels are associated with less daily activity. Interventions to improve symptoms such as fatigue may also increase physical activity levels in PAH.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania School of Nursing, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
| | - Haochang Shou
- Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Jason S Fritz
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - K Akaya Smith
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Anjali Vaidya
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Diane Pinder
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Christine Archer-Chicko
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Danielle Dubow
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Harold I Palevsky
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Marilyn S Sommers
- University of Pennsylvania School of Nursing, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
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Kukkonen M, Puhakka A, Halme M. Quality of life among pulmonary hypertension patients in Finland. Eur Clin Respir J 2016; 3:26405. [PMID: 26787306 PMCID: PMC4718930 DOI: 10.3402/ecrj.v3.26405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/27/2015] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of the study was to examine pulmonary hypertension (PH) patients’ quality of life (QOL) for the first time in Finland. Methods This was a non-interventional, cross-sectional study. The SF-36v2 questionnaire was sent to the PH patients who had been referred to or followed up on at the Helsinki University Central Hospital's pulmonary clinic for idiopathic pulmonary arterial hypertension, associated pulmonary arterial hypertension (APAH), or chronic thromboembolic PH (CTEPH). The patients were on pulmonary arterial hypertension (PAH) – specific drugs, were at least 18 years old, and had signed an informed consent. Results There were 62 patients who fulfilled the inclusion criteria, and 53% of respondents rated their health as moderate. Similarly, 55% of respondents rated their health status approximately the same compared to their situation 1 year ago. QOL was impaired in all other subscales, except for the mental health and mental component score. A majority of patients suffered from PH symptoms, which worsened their QOL. The greatest impact on their QOL was associated with a high World Health Organization (WHO) functional class (FC), poor performance in a 6-min walking test (6MWT), symptoms, oxygen therapy, elevated pro-brain natriuretic peptide, pericardial effusion, APAH etiology, and being retired from work. Conclusions The respondents had a reduced QOL, compared to the general population, in all other subscales, except for mental health. APAH patients had the worst QOL. Good results in functional capacity measures (WHO FC, 6MWT) were associated with a better QOL. Patients’ QOL can be improved by reducing the symptoms of PAH.
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Affiliation(s)
- Merja Kukkonen
- Department of Pulmonary Diseases, Helsinki University Central Hospital, Helsinki, Finland;
| | - Airi Puhakka
- Actelion Pharmaceuticals Sverige AB filial Finland, Espoo, Finland
| | - Maija Halme
- Department of Pulmonary Diseases, Helsinki University Central Hospital, Helsinki, Finland
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Matura LA, McDonough A, Carroll DL. Symptom Interference Severity and Health-Related Quality of Life in Pulmonary Arterial Hypertension. J Pain Symptom Manage 2016; 51:25-32. [PMID: 26300023 PMCID: PMC4698220 DOI: 10.1016/j.jpainsymman.2015.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/08/2015] [Accepted: 07/23/2015] [Indexed: 02/02/2023]
Abstract
CONTEXT While assessing symptom severity is an important component of evaluating symptoms, understanding those symptoms that interfere with patients' lives is also key. Pulmonary arterial hypertension (PAH) is a chronic disease resulting in right heart failure and increased mortality. Patients with PAH experience multiple symptoms but we do not know which symptoms and to what extent their symptoms interfere with daily life. OBJECTIVES To: (1) describe the prevalence of those symptoms that interfere with life; (2) describe the severity of symptom interference; and (3) determine those sociodemographic and clinical characteristics and interfering symptoms associated with health-related quality of life (HRQOL) in patients with PAH. METHODS A convenience sample of 191 patients with PAH completed a sociodemographic form, the Pulmonary Arterial Hypertension Symptom Interference Scale (PAHSIS) and the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hierarchical multiple linear regression was used to analyze demographic and medical characteristics along with symptom interference from the PAHSIS as predictors of HRQOL from the composite mental and physical health summary scores of the Short Form-36. RESULTS The most interfering symptoms reported were fatigue, shortness of breath with exertion, and difficulty sleeping. Age, gender, functional class, oxygen use, fatigue, dizziness, and Raynaud phenomenon were associated with the HRQOL physical health summary scores. The symptoms fatigue and SOB while lying down were associated with the HRQOL mental health summary scores. CONCLUSION Patients with PAH are experiencing multiple symptoms that are interfering with their HRQOL and ability to function.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
| | | | - Diane L Carroll
- Yvonne L. Munn Center for Nursing Research, Institute for Patient Care, Massachusetts General Hospital, Boston, Massachusetts, USA
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Fenstad ER, Wordingham SE, Swetz KM. Pulmonary Hypertension and Palliative Care: What, When, Where, and Why? ACTA ACUST UNITED AC 2016. [DOI: 10.21693/1933-088x.15.1.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Summary:
Pulmonary hypertension (PH) can be associated with a high level of symptom burden from the disease as well as its treatment. Involvement of palliative care (PC) services may help facilitate discussion regarding goals of care, prognostic planning, and treatment options focused on improving quality of life (QOL).
Background:
PC is active total care of a patient whose disease is not fully responsive to curative therapies, with symptom control as the top priority. After a life-limiting diagnosis is made, health care teams and patients determine prognosis, whether cure is attainable or reasonable, what treatment options are available, risks and benefits of associated treatments, and how treatment or nontreatment will impact QOL and survival. QOL is often the focus of palliative interventions, with the goal to minimize symptoms and empower patients with accurate information to help affirm life and meet objectives of care.
Implications for clinicians:
PC can begin at the onset of symptoms in a disease that cannot be cured. Early PC may help facilitate discussion regarding goals of care when patient expectations are discordant with prognosis. While PC is a responsibility of all clinicians, subspecialist assistance can be helpful when a clinical decline occurs, in the setting of uncertainty, when patients are removed from the transplant list, or when long-term QOL issues are present.
Conclusion:
Communication with patients who have PH can be delicate and requires an understanding of the disease's process, trajectory, and prognosis. PC teams possess communication skills that may benefit patients and providers with QOL optimization, delivery of difficult news, advanced care planning, and shared decision-making.
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Affiliation(s)
- Eric R. Fenstad
- Clinical Cardiologist, Minneapolis Heart Institute Baxter, MN
| | - Sara E. Wordingham
- Instructor in Medicine, Mayo Clinic College of Medicine Mayo Clinic Arizona Phoenix, AZ
| | - Keith M. Swetz
- Associate Professor of Medicine, University of Alabama School of Medicine Assistant Director, UAB Center for Palliative and Supportive Care Section Chief, Palliative Care, Birmingham VA Medical Center Birmingham, AL
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Interleukin-6 and tumor necrosis factor-α are associated with quality of life-related symptoms in pulmonary arterial hypertension. Ann Am Thorac Soc 2015; 12:370-5. [PMID: 25615959 DOI: 10.1513/annalsats.201410-463oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Inflammation is associated with symptoms in many chronic illnesses; however, this link has not been established in pulmonary arterial hypertension. OBJECTIVES The objective of this study was to investigate the association between inflammatory markers and quality of life-related symptoms in patients with pulmonary arterial hypertension. We hypothesized that higher circulating IL-6 and tumor necrosis factor-α levels would be associated with worse quality of life-related symptoms. METHODS We performed a secondary analysis using baseline and 3-month assessments of 62 subjects in a clinical trial of aspirin and simvastatin to determine the association between plasma IL-6 and tumor necrosis factor-α levels and the Medical Outcomes Study Short Form-36 subscales (pain, vitality, mental health). MEASUREMENTS AND MAIN RESULTS The mean age was 49.7±13.4 years; 87% were female. Higher IL-6 levels were significantly associated with lower Medical Outcomes Study Short Form-36 subscale scores, indicating worse bodily pain, vitality, and mental health (all P<0.01). Higher tumor necrosis factor-α levels were significantly associated with increased bodily pain, but better mental health scores. CONCLUSIONS IL-6 and tumor necrosis factor-α levels are associated with certain quality of life domains in patients with pulmonary arterial hypertension. Clinical trial registered with www.clinicaltrials.gov (NCT00384865).
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Pandey A, Garg S, Khunger M, Garg S, Kumbhani DJ, Chin KM, Berry JD. Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension: Systematic Review and Meta-Analysis. Circ Heart Fail 2015; 8:1032-43. [PMID: 26185169 DOI: 10.1161/circheartfailure.115.002130] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise training has been shown to improve cardiorespiratory fitness, physical capacity, and quality of life in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease. However, its role in management of pulmonary hypertension is not well defined. In this study, we aim to evaluate the efficacy and safety of exercise training in patients with pulmonary hypertension. METHODS AND RESULTS We included all prospective intervention studies that evaluated the efficacy and safety of exercise training in patients with pulmonary hypertension. Primary outcome of this meta-analysis was a change in 6-minute walk distance. We also assessed the effect of exercise on peak oxygen uptake, resting pulmonary arterial systolic pressure, peak exercise heart rate, and quality of life. A total of 469 exercise-training participants enrolled in 16 separate training studies were included. In the pooled analysis, exercise training was associated with significant improvement in 6-minute walk distance (weighted mean difference, 53.3 m; 95% confidence interval, 39.5-67.2), peak oxygen uptake (weighted mean difference, 1.8 mL/kg per minute; 95% confidence interval, 1.4-2.3), pulmonary arterial systolic pressure (weighted mean difference, -3.7 mm Hg; 95% confidence interval, -5.4 to -1.9), peak exercise heart rate (weighted mean difference, 10 beats per min; 95% confidence interval, 6-15), and quality of life as measured on SF-36 questionnaire subscale scores. Furthermore, exercise training was well tolerated with a low dropout rate, and no major adverse events were related to exercise training. CONCLUSIONS Exercise training in patients with pulmonary hypertension appears safe and is associated with a significant improvement in exercise capacity, pulmonary arterial pressure, and quality of life.
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Affiliation(s)
- Ambarish Pandey
- From the Division of Cardiology, Department of Internal Medicine (A.P., Sonia Garg, D.J.K., J.D.B.), Division of Pulmonary Medicine, Department of Internal Medicine (K.M.C.), and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (Sushil Garg); and Department of Internal Medicine, Cleveland Clinic, OH (M.K.)
| | - Sushil Garg
- From the Division of Cardiology, Department of Internal Medicine (A.P., Sonia Garg, D.J.K., J.D.B.), Division of Pulmonary Medicine, Department of Internal Medicine (K.M.C.), and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (Sushil Garg); and Department of Internal Medicine, Cleveland Clinic, OH (M.K.)
| | - Monica Khunger
- From the Division of Cardiology, Department of Internal Medicine (A.P., Sonia Garg, D.J.K., J.D.B.), Division of Pulmonary Medicine, Department of Internal Medicine (K.M.C.), and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (Sushil Garg); and Department of Internal Medicine, Cleveland Clinic, OH (M.K.)
| | - Sonia Garg
- From the Division of Cardiology, Department of Internal Medicine (A.P., Sonia Garg, D.J.K., J.D.B.), Division of Pulmonary Medicine, Department of Internal Medicine (K.M.C.), and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (Sushil Garg); and Department of Internal Medicine, Cleveland Clinic, OH (M.K.)
| | - Dharam J Kumbhani
- From the Division of Cardiology, Department of Internal Medicine (A.P., Sonia Garg, D.J.K., J.D.B.), Division of Pulmonary Medicine, Department of Internal Medicine (K.M.C.), and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (Sushil Garg); and Department of Internal Medicine, Cleveland Clinic, OH (M.K.)
| | - Kelly M Chin
- From the Division of Cardiology, Department of Internal Medicine (A.P., Sonia Garg, D.J.K., J.D.B.), Division of Pulmonary Medicine, Department of Internal Medicine (K.M.C.), and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (Sushil Garg); and Department of Internal Medicine, Cleveland Clinic, OH (M.K.)
| | - Jarett D Berry
- From the Division of Cardiology, Department of Internal Medicine (A.P., Sonia Garg, D.J.K., J.D.B.), Division of Pulmonary Medicine, Department of Internal Medicine (K.M.C.), and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (Sushil Garg); and Department of Internal Medicine, Cleveland Clinic, OH (M.K.).
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Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease that ultimately leads to right heart failure and death. PAH is defined as a mean pulmonary arterial pressure ≥ 25 mm Hg with a pulmonary capillary wedge pressure ≤ 15 mm Hg at rest. The diagnosis of PAH is one of exclusion; diagnostics include an extensive history, serology, chest radiograph, pulmonary function tests, ventilation/perfusion scan, transthoracic echocardiogram, and right heart catheterization. Treatment and care of patients with PAH can be complex. Therefore, the nurse practitioner is an integral member of the healthcare team caring for PAH patients, helping to ensure seamless care and support.
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Affiliation(s)
- Joanna Wapner
- University of Pennsylvania, 2101 Market Street Unit 804, Philadelphia PA 19103
| | - Lea Ann Matura
- University of Pennsylvania, School of Nursing, Claire M. Fagin Hall, 418 Curie Blvd., Room 322, Philadelphia, Pennsylvania 19104-4217 USA
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Fenstad ER, Shanafelt TD, Sloan JA, Novotny PJ, Durst LA, Frantz RP, McGoon MD, Swetz KM. Physician attitudes toward palliative care for patients with pulmonary arterial hypertension: results of a cross-sectional survey. Pulm Circ 2015; 4:504-10. [PMID: 25621164 DOI: 10.1086/677365] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/16/2014] [Indexed: 11/03/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic, symptomatic, life-threatening illness; however, it is complex, with variable expression regarding impact on quality of life (QOL). This study investigated attitudes and comfort of physicians regarding palliative care (PC) for patients with PAH and explored potential barriers to PC in PAH. An internet-based, mixed-methods survey was distributed to Pulmonary Hypertension Clinicians and Researchers, a professional organization within the Pulmonary Hypertension Association. Only responses from physicians involved in clinical care of patients with PAH were analyzed. Of 355 clinicians/researchers, 79 (22%) returned surveys, including 76 (21%) providers involved in clinical care. Responding physicians were mainly pulmonologists (67%), practiced in university/academic medical centers (89%), had been in practice a mean of 12 ± 7 years, cared for a median of 100 PAH patients per year, and reported a high level of confidence in managing PAH (87%), advanced PAH-specific pharmacologic interventions (95%), and end-of-life care (88%). Smaller proportions were comfortable managing pain (62%) and QOL issues (78%). Most physicians (91%) reported utilizing PC consultation at least once in the prior year, primarily in the setting of end-of-life/active dying (59%), hospice referral (46%), or symptomatic dyspnea/impaired QOL (40%). The most frequent reasons for not referring patients to PC included nonapproval by the patient/family (51%) and concern that PC is "giving up hope" (43%). PAH may result in symptoms that impair QOL despite optimal PAH therapy; however, PC awareness and utilization for PAH providers is low. Opportunities may exist to integrate PC into care for PAH patients.
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Affiliation(s)
- Eric R Fenstad
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tait D Shanafelt
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeff A Sloan
- Section of Cancer Center Statistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul J Novotny
- Section of Cancer Center Statistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Louise A Durst
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert P Frantz
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael D McGoon
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Keith M Swetz
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Health-related quality of life and psychological states in patients with pulmonary arterial hypertension. J Cardiovasc Nurs 2014; 29:178-84. [PMID: 23151837 DOI: 10.1097/jcn.0b013e318275330d] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a chronic illness that impairs physical function and leads to right-sided heart failure and premature death. There is limited knowledge on health-related quality of life (HRQOL) and psychological states in patients with PAH. OBJECTIVE The aim of this study was to determine the HRQOL and the psychological states of patients with PAH along with predictors of HRQOL. METHODS In a cross-sectional design, participants with PAH completed the Medical Outcomes Study Short Form-36 v2 to measure generic HRQOL, the US Cambridge Pulmonary Hypertension Outcome Review to measure disease-specific HRQOL, and the Profile of Mood States to measure the psychological states. Descriptive statistics were used to calculate all sociodemographic and clinical data and were expressed as means and standard deviations for continuous variables and as frequencies and proportions for dichotomous and nominal variables. The statistical significance level was set at P < 0.05. A multiple linear regression analysis was performed to examine the sociodemographic and clinical variables as predictors of HRQOL. A bivariate analysis of the sociodemographic and clinical variables was performed to determine correlates with HRQOL. The variables that correlated with HRQOL at the 0.20 level of significance were included. RESULTS There were 149 participants, 127 women and 22 men, with a mean age of 53.5 years. The participants demonstrated diminished general health, physical functioning, role physical, and vitality on the Short Form-36 v2. Functional class, education level, oxygen use, years since diagnosis, and calcium channel blocker therapy were predictive of poorer HRQOL. CONCLUSIONS Patients with PAH are experiencing diminished physical health and HRQOL. Future studies are needed to design and test interventions to improve HRQOL.
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Matura LA, McDonough A, Carroll DL. Symptom Prevalence, Symptom Severity, and Health-Related Quality of Life Among Young, Middle, and Older Adults With Pulmonary Arterial Hypertension. Am J Hosp Palliat Care 2014; 33:214-21. [PMID: 25294227 DOI: 10.1177/1049909114554079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic, life threatening illness that affects primarily women. The purpose of this study was to describe the prevalence of PAH symptoms and to determine whether there are differences in symptom severity and HRQOL in PAH symptoms among young, middle, and older adults with PAH. A cross sectional design was utilized. For all the age groups, shortness of breath (SOB) on exertion and fatigue were the two most prevalent symptoms. SOB on exertion had the highest symptom severity scores followed by fatigue for all groups. Symptom severity was significantly different among the groups for palpitations, abdominal swelling and nausea. For components of HRQOL, physical functioning worsened with age. All groups had diminished general health, role physical and vitality levels. There are some differences in symptom prevalence, symptom severity and HRQOL among young, middle and older adults. Awareness of these differences is important for healthcare providers to know and assess overtime. Palliative care should be an integral part of caring for patients with PAH.
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Affiliation(s)
- Lea Ann Matura
- School of Nursing, University of Pennsylvania, Philadelphia , PA, USA
| | - Annette McDonough
- Massachusetts General Hospital, University of Massachusetts, Lowell, MA, USA
| | - Diane L Carroll
- Munn Center for Nursing Research, Institute for Patient Care, Boston, MA, USA
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Abstract
The neurovascular unit is a key player in brain development, homeostasis, and pathology. Mental stress affects coagulation, while severe mental illnesses, such as recurrent depression and schizophrenia, are associated with an increased thrombotic risk and cardiovascular morbidity. Evidence indicates that the hemostatic system is involved to some extent in the pathogenesis, morbidity, and prognosis of a wide variety of psychiatric disorders. The current review focuses on emerging data linking coagulation and some psychiatric disorders.
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Affiliation(s)
- Silvia Hoirisch-Clapauch
- Department of Hematology, Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, National Institute for Translational Medicine (INCT-TM), Brazil
| | | | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus and Technion Institute of Technology, Haifa, Israel
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Rochester CL, Fairburn C, Crouch RH. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease. Clin Chest Med 2014; 35:369-89. [PMID: 24874132 DOI: 10.1016/j.ccm.2014.02.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary rehabilitation (PR) is an important therapeutic intervention that should no longer be considered suitable only for patients with chronic obstructive pulmonary disease (COPD). A strong rationale exists for providing PR to persons with a broad range of respiratory disorders other than COPD. Evidence shows that PR for these patients is feasible, safe and effective. A disease-relevant approach should be undertaken, based on individual patients' needs. Further research is needed to better understand the optimal program content, duration and outcomes measures, to enable diverse patients to achieve maximal benefits of PR.
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Affiliation(s)
- Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep, Yale University School of Medicine, 333 Cedar Street, Building LCI-105, New Haven, CT 06520, USA.
| | - Carl Fairburn
- Duke Cardiopulmonary Rehabilitation, Duke University School of Medicine, 1821 Hillandale Road, Suite 25B, Durham, NC 27705, USA
| | - Rebecca H Crouch
- Duke Cardiopulmonary Rehabilitation, Duke University School of Medicine, 1821 Hillandale Road, Suite 25B, Durham, NC 27705, USA
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Matura LA, McDonough A, Hanlon AL, Carroll DL, Riegel B. Sleep disturbance, symptoms, psychological distress, and health-related quality of life in pulmonary arterial hypertension. Eur J Cardiovasc Nurs 2014; 14:423-30. [DOI: 10.1177/1474515114537951] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 05/09/2014] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Diane L Carroll
- Munn Center for Nursing Research, Institute for Patient Care, USA
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Matura LA, McDonough A, Hanlon AL, Carroll DL. Development and initial psychometric properties of the Pulmonary Arterial Hypertension Symptom Scale (PAHSS). Appl Nurs Res 2014; 28:42-7. [PMID: 24880966 DOI: 10.1016/j.apnr.2014.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/23/2014] [Accepted: 04/05/2014] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study is to report the development and psychometric properties of the Pulmonary Arterial Hypertension Symptom Scale (PAHSS). BACKGROUND Patients with pulmonary arterial hypertension (PAH) experience multiple symptoms such as dyspnea, fatigue and chest pain, yet there is no comprehensive, validated symptom assessment tool to date. METHODS This study used a cross sectional design. Participants completed: socio-demographic and medical data form, the PAHSS, the Medical Outcomes Study Short Form-36 and the Profile of Mood States short form. RESULTS The PAHSS contains 17 symptoms measured on a 0 to 10 scale. Principal components analysis demonstrated a three factor solution for the PAHSS: pulmonary, diffuse, and cardiac. Coefficient alphas were good. Statistically significant Pearson coefficients were found between the PAHSS and the Medical Outcomes Study Short Form-36 and the Profile of Mood States short form. CONCLUSION Findings show that the PAHSS is a promising scale to assess symptom severity.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania, School of Nursing, Philadelphia, PA 19104-4217 USA.
| | | | - Alexandra L Hanlon
- University of Pennsylvania, School of Nursing, Philadelphia, PA 19104-4217 USA.
| | - Diane L Carroll
- Munn Center for Nursing Research, Institute for Patient Care, Boston, MA 02114 USA.
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Incremental burden of disease in patients diagnosed with pulmonary arterial hypertension receiving monotherapy and combination vasodilator therapy. Adv Ther 2014; 31:168-79. [PMID: 24449285 DOI: 10.1007/s12325-014-0094-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a rare, severely debilitating disease with high mortality. There are limited data available on treatment patterns and burden of disease from conditions of actual care. METHODS This analysis assesses the burden of disease for patients with PAH treated with monotherapy and combination therapies excluding and including intravenous (IV) prostacyclin analogues (PGI2). Data were drawn from the Adelphi PAH Disease Specific Programme, a cross sectional survey of consulting patients undertaken in the US, Germany, Italy and the UK in 2010. Outcomes included demographics, clinical characteristics, health-care resource utilization, and quality of life measured by the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). RESULTS Data were analyzed from 446 patients receiving ≥1 of 3 PAH-specific treatment classes. Physicians comprised mainly pulmonologists and cardiologists. The symptoms, functioning and quality of life scales of the CAMPHOR instrument were completed by 218, 229, and 214 patients, respectively. Although 46.2% of patients were classified as World Health Organization (WHO) functional class III or IV, only 24.4% of the population received combination therapy. Combination therapy including IV PGI2 was used in 4.7% of all patients. Patients on monotherapy had the lowest pulmonary vascular resistance values, the highest recorded 6-min walk distance and the lowest recorded levels of dyspnea. Patients on combination therapy including IV PGI2 scored worse on all three variables and had more hospitalizations than patients on less aggressive combination therapy. With increasing therapeutic regimens, the CAMPHOR scores were higher, indicating worse states of health. CONCLUSIONS Combination treatment and particularly the use of prostacyclins remain underused in an unselected population of PAH patients surveyed under conditions of actual care. The disease burden is substantial and increases with greater severity of disease and more aggressive treatments. This necessitates improvement in optimizing current therapy, as well as novel and innovative combination options.
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Yorke J, Armstrong I. The assessment of breathlessness in pulmonary arterial hypertension: Reliability and validity of the Dyspnoea-12. Eur J Cardiovasc Nurs 2013; 13:506-14. [DOI: 10.1177/1474515113514891] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Breathlessness is a cardinal symptom of pulmonary arterial hypertension (PAH); yet no breathlessness instrument has been previously tested for reliability and validity for this population. Using a cross-sectional design, we tested the psychometric properties of the Dyspnoea-12 (D-12), for the assessment of breathlessness in PAH. Pearson’s correlations with World Health Organization functional class (WHO FC), Minnesota Living with Heart failure – pulmonary hypertension modified version (MLHF-PH), Hospital Anxiety and Depression scale (HADS) and 6-minute walk distance test (6MWD) were conducted. Participants ( n = 176) were mostly female (70.5%), mean age 54.3±14 years; diagnosed with idiopathic PAH (48.9%), congenital heart disease (27.8%) and connective tissue disease (23.3%); and most were WHO FC II (32.4%) and III (52.3%). The D-12 showed excellent internal consistency for the total and two-component scores for physical and emotional (Cronbach’s α 0.95, 0.93 and 0.94, respectively). D-12 total score was significantly associated with MLHF-PH ( r = 0.70), HADS (anxiety r = 0.54 and depression r = 0.68), WHO FC ( r = 0.49), and 6MWD ( r = -0.26). In patients with PAH, the D-12 - a short patient reported measure of breathlessness severity that taps the physical and emotional components, is a reliable and valid instrument.
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Affiliation(s)
| | - Iain Armstrong
- Pulmonary Vascular Unit, Royal Hallamshire Hospital, Sheffield, UK
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40
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Affiliation(s)
- Silke Apers
- Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Child and Adolescent Development, KU Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Belgium
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- The Heart Centre, Copenhagen University Hospital, Denmark
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Cyber support: describing concerns of caregivers of people with pulmonary hypertension. Comput Inform Nurs 2013; 31:581-8. [PMID: 24113162 DOI: 10.1097/cin.0000000000000008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to gain an understanding of how caregivers of people with pulmonary hypertension are using an online discussion board. The chronicity and complex medical needs of people with pulmonary hypertension warrant a holistic nursing approach combining the patient and caregiver concerns to adequately address their needs. A qualitative descriptive approach was utilized. A convenience sample over an 18-month period of those caregivers who posted Internet messages to the Pulmonary Hypertension Discussion Board was included. Sociodemographics collected were age and gender of the person with pulmonary hypertension and the relationship of the caregiver to the person with pulmonary hypertension. Clinical variables collected were medications and oxygen use and years since diagnosis. Thematic analysis was used to identify themes. A total of 98 caregivers posted to the discussion board during the 18-month period; 46% of those posting were mothers of children with pulmonary hypertension. Four themes emerged: fear and frustration, questions and concerns, someone to listen to, and moving on with life. These themes characterize how caregivers of people with pulmonary hypertension were using the discussion board. Caregivers of people with pulmonary hypertension may need more information and support from their healthcare providers to adequately care for those with pulmonary hypertension.
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Twiss J, McKenna S, Ganderton L, Jenkins S, Ben-L'amri M, Gain K, Fowler R, Gabbay E. Psychometric performance of the CAMPHOR and SF-36 in pulmonary hypertension. BMC Pulm Med 2013; 13:45. [PMID: 23844640 PMCID: PMC3751055 DOI: 10.1186/1471-2466-13-45] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 07/03/2013] [Indexed: 12/23/2022] Open
Abstract
Background The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) and the Medical Outcomes Study Short Form 36 (SF-36) are widely used to assess patient-reported outcome in individuals with pulmonary hypertension (PH). The aim of the study was to compare the psychometric properties of the two measures. Methods Participants were recruited from specialist PH centres in Australia and New Zealand. Participants completed the CAMPHOR and SF-36 at two time points two weeks apart. The SF-36 is a generic health status questionnaire consisting of 36 items split into 8 sections. The CAMPHOR is a PH-specific measure consisting of 3 scales; symptoms, activity limitations and needs-based QoL. The questionnaires were assessed for distributional properties (floor and ceiling effects), internal consistency (Cronbach's alpha), test-retest reliability and construct validity (scores by World Health Organisation functional classification). Results The sample comprised 65 participants (mean (SD) age = 57.2 (14.5) years; n(%) male = 14 (21.5%)). Most of the patients were in WHO class 2 (27.7%) and 3 (61.5%). High ceiling effects were observed for the SF-36 bodily pain, social functioning and role emotional domains. Test-retest reliability was poor for six of the eight SF-36 domains, indicating high levels of random measurement error. Three of the SF-36 domains did not distinguish between WHO classes. In contrast, all CAMPHOR scales exhibited good distributional properties, test retest reliability and distinguished between WHO functional classes. Conclusions The CAMPHOR exhibited superior psychometric properties, compared with the SF-36, in the assessment of PH patient-reported outcome.
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Affiliation(s)
- James Twiss
- Galen Research Ltd, Manchester, United Kingdom.
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Weinstein AA, Chin LMK, Keyser RE, Kennedy M, Nathan SD, Woolstenhulme JG, Connors G, Chan L. Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med 2013; 107:778-84. [PMID: 23478192 DOI: 10.1016/j.rmed.2013.02.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 01/26/2013] [Accepted: 02/11/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the effectiveness of an exercise intervention for decreasing fatigue severity and increasing physical activity in individuals with pulmonary arterial hypertension (PAH). A small, phase 2 randomized clinical trial of the effect of aerobic exercise training on fatigue severity and physical activity in patients with idiopathic or PAH associated with other conditions was conducted. METHODS Twenty-four patients with PAH (24 female; age: 54.4 ± 10.4 years; BMI: 30.8 ± 7.2 kg/m(2)) participated in the study. A convenience sample was recruited in which 9% (28 of 303) of screened patients were enrolled. The project was carried out in a clinical pulmonary rehabilitation clinic during existing pulmonary rehabilitation program sessions. Patients with PH were randomized into a 10-week program that consisted of patient education only or patient education plus an aerobic exercise-training regimen. Both groups received 20 lectures, two per week over the 10-weeks, on topics related to PAH and its management. The aerobic exercise training consisted of 24-30 sessions of treadmill walking for 30-45 min per session at an intensity of 70-80% of heart rate reserve, three days per week over the 10 weeks. RESULTS After 10-weeks of intervention, patients receiving aerobic exercise training plus education reported routinely engaging in higher levels of physical activity (p < 0.05) and a decrease in fatigue severity (p = 0.03). Patients in the education only group did not report changes in fatigue severity or participation in physical activity. CONCLUSIONS The 10-week aerobic exercise training intervention resulted in increased physical activity and decreased fatigue in individuals with PAH. ClinicalTrials.gov Identifier: NCT00678821.
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Affiliation(s)
- Ali A Weinstein
- Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, 4400 University Drive, MSN 2G7, Fairfax, VA 22030, USA.
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