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Wieteska-Miłek M, Witowicz A, Szmit S, Florczyk M, Peller M, Dzienisiewicz M, Kurzyna M. Anxiety and Depression in Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension after the Removal of COVID-19 Pandemic Restrictions. J Clin Med 2024; 13:3532. [PMID: 38930062 PMCID: PMC11204547 DOI: 10.3390/jcm13123532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: There was increased risk of mental disturbances during the COVID-19 pandemic. Patients with chronic diseases, including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), were particularly vulnerable. Our previous study showed high levels of fear of COVID-19 (FCV-19S), anxiety (HADS-A), and depression (HADS-D) in the second year of the pandemic among PAH/CTEPH patients. The aim of the present study was to assess changes in the levels of FCV-19S, HADS-A, and HADS-D after removing restrictions related to the COVID-19 pandemic. Methods: In this prospective, single-center study, 141 patients (62% females, 64% PAH) with a median age of 60 (range 42-72) years were included. Patients completed appropriate surveys in the second year of the pandemic, and then, after the restrictions were lifted in Poland (after 28 March 2022). Results: FVC-19S decreased significantly from 18 (12-23) to 14 (9-21), p < 0.001. The levels of anxiety (HADS-A ≥ 8 points) and depression (HADS-D ≥ 8 points) were abnormal in 26% and 16% of patients, respectively; these did not change at follow-up (p = 0.34 for HADS-A and p = 0.39 for HADS-D). Conclusions: Among PAH/CTEPH patients, fear of COVID-19 decreased significantly after the COVID-19 pandemic restrictions were removed, but anxiety and depression remained high, indicating that the COVID-19 pandemic was not a major factor in causing these disorders.
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Affiliation(s)
- Maria Wieteska-Miłek
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, ul. Borowa 14/18, 05-400 Otwock, Poland; (A.W.); (M.F.); (M.K.)
| | - Anna Witowicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, ul. Borowa 14/18, 05-400 Otwock, Poland; (A.W.); (M.F.); (M.K.)
- Department of Cardiology and Internal Diseases, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Sebastian Szmit
- Department of Cardio-Oncology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, ul. Borowa 14/18, 05-400 Otwock, Poland; (A.W.); (M.F.); (M.K.)
| | - Michał Peller
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland;
| | | | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, ul. Borowa 14/18, 05-400 Otwock, Poland; (A.W.); (M.F.); (M.K.)
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Park H, Lee CH. The Impact of Pulmonary Disorders on Neurological Health (Lung-Brain Axis). Immune Netw 2024; 24:e20. [PMID: 38974208 PMCID: PMC11224666 DOI: 10.4110/in.2024.24.e20] [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] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 07/09/2024] Open
Abstract
The brain and lungs, vital organs in the body, play essential roles in maintaining overall well-being and survival. These organs interact through complex and sophisticated bi-directional pathways known as the 'lung-brain axis', facilitated by their close proximity and neural connections. Numerous studies have underscored the mediation of the lung-brain axis by inflammatory responses and hypoxia-induced damage, which are pivotal to the progression of both pulmonary and neurological diseases. This review aims to delve into how pulmonary diseases, including acute/chronic airway diseases and pulmonary conditions, can instigate neurological disorders such as stroke, Alzheimer's disease, and Parkinson's disease. Additionally, we highlight the emerging research on the lung microbiome which, drawing parallels between the gut and lungs in terms of microbiome contents, may play a significant role in modulating brain health. Ultimately, this review paves the way for exciting avenues of future research and therapeutics in addressing respiratory and neurological diseases.
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Affiliation(s)
- Hongryeol Park
- Department of Tissue Morphogenesis, Max-Planck Institute for Molecular Biomedicine, Muenster 48149, Germany
| | - Chan Hee Lee
- Department of Biomedical Science, Hallym University, Chuncheon 24252, Korea
- Program of Material Science for Medicine and Pharmaceutics, Hallym University, Chuncheon 24252, Korea
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Heller S, See C, Singh I, Fredericks CA. Cognitive impairment in pulmonary arterial hypertension. Ann Clin Transl Neurol 2023; 10:1899-1903. [PMID: 37550957 PMCID: PMC10578884 DOI: 10.1002/acn3.51867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by progressive pulmonary vascular remodeling with resultant abnormal increase in pulmonary artery pressure and right heart dysfunction. There is evidence that PAH includes cognitive impairment. However, the cognitive impairment syndrome has not been well described, and both the underlying mechanism and the relationship between cardiopulmonary and cognitive dysfunction in PAH are unknown. We performed cognitive evaluations and same day sub-maximum cardiopulmonary exercise testing on adult subjects with PAH. A frontal-subcortical syndrome suggestive of vascular cognitive impairment was found in 26% of subjects and was associated with noninvasive markers of pulmonary vascular remodeling.
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Affiliation(s)
- Sloane Heller
- Department of NeurologyYale‐New Haven HospitalNew HavenConnecticutUSA
- Yale School of MedicineNew HavenConnecticutUSA
- Department of NeurologyColumbia University Irving Medical CenterNew YorkUSA
| | - Claudia See
- Yale School of MedicineNew HavenConnecticutUSA
| | - Inderjit Singh
- Yale School of MedicineNew HavenConnecticutUSA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal MedicineYale‐New Haven HospitalNew HavenConnecticutUSA
| | - Carolyn A. Fredericks
- Department of NeurologyYale‐New Haven HospitalNew HavenConnecticutUSA
- Yale School of MedicineNew HavenConnecticutUSA
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Wiafe YA, Amponsah GM, Asafu Adjaye Frimpong G, Owusu IK. Progressive Memory Decline in a Patient With Atrial Septal Defect: Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231176713. [PMID: 37255701 PMCID: PMC10225960 DOI: 10.1177/11795476231176713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/01/2023] [Indexed: 06/01/2023]
Abstract
Atrial septal defect (ASD) is a common congenital anomaly that increases the risk of heart failure as well as strokes which can lead to cognitive impairment. The risk of stroke is higher when pulmonary hypertension develops and there is reversal of shunt. Stroke in ASD may be due to paradoxical emboli from the right heart or a left ventricular thrombus which develops as a result of atrial fibrillation, a common arrhythmia in ASD. We present a case of a 32-year-old Ghanaian man with history of ASD who presented with progressive memory loss with magnetic resonance imaging scan of the brain showing multiple infarcts, microvascular disease, and cerebral atrophy.
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Affiliation(s)
- Yaw Amo Wiafe
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gordon Manu Amponsah
- Department of Physiology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Asafu Adjaye Frimpong
- Department of Radiology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Kofi Owusu
- Department of Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Gorini A, De Maria B, Krasinska P, Bussotti M, Perego F, Dalla Vecchia LA. Physiological and Psychological Response to Acute Mental Stress in Female Patients Affected by Chronic Pulmonary Arterial Hypertension: An Explorative Controlled Pilot Trial. Pharmaceuticals (Basel) 2023; 16:ph16040493. [PMID: 37111250 PMCID: PMC10146967 DOI: 10.3390/ph16040493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Little is known about physiological and psychological responses to mental stress in stable patients affected by pulmonary arterial hypertension (PAH). The current explorative controlled pilot study was conducted to investigate whether heart rate (HR) and perceived stress would differ during standardized mental stress testing in PAH patients compared to healthy subjects. Correlation analysis between HR, perceived stress, participants’ psychological status and performance on the mental stress task was also performed. The study included 13 female PAH patients (average age: 44.38 ± 10.88 years; average education: 14 ± 3.07 years; mean duration of illness: 9.15 ± 5.37 years) and 13 female controls similar in age (mean age: 47.85 ± 6.36 years) and education (15.92 ± 1.55 years). Participants performed a standardized 9 min mental stress test (computer based, adaptive math task). HR and perceived stress during the task were compared to resting baseline and correlated with psychological state and task performance. Both HR and perceived stress significantly increased during mental stress in a similar way in both groups. A significant correlation was found between HR and perceived stress. Our data show that moderate mental stress has a comparable effect on HR and perceived stress increase in stable PAH patients and control subjects.
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Affiliation(s)
- Alessandra Gorini
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy
| | - Beatrice De Maria
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
- Correspondence:
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Li JL, Xiao F, Liu HT, Li HT, Zhao QH, Sun CY, Zhu Y, Yan L, Wang WY, Luo H, Gong SG, Jiang R, Liu JM, Zhang R, Wang L. Long-term outcomes in health-related quality of life influence chronic disease management in patients with pulmonary hypertension. Front Cardiovasc Med 2022; 9:1008253. [DOI: 10.3389/fcvm.2022.1008253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/23/2022] [Indexed: 11/12/2022] Open
Abstract
BackgroundSignificantly improved survival in patients with pulmonary hypertension (PH) has raised interest in maintaining a good quality of long-term survivorship. In this study, health-related quality of life (HRQOL) measurement was used to assess the long-term changes of physical and mental outcomes.MethodsA total of 559 consecutive inpatients with PH completed generic HRQOL (Short Form-36) who were diagnosed with PH by right heart catheterization. Assessments were carried out at short-term (1 year), midterm (3 years), and long-term (5 years) follow-ups.ResultsPatients with PH suffered more severe impairments in both physical and emotional domains than the U.S. population normative values. Patients with PH due to chronic lung disease had the worst physical component summary (PCS) score, but there was no difference in mental component summary (MCS) score among different PH types. A reduced PCS score was correlated with WHO FC severity and pulmonary vascular resistance (PVR). The Z score showed that the changing trend of mental conditions continuously declined from baseline to midterm and long-term follow-ups, but the PCS score seemed to be stable or improved. Cox regression analysis indicated increased baseline PVR and WHO FC III and IV, and decreased physical subscale of role physical, mental subscale of social functioning, and the MCS score have increased risk of mortality in the long-term follow-up.ConclusionPatients with PH have poor HRQOL. The long-term change of physical status seemed to be stable, but the mental state was continuously worse. These suggested identifying and intervening mental health progresses is a noteworthy issue in PH chronic management.
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Maroofi A, Moro T, Agrimi J, Safari F. Cognitive decline in heart failure: Biomolecular mechanisms and benefits of exercise. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166511. [PMID: 35932891 DOI: 10.1016/j.bbadis.2022.166511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022]
Abstract
By definition, heart failure (HF) is a human pathological condition affecting the structure and function of all organs in the body, and the brain is not an exception to that. Failure of the heart to pump enough blood centrally and peripherally is at the foundation of HF patients' inability to attend even the most ordinary daily activities and progressive deterioration of their cognitive capacity. What is more, between heart and brain exists a bidirectional relationship that goes well beyond hemodynamics and concerns bioelectric and endocrine signaling. This increasingly consolidated evidence makes the scenario even more complex. Studies have mainly chased how HF impairs cognition without focusing much on preventive measures, notably cardio-cerebral health proxies. Here, we aim to provide a brief account of known and hypothetical factors that may explain how exercise can help obviate cognitive dysfunction associated with HF in its different forms. As we shall see, there is a stringent need for a deeper grasp of such mechanisms. Indeed, gaining this new knowledge will automatically shed new light on the inner workings of HF itself, thus resulting in more effective prevention and treatment of this escalating syndrome.
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Affiliation(s)
- Abdulbaset Maroofi
- Department of Exercise Physiology, Faculty of Physical Education & Sport Sciences, University of Guilan, Rasht, Iran
| | - Tatiana Moro
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy
| | - Jacopo Agrimi
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy.
| | - Fatemeh Safari
- Department of Physiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Mai AS, Lim OZH, Ho YJ, Kong G, Lim GEH, Ng CH, Ho C, Ho R, Lim Y, Kuntjoro I, Tay E, Yip J, Chew NWS, Low TT. Prevalence, Risk Factors and Intervention for Depression and Anxiety in Pulmonary Hypertension: A Systematic Review and Meta-analysis. Front Med (Lausanne) 2022; 9:765461. [PMID: 35252232 PMCID: PMC8892950 DOI: 10.3389/fmed.2022.765461] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCurrent guidelines recommend psychological support for patients with pulmonary hypertension suffering from psychological adversity. However, little is known about the prevalence and risk factors of depression and anxiety in patients with pulmonary hypertension (PH).MethodsMedline and Embase were searched from inception to 6 May 2021. Meta-analysis of proportions using the generalized linear mixed model was conducted to analyze the pooled prevalence rates of depression and anxiety in PH patients. Risk factors for depression and anxiety in PH patients were evaluated using meta regression.ResultsA total of 24 studies involving 2,161 PH patients were included. The pooled prevalence of depression in PH was 28.0% (95% CI: 20.5–36.8) and pooled prevalence of anxiety was 37.1% (95% CI: 28.7–46.4). There was a significantly higher prevalence of anxiety (p = 0.0013) amongst PH patients in Asia (61.1%) compared to Europe (40.3%) and North America (22.9%). In terms of risk factors, congenital heart disease-related pulmonary arterial hypertension (PAH-CHD) were significantly associated with both depression (OR: 1.68, 95% CI: 1.27–2.23, p = 0.024) and anxiety (OR: 1.63, 95% CI: 1.45–1.83, p = 0.002). On the other hand, chronic thromboembolic pulmonary hypertension (CTEPH, OR: 1.18, 95% CI: 1.10–1.26, p = 0.004) was significantly associated with depression, whereas worse pulmonary vascular resistance (β: 0.30, 95% CI: 0.09–0.52, p = 0.005) and cardiac index (β: −0.96, 95% CI: −1.58 to −0.35, p = 0.002) were significantly correlated with anxiety.ConclusionThe prevalence of anxiety and depression in PH patients is alarmingly high, with an increased prevalence of anxiety in Asia compared to Europe or North America. Psychological support is warranted for patients with PH, particularly those with underlying congenital heart disease, CTEPH, and severe disease.Systematic Review RegistrationCRD42021251733.
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Affiliation(s)
- Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Oliver Zi Hern Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeung Jek Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Grace En Hui Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cheng Han Ng ; orcid.org/0000-0002-8297-1569
| | - Cyrus Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yinghao Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ivandito Kuntjoro
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Edgar Tay
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
| | - James Yip
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Nicholas W. S. Chew
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
- *Correspondence: Nicholas W. S. Chew
| | - Ting-Ting Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
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Batta A, Sharma YP, Hatwal J, Panda P, Kumar BGV, Bhogal S. Predictors of dementia amongst newly diagnosed non-valvular atrial fibrillation patients. Indian Heart J 2022; 74:505-509. [PMID: 36462552 PMCID: PMC9773279 DOI: 10.1016/j.ihj.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022] Open
Abstract
Atrial fibrillation (AF) confers a 2-to-3-fold increased risk of developing cognitive dysfunction and dementia, independent of age and past stroke. The purpose of study was to identify risk factors for developing dementia amongst AF patients in India. This was a single-centre, prospective, observational study wherein recently diagnosed, treatment naïve, persistent non-valvular AF patients were enrolled. All patients were screened for dementia using the Mini-Mental state exam. Amongst a total of 108 patients enrolled, 40 (37%) had dementia. The most common cognitive deficits were in attention and calculation followed by memory deficits. Factors independently contributing to dementia were advanced age, female sex, presence of diabetes, elevated pulmonary artery pressures and a lower serum albumin.
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Affiliation(s)
- Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India,Dayanand Medical College and Hospital, Ludhiana, Punjab, 141001, India
| | - Yash Paul Sharma
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India,Corresponding author.
| | - Juniali Hatwal
- Department of Internal Medicine, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Prashant Panda
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Budumuri Gautam Vinay Kumar
- Department of Internal Medicine, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Sukhdeep Bhogal
- Department of Interventional Cardiology, MedStar Washington Hospital Centre, 110 Irving St. Suite 4B-1, Washington, NWDC, 20010, USA
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Fear of COVID-19, Anxiety and Depression in Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension during the Pandemic. J Clin Med 2021; 10:jcm10184195. [PMID: 34575303 PMCID: PMC8464969 DOI: 10.3390/jcm10184195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 01/29/2023] Open
Abstract
The COVID-19 pandemic has affected the physical and mental health of people around the world. This may be particularly true for patients with life-threatening diseases. We analyzed the level of fear of COVID-19 (FCV-19S), the prevalence of anxiety (HADS-A) and depression (HADS-D) in pulmonary arterial and chronic thromboembolic pulmonary hypertension (PAH and CTEPH) patients during the COVID-19 pandemic. In this multicenter prospective study, 223 patients (63% females, 66% PAH) with age range 18-90 years were included. The fear of COVID-19 was high, at a mean level of 18.9 ± 7.4 points. Anxiety (HADS-A ≥ 8 points) was diagnosed in 32% of all patients, depression (HADS-D ≥ 8 points) in 21%, and anxiety or depression in 38%. FCV-19S was higher in woman and in elderly people (p = 0.02; p = 0.02, respectively). In the multivariate analysis, FCV-19S higher than the median increased the odds ratio of anxiety, but not of depression (R 6.4 (95%CI 2.0-20.0), p = 0.002; OR 1.9 (0.9-3.9), p = 0.06, respectively). History of COVID-19 increased risk of both HADS-A and HADS-D. Patients with PAH and CTEPH, especially woman over 65 years and those who had been infected with COVID-19, may need additional psychological support due to fear of COVID-19, anxiety or depression.
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Abstract
Rationale: The evidence base for rehabilitation in pulmonary hypertension is expanding, but adoption in clinical practice is limited.Objectives: The World Health Organization International Classification for Functioning, Disability and Health identifies three health domains: Body Functions/Structures, Activity and Participation in society. To ensure that the wider impact of rehabilitation in pulmonary hypertension is accurately assessed, it is important that study endpoints reflect all three domains.Methods: A systematic review of the literature was conducted to identify studies of rehabilitation in patients with pulmonary hypertension from 2006 to 2019.Results: Searches across five databases yielded 2,564 articles, of which 34 met eligibility criteria; 50 different outcome measures (mean = 5, minimum = 1, maximum = 9) were identified. When mapped onto the World Health Organization International Classification for Functioning, Disability and Health, 48% of instances of outcome usage were measures of Body Functions/Structure, 33% were measures of Activity, and 18% were measures of Participation. Measures of Participation were not included in seven studies (21%).Conclusions: Studies of rehabilitation in pulmonary hypertension have focused primarily on measures of Body Functions/Structure; the impact in other health domains is not well characterized. Greater inclusion of outcome measures reflecting Activity and Participation in society is needed to allow assessment of the wider impact of rehabilitation in patients with pulmonary hypertension.
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Chao HY, Hsu CH, Wang ST, Yu CY, Chen HM. Mediating effect of social support on the relationship between illness concealment and depression symptoms in patients with pulmonary arterial hypertension. Heart Lung 2021; 50:706-713. [PMID: 34107395 DOI: 10.1016/j.hrtlng.2021.03.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Depression symptoms are common in patients with pulmonary arterial hypertension (PAH). Social support may mediate the effect of illness concealment on depression symptoms. OBJECTIVE To examine the relationships between illness concealment, dimensions of social support, and depression symptoms and the mediating effect of the dimensions of social support on depression symptoms in PAH patients. METHODS A cross-sectional design and convenience sampling were applied. Data were collected with three questionnaires and analyzed with hierarchical regression and the PROCESS macro. RESULTS Ninety-seven participants were enrolled (mean age 50 ± 14 years). In total, 8% had a Patient Health Questionnaire (PHQ)-9 score ≥15. Hierarchical regression analysis showed that education level (β = 0.28, p < 0.05), illness concealment (β = 0.21, p < 0.05), and emotional support (β = 0.29, p < 0.01) were determinants of depression symptoms. Emotional support mediated the relationship between illness concealment and depression symptoms. CONCLUSIONS Emotional support can help patients reduce the effect of illness concealment on depression symptoms.
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Affiliation(s)
- Hsin-Yu Chao
- Department of Nursing, College of Medical, National Cheng Kung University, Tainan City, Taiwan.
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
| | - Shan-Tair Wang
- Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Ching-Yun Yu
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Hsing-Mei Chen
- Department of Nursing, College of Medical, National Cheng Kung University, Tainan City, Taiwan.
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Giri PC, Stevens GJ, Merrill-Henry J, Oyoyo U, Balasubramanian VP. Participation in pulmonary hypertension support group improves patient-reported health quality outcomes: a patient and caregiver survey. Pulm Circ 2021; 11:20458940211013258. [PMID: 34035896 PMCID: PMC8132099 DOI: 10.1177/20458940211013258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Support group participation has been shown to be effective in many chronic medical conditions. The evidence for integrating support group into pulmonary hypertension care and its effect on quality of life, physical and psychological well-being is limited. We sought to assess the effect of support group participation on quality of life in patients diagnosed with pulmonary hypertension and their caregivers. The emPHasis-10 questionnaire (a tool validated for quality of life assessment in pulmonary hypertension) was used to evaluate the effect of support group participation. Additional demographic and health-related quality measures were examined. Results showed that 165 subjects were enrolled in the study; 122 (74.4%) were patients with pulmonary hypertension, 41 (25.0%) were their caregivers, and 2 (0.02%) did not respond. The cohort was predominantly female (n = 128, 78%), Caucasian (n = 10, 61%), and the principal self-reported classification of pulmonary hypertension was World Health Organization Group 1 (n = 85, 51.8%) and the self-reported New York Heart Association Functional Class was II and III (n = 43, 57.3%). Most participants (n = 118, 71.5%) attended support groups and of them, a majority (n = 107, 90.6%) stated it helped them. There was no difference in quality of life as assessed by emPHasis-10 scores with support group participation (median score 30 vs 32, p = 0.387). There was self-reported improvement in understanding condition better including procedures such as right heart catheterization, medication compliance, and confidence in self-care (p < 0.05). Using multivariate logistic regression, baseline variables that were independently associated with emPHasis-10 scores for the entire cohort included knowledge of New York Heart Association Functional Class (odds ratio: 1.919, 95% CI: 1.004–3.67, p = 0.04) and greater distance traveled to visit pulmonary hypertension physician (odds ratio: 1.391, 95% CI: 0.998--1.94, p = 0.05). In conclusion, support group participation does not improve quality of life as assessed by emPHasis-10 scores but improves other meaningful health-related quality outcomes.
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Affiliation(s)
- Paresh C Giri
- Pulmonary and Critical Care Department, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Gizelle J Stevens
- Pulmonary and Critical Care Department, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Udochukwu Oyoyo
- Department of Dental Education Services, Loma Linda University School of Dentistry, Loma Linda, CA, USA
| | - Vijay P Balasubramanian
- Pulmonary and Critical Care Department, University of California San Francisco-Fresno, Fresno, CA, USA
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14
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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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15
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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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16
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Roy B, Vacas S, Ehlert L, McCloy K, Saggar R, Kumar R. Brain Structural Changes in Patients with Pulmonary Arterial Hypertension. J Neuroimaging 2021; 31:524-531. [PMID: 33565204 DOI: 10.1111/jon.12840] [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: 10/12/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with pulmonary arterial hypertension (PAH) frequently present with anxiety, depression, autonomic, and cognitive deterioration, which may indicate brain changes in regions that control these functions. However, the precise regional brain-injury in sites that regulate cognitive, autonomic, and mood functions in PAH remains unclear. We examined the shifts in regional gray matter (GM) volume, using high-resolution T1-weighted images, and brain tissue alterations, using T2-relaxometry procedures, in PAH compared to healthy subjects. METHODS We collected two high-resolution T1-weighted series, and proton-density and T2-weighted images using a 3.0-Tesla magnetic resonance imaging scanner from 9 PAH and 19 healthy subjects. Both high-resolution T1-weighted images were realigned and averaged, partitioned to GM tissue type, normalized to a common space, and smoothed. Using proton-density and T2-weighted images, T2-relaxation maps were calculated, normalized to a common space, and smoothed. Whole-brain GM volume and T2-relaxation maps were compared between PAH and controls using analysis of covariance (covariates, age, sex, and total-brain-volume; false discover rate corrections). RESULTS Significantly decreased GM volumes, indicating tissue injury, emerged in multiple brain regions, including the hippocampus, insula, cerebellum, parahippocampus, temporal, frontal, and occipital gyri, cingulate, amygdala, and thalamus. Higher T2-relaxation values, suggesting tissue damage, appeared in the cerebellum, hippocampus, parahippocampus, frontal, lingual, and temporal and occipital gyri, and cingulate areas in PAH compared to healthy subjects. CONCLUSIONS PAH patients showed significant GM injury and brain tissue changes in sites that regulate cognition, autonomic, and mood functions. These findings indicate a brain structural basis for functional deficits in PAH patients.
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Affiliation(s)
- Bhaswati Roy
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA
| | - Susana Vacas
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA
| | - Luke Ehlert
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA
| | - Kathy McCloy
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Rajan Saggar
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA.,Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA.,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA.,Department of Brain Research Institute, University of California Los Angeles, Los Angeles, CA
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17
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Kearney K, Kotlyar E, Lau EMT. Pulmonary Vascular Disease as a Systemic and Multisystem Disease. Clin Chest Med 2021; 42:167-177. [PMID: 33541610 DOI: 10.1016/j.ccm.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a disease of progressive pulmonary vascular remodeling due to abnormal proliferation of pulmonary vascular endothelial and smooth muscle cells and endothelial dysfunction. PAH is a multisystem disease with systemic manifestations and complications. This article covers the chronic heart failure syndrome, including the systemic consequences of right ventricle-pulmonary artery uncoupling and neurohormonal activation, skeletal and respiratory muscle effects, systemic endothelial dysfunction and coronary artery disease, systemic inflammation and infection, endocrine and metabolic changes, the liver and gut axis, sleep, neurologic complications, and skin and iron metabolic changes.
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Affiliation(s)
- Katherine Kearney
- Cardiology Department, St Vincent's Hospital, 394 Victoria Street, Darlinghurst, New South Wales 2010, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Eugene Kotlyar
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia; Heart Transplant Unit, St Vincent's Hospital, 394 Victoria Street, Darlinghurst, New South Wales 2010, Australia
| | - Edmund M T Lau
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia.
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18
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Yoris A, Legaz A, Abrevaya S, Alarco S, López Peláez J, Sánchez R, García AM, Ibáñez A, Sedeño L. Multicentric evidence of emotional impairments in hypertensive heart disease. Sci Rep 2020; 10:14131. [PMID: 32839479 PMCID: PMC7445248 DOI: 10.1038/s41598-020-70451-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
The mechanisms underlying emotional alterations constitute a key research target in neuroscience. Emerging evidence indicates that these disruptions can be related to abnormal interoception (i.e., the sensing of visceral feelings), as observed in patients with cardiodynamic deficits. To directly assess these links, we performed the first multicenter study on emotion recognition and interoception in patients with hypertensive heart disease (HHD). Participants from two countries completed a facial emotion recognition test, and a subsample additionally underwent an interoception protocol based on a validated heartbeat detection task. HHD patients from both countries presented deficits in the recognition of overall and negative emotions. Moreover, interoceptive performance was impaired in the HHD group. In addition, a significant association between interoceptive performance and emotion recognition was observed in the control group, but this relation was abolished in the HHD group. All results survived after covariance with cognitive status measures, suggesting they were not biased by general cognitive deficits in the patients. Taken together, these findings suggest that emotional recognition alterations could represent a sui generis deficit in HHD, and that it may be partially explained by the disruption of mechanisms subserving the integration of neuro-visceral signals.
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Affiliation(s)
- Adrián Yoris
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina
| | - Agustina Legaz
- National Scientific and Technical Research Council (CONICET), Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina
- Universidad de San Andrés, Buenos Aires, Argentina
| | - Sofía Abrevaya
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina
| | - Sofía Alarco
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | | | - Ramiro Sánchez
- Metabolic and Arterial Hypertension Unit, Favaloro Foundation Hospital, Buenos Aires, Argentina
| | - Adolfo M García
- National Scientific and Technical Research Council (CONICET), Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina
- Universidad de San Andrés, Buenos Aires, Argentina
- Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
- Global Brain Health Institute, University of California, San Francisco, USA
| | - Agustín Ibáñez
- National Scientific and Technical Research Council (CONICET), Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina
- Universidad de San Andrés, Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, USA
- Universidad Autónoma del Caribe, Barranquilla, Colombia
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Lucas Sedeño
- National Scientific and Technical Research Council (CONICET), Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.
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19
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Zhou X, Shi H, Yang Y, Zhang Z, Zhai Z, Wang C. Anxiety and depression in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Results from a Chinese survey. Exp Ther Med 2020; 19:3124-3132. [PMID: 32256800 DOI: 10.3892/etm.2020.8566] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
Limited studies have focused on mental symptoms (anxiety and depression) and their impact on quality of life (QoL) in patients with pulmonary hypertension (PH). The objective of the present study was to assess the prevalence of anxiety and depression and their association with QoL in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) in a Chinese population. Patients diagnosed with PH by right heart catheterization between March 2015 and February 2016 were recruited. QoL [short form 36 Health Survey Questionnaire (SF-36)] and depression (Patient Health Questionnaire depression scale-9) and anxiety (Generalized Anxiety Disorder-7) were assessed at baseline. Patients were followed up every 3 months. A total of 36 patients with PAH and 62 patients with CTEPH were enrolled. According to the results of the clinical examination and the questionnaires for depression and anxiety, patients were divided into two groups: Group 1, with depression and/or anxiety (n=65, 66.3%) and group 2, without depression or anxiety (n=33, 33.7%). At baseline, the two groups did not differ in their hemodynamics. Patients with depression and/or anxiety (group 1) had a significantly lower score in all subscales of SF-36 (P<0.05). The impairment of QoL significantly correlated with the severity of depression (P<0.001) and anxiety (P<0.05). During the follow-up period, end-point events (death or admission due to deterioration) occurred in 17 patients (17.3%); 8 patients (8.1%) were lost to follow-up. The end-point event-free survival rate in group 2 was significantly higher than that in group 1. Multivariate logistic regression analysis suggested that the financial situation and right ventricular enlargement were influencing factors of depression and/or anxiety. In conclusion, in patients with PH from a Chinese population, anxiety and depression were frequently encountered and significantly correlated with QoL. The significant relevant factors influencing anxiety/depression were the financial situation and right ventricular enlargement and patients with depression had a worse prognosis than those without.
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Affiliation(s)
- Xia Zhou
- Department of Respiratory Medicine, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing 100043, P.R. China
| | - Hui Shi
- Department of Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Yuanhua Yang
- Department of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Zuoqing Zhang
- Department of Respiratory Medicine, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing 100043, P.R. China
| | - Zhenguo Zhai
- Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Peking University Health Science Center, Beijing 100029, P.R. China.,Department of Respiratory Medicine, Capital Medical University, Beijing 100069, P.R. China
| | - Chen Wang
- Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Peking University Health Science Center, Beijing 100029, P.R. China.,Department of Respiratory Medicine, Capital Medical University, Beijing 100069, P.R. China
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20
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Rosenkranz S, Howard LS, Gomberg-Maitland M, Hoeper MM. Systemic Consequences of Pulmonary Hypertension and Right-Sided Heart Failure. Circulation 2020; 141:678-693. [PMID: 32091921 DOI: 10.1161/circulationaha.116.022362] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary hypertension (PH) is a feature of a variety of diseases and continues to harbor high morbidity and mortality. The main consequence of PH is right-sided heart failure which causes a complex clinical syndrome affecting multiple organ systems including left heart, brain, kidneys, liver, gastrointestinal tract, skeletal muscle, as well as the endocrine, immune, and autonomic systems. Interorgan crosstalk and interdependent mechanisms include hemodynamic consequences such as reduced organ perfusion and congestion as well as maladaptive neurohormonal activation, oxidative stress, hormonal imbalance, and abnormal immune cell signaling. These mechanisms, which may occur in acute, chronic, or acute-on-chronic settings, are common and precipitate adverse functional and structural changes in multiple organs which contribute to increased morbidity and mortality. While the systemic character of PH and right-sided heart failure is often neglected or underestimated, such consequences place additional burden on patients and may represent treatable traits in addition to targeted therapy of PH and underlying causes. Here, we highlight the current state-of-the-art understanding of the systemic consequences of PH and right-sided heart failure on multiple organ systems, focusing on self-perpetuating pathophysiological mechanisms, aspects of increased susceptibility of organ damage, and their reciprocal impact on the course of the disease.
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Affiliation(s)
- Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, Germany (S.R.).,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Germany (S.R.)
| | - Luke S Howard
- National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, United Kingdom (L.S.H.)
| | | | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Germany (M.M.H.).,German Center for Lung Research (DZL), Hannover, Germany (M.M.H.)
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21
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Oliveira AC, Richards EM, Raizada MK. Pulmonary hypertension: Pathophysiology beyond the lung. Pharmacol Res 2020; 151:104518. [PMID: 31730803 PMCID: PMC6981289 DOI: 10.1016/j.phrs.2019.104518] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
Pulmonary hypertension (PH) is classically considered a disease of pulmonary vasculature which has been the predominant target for drug development and PH therapy. Despite significant advancement in recent years in identification of new drug targets and innovative treatment strategies, the prognosis of PH remains poor, with median survival of 5 years. Recent studies have demonstrated involvement of neuroinflammation, altered autonomic and gastrointestinal functions and increased trafficking of bone marrow-derived cells in cardiopulmonary pathophysiology. This has led to the proposal that PH could be considered a systemic disease involving complex interactions among many organs. Our objectives in this review is to summarize evidence for the involvement of the brain, bone marrow and gut in PH pathophysiology. Then, to synthesize all evidence supporting a brain-gut-lung interaction hypothesis for consideration in PH pathophysiology and finally to summarize unanswered questions and future directions to move this novel concept forward. This forward-thinking view, if proven by further experiments, would provide new opportunities and novel targets for the control and treatment of PH.
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Affiliation(s)
- Aline C Oliveira
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Elaine M Richards
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mohan K Raizada
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
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22
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Doğan V, Çil C, Çelik O, Özlek B, Özlek E, Gökçek A. Behavioral and Psychological Symptoms in Patients With Pulmonary Hypertension. PSYCHOSOMATICS 2019; 60:224-225. [PMID: 30509555 DOI: 10.1016/j.psym.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Volkan Doğan
- Department of Cardiology, Muğla University, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Muğla University, Muğla, Turkey.
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla University, Muğla, Turkey
| | - Bülent Özlek
- Department of Cardiology, Muğla University, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Muğla University, Muğla, Turkey
| | - Aysel Gökçek
- Department of Cardiology, Muğla University, Muğla, Turkey
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23
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Bussotti M, Sommaruga M. Anxiety and depression in patients with pulmonary hypertension: impact and management challenges. Vasc Health Risk Manag 2018; 14:349-360. [PMID: 30510427 PMCID: PMC6231438 DOI: 10.2147/vhrm.s147173] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Anxiety and depression are frequent disorders in patients with pulmonary arterial hypertension (PAH), but despite this only less than one-fourth of them is treated. Our aim was to review the studies regarding the prevalence and the impact of anxiety and depression and to propose management challenges. Methods A literature review regarding 1) anxiety and depression studies in PAH patients and caregivers, 2) psychological interventions, 3) slow breathing approach, and 4) pharmacological approach was performed, based on evidence of effectiveness through a search of the most well-known databases (Cochrane Library, Medline, PsychINFO [2004–2018]). Results The prevalence of mental disorders in PAH patients lies between 7.5% and 53% for depression and 19% and 51% for anxiety and panic disorders. The latest guidelines of the European Society of Cardiology recommend a psychological support with a class of recommendation I and a level of evidence c. The analysis of psychological intervention shows that at present there is no evidence of specific psychological interventions in these patients. However, treatment approaches based on other chronic illnesses are suggested, especially based on relaxation training, slow breathing, and cognitive behavioral therapy. Finally, data concerning the use of antidepressant drugs are conflicting. Conclusion Firstly, our data demonstrate a common underestimation of mental disorders by health professionals and secondly, the need of implementing appropriate methods of screening for mental disorders in PAH patients. However, the paucity of large observational studies in this area requires the attention of researchers. The evidence about optimal approaches for managing anxiety and depression in PAH also remains unclear and largely speculative. The challenge is the introduction of routine psychological intervention, as suggested by the European Society of Cardiology and already applied in other chronic disease.
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Affiliation(s)
- Maurizio Bussotti
- Cardiorespiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy,
| | - Marinella Sommaruga
- Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy
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24
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Lo C, Sarker T, Canning O, Martin V, McCarthy MA, Granton J, Tan A. Clinical presentation of existential distress in pulmonary arterial hypertension. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2018.1507614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Chris Lo
- Psychology, University of Guelph-Humber, Toronto, Canada
- Psychiatry, University of Toronto, Toronto, Canada
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tasmie Sarker
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Orla Canning
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Vanessa Martin
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Mary A. McCarthy
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
| | - John Granton
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Adrienne Tan
- Psychiatry, University of Toronto, Toronto, Canada
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
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Tulloh RMR, Garratt V, Tagney J, Turner-Cobb J, Marques E, Greenwood R, Howard L, Gin-Sing W, Barton A, Ewings P, Craggs P, Hollingworth W. A pilot randomised controlled trial investigating a mindfulness-based stress reduction (MBSR) intervention in individuals with pulmonary arterial hypertension (PAH): the PATHWAYS study. Pilot Feasibility Stud 2018; 4:78. [PMID: 29796292 PMCID: PMC5961480 DOI: 10.1186/s40814-018-0270-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 04/11/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is an uncommon condition with progressive heart failure and premature death. Treatment costs up to £120,000 per patient per year, and the psychological burden of PAH is substantial. Mindfulness-based stress reduction (MBSR) is an intervention with the potential to reduce this burden, but to date, it has not been applied to people with pulmonary hypertension. We wished to determine whether a trial of MBSR for people with PAH would be feasible. METHODS A customised gentle MBSR programme of eight sessions was developed for people with physical disability due to PAH, and they were randomised to group-based MBSR or treatment as usual. The completeness of outcome measures including Beck Anxiety Index, Beck Depression Inventory and standard physical assessment at 3 months after randomisation were recorded. Health care utilisation was measured. Attendance at the sessions and the costs involved in delivering the intervention were assessed. Semi-structured interviews were conducted to explore the acceptability of the MBSR intervention and when appropriate the reasons for trial non-participation. RESULTS Fifty-two patients were recruited, but only 34 were randomised due to patients finding it difficult to travel to sessions. Twenty-two completed all questionnaires and attended all clinics, both routine and additional in order to collect outcomes measures. The MSBR sessions were delivered in Bristol, Cardiff and London, costing, on average, between £2234 (Cardiff) and £4128 (London) per patient to deliver. Attendance at each session averaged between two patients in Bristol and Cardiff and three in London. For those receiving treatment as usual, clinician blinding was achievable. Interviews revealed that people who attended MBSR found it interesting and helpful in managing their symptoms and minimising the psychological component of their disease. CONCLUSIONS We found that attendance at group MBSR was poor in people with chronic PAH within the context of a trial. Achieving better MBSR intervention attendance or use of an Internet-based programme might maximise the benefit of MBSR.
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Affiliation(s)
- R. M. R. Tulloh
- Department of Congenital Heart Disease, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ UK
| | - V. Garratt
- Department of Congenital Heart Disease, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ UK
| | - J. Tagney
- Bristol Heart Institute, Upper Maudlin Street, Bristol, BS2 8HW UK
| | - J. Turner-Cobb
- Department of Psychology, Bournemouth University, Poole, BH12 5BB UK
| | - E. Marques
- Health Economics, Musculoskeletal Research Unit, Southmead Hospital, University of Bristol, Bristol, BS10 5NB UK
| | - R. Greenwood
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ UK
| | - L. Howard
- Hammersmith Hospital, Du Cane Road, London, UK
| | - W. Gin-Sing
- Hammersmith Hospital, Du Cane Road, London, UK
| | - A. Barton
- ITTC Building, Plymouth Science Park, Plymouth University School of Medicine and Dentistry, Plymouth, PL6 8BX UK
| | - P. Ewings
- Research Design Service, Taunton and Somerset Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, TA1 5DA UK
| | - P. Craggs
- Department Congenital Heart Disease, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK
| | - W. Hollingworth
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Aguirre-Camacho A, Moreno-Jiménez B. Depression and Anxiety in Patients With Pulmonary Hypertension: The Role of Life Satisfaction and Optimism. PSYCHOSOMATICS 2018; 59:575-583. [PMID: 29961653 DOI: 10.1016/j.psym.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary hypertension is a highly disabling condition characterized by a progressive increase in pulmonary arterial pressure. Even though pulmonary hypertension may cause great emotional distress, research examining the determinants of patients' emotional well-being has been scarce and has mostly focused on the role of disease-related factors. OBJECTIVES This study examined whether patients' emotional well-being may be effected by their life circumstances. METHODS Sixty-four patients with pulmonary hypertension completed measures of symptoms of pulmonary hypertension, functional disability, depression and anxiety symptoms, life satisfaction, optimism, and quality of life (QoL). RESULTS Clinically-significant symptoms of depression and anxiety were only accurately predicted in 50.5% and 56.5% of patients, respectively, based on disease severity alone. However, the addition of life satisfaction and optimism to the models improved the prediction of depressive and anxiety symptomatology. Further, symptoms of anxiety were a significant predictor of QoL, above and beyond disease severity. CONCLUSIONS Patients with considerably different levels of disease severity may develop clinically-significant depressive and anxiety symptomatology. This suggests that there is not a perfect correspondence between the level of disease severity and the repercussions thereof across patients. Accordingly, these results suggest that emotional well-being may be better explained by taking into consideration patients' life circumstances, as these may modulate the repercussions of having pulmonary hypertension. The results also showed that anxiety symptoms constituted an extra burden to patients' QoL. The higher prevalence in this sample of clinically-significant symptoms of anxiety, compared to that of depression, suggest that feelings of fear and uncertainty may require special attention among patients with pulmonary hypertension.
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Affiliation(s)
- Aldo Aguirre-Camacho
- Health Psychology, Universidad Autónoma de Madrid, Madrid, Spainb- School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain; Department of Biological and Health Psychology, Autonomous University of Madrid, Madrid, Spain; Asociación Nacional de Hipertensión Pulmonar, Madrid, Spain.
| | - Bernardo Moreno-Jiménez
- Department of Biological and Health Psychology, Autonomous University of Madrid, Madrid, Spain
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Reis A, Santos M, Vicente M, Furtado I, Cruz C, Melo A, Carvalho L, Gonçalves F, Sa-Couto P, Almeida L. Health-Related Quality of Life in Pulmonary Hypertension and Its Clinical Correlates: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3924517. [PMID: 29750153 PMCID: PMC5884279 DOI: 10.1155/2018/3924517] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/18/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) impairment is common in pulmonary hypertension (PH), but its clinical predictors are not well established. This study aims to characterize the HRQoL of patients with pulmonary arterial hypertension (PAH) and other precapillary forms of PH (pcPH) and to explore its clinical correlates. MATERIALS AND METHODS A cross-sectional, observational study of patients with documented PAH and other forms of pcPH. Patients completed two patient-reported outcome measures (PROM): Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) and Nottingham Health Profile (NHP). Clinical characteristics were retrieved from electronic medical records. RESULTS Mean CAMPHOR and NHP scores for the study population were indicative of a moderate HRQoL impairment. Patients in World Health Organisation Functional Classes (WHO FC) III/IV showed significantly worse HRQoL. The main clinical correlates of HRQoL were WHO FC, 6-minute walking distance (6MWD), and Borg dyspnoea index. Overall quality of life (QoL), assessed through CAMPHOR's QoL domain, showed patterns comparable to HRQoL measured by both instruments. CONCLUSIONS HRQoL, measured by two different PROMs, is impaired in Portuguese patients with PAH and other forms of pcPH, particularly in patients with increased disease severity. WHO FC, 6MWD, and Borg dyspnoea index are highly correlated with HRQoL and QoL.
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Affiliation(s)
- Abílio Reis
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Mário Santos
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
- Cardiology Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto, Porto, Portugal
| | - Margarida Vicente
- Department of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Inês Furtado
- Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Célia Cruz
- Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Alzira Melo
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Luísa Carvalho
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
- Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Fabienne Gonçalves
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
- Internal Medicine Service, Medicine Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Pedro Sa-Couto
- Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Luís Almeida
- MedInUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
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Yorke J, Deaton C, Campbell M, McGowen L, Sephton P, Kiely DG, Armstrong I. Symptom severity and its effect on health-related quality of life over time in patients with pulmonary hypertension: a multisite longitudinal cohort study. BMJ Open Respir Res 2018. [PMID: 29531745 PMCID: PMC5844371 DOI: 10.1136/bmjresp-2017-000263] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction The aim of this cohort study was to examine health-related quality of life (HRQoL) and symptomatology in patients with pulmonary hypertension (PH) and explore factors that influence its evolution over time. Methods A prospective longitudinal multisite cohort study. Participants were recruited from specialist UK PH centres and completed a questionnaire pack at baseline, 6, 12 and 18 months to assess HRQoL (emPHasis-10), dyspnoea, fatigue, sleep, anxiety and depression. Results 185 patients entered the study at baseline and 126 (68%) completed month 18. At baseline, patients had significant impairment of HRQoL, anxiety, depression, dyspnoea and severe fatigue. No significant changes, apart from a reduction in the Hospital Anxiety and Depression Scale-Anxiety score (P=0.04), were observed over 18 months. Depression and dyspnoea were predictors of HRQoL (P=0.002 and P=0.03, respectively). Oxygen use was also associated with diminished HRQoL and increased symptom severity. Conclusion Patients with PH experience high levels of symptom severity and the negative impact on HRQoL was unchanged over time. The use of oxygen therapy, in particular, was associated with a significant impact on HRQoL. Further study of factors impacting HRQoL and interventions that target a combination of physiological and psychosocial consequences of living with PH are needed.
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Affiliation(s)
- Janelle Yorke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christi Deaton
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Malcolm Campbell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Linda McGowen
- School of Healthcare, University of Leeds, Leeds, UK
| | - Paul Sephton
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
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Impact of psychological factors on the health-related quality of life of patients treated for pulmonary arterial hypertension. J Psychosom Res 2018; 105:45-51. [PMID: 29332633 DOI: 10.1016/j.jpsychores.2017.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a rare and life-threatening disease well-marked by under diagnosis, delayed diagnosis and atypical treatments. Few data are available on the quality of life (QoL) and psychosocial characteristics of patients with PAH. Our aim is to describe the impact of psychological factors on the health-related quality of life (HRQoL) of treated PAH patients in a cross-sectional study. METHODS Consecutive patients presenting at our Competency Centre for PAH were recruited. The aetiology, New York Heart Association (NYHA) stage, haemodynamics, 6-min walk distance (6MWD), delta SPO2 (Pulse oximeter oxygen saturation; baseline lowest value during 6-min walk test (6MWT), current treatments and psychological history were recorded. HRQoL, anxiety, depression and coping strategies were explored using self-administered questionnaires (SF-36, HADS, STAI-Y, CHIP and WCC). RESULTS A total of 55 patients were included. The HRQoL of PAH patients was poor with altered results on several scales. Anxiety and depression were high and coping was focused on medical information strategies. Multivariate analysis indicated a positive relationship between 6MWD and the Physical Composite Score for QoL (p=0.004), as well as a negative relationship between delta SPO2 and the Mental Composite Score (p=0.02), irrespective of other known prognostic factors (such as haemodynamics at right heart catheterization). Depression and Trait-Anxiety were associated with a lower physical (p=0.001) and mental (p<0.001) QoL, respectively. CONCLUSIONS Psychological factors impact the HRQoL of treated patients. A longitudinal and qualitative study should refine these results. TRIAL REGISTRATION Clinical trial N°: NCT01380054.
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Pfeuffer E, Krannich H, Halank M, Wilkens H, Kolb P, Jany B, Held M. Anxiety, Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH. Lung 2017; 195:759-768. [PMID: 28993877 DOI: 10.1007/s00408-017-0052-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/10/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening diseases with a high burden of symptoms. Although depression, anxiety, and reduced health related quality of life (HRQOL) have also been reported, a comparative analysis which explores these traits and their underlying factors was lacking. METHODS A retrospective analysis of depression, anxiety, and health related QOL was conducted using a Hospital anxiety and depression scale (HADS) as well as the SF-36 HRQOL questionnaire. Results from these tools were compared with haemodynamic and functional parameters in 70 PAH and 23 CTEPH outpatients from a German tertiary care center specializing in pulmonary hypertension. RESULTS Although HRQOL was reduced in both cohorts of patients, individuals diagnosed with CTEPH scored lower in nearly all SF-36 parameters. Significance was noted in both "mental health" (p = 0.01) and "mental component summary score" (MCS) (p = 0.02). Depression was also more frequent in patients with CTEPH (56%) than in patients with PAH (30%), (p = 0.03). Overall, depression and anxiety correlated with most SF-36 scales in both PAH and CTEPH. In CTEPH, depression also correlated with the Borg Dyspnea Scale (r = 0.44, p = 0.01). These patients also had significantly lower pCO2 levels than the PAH cohort reflecting more severe ventilation/perfusion mismatch. All other haemodynamic and functional parameters did not differ across the groups. CONCLUSION While both cohorts of patients suffer from a reduced HRQOL as well as depression and anxiety, decreases in mental health parameters are more pronounced in the CTEPH cohort. This suggests a strong effort to improve early detection, especially in dyspneic patients with classical risk factors for CTEPH and PAH and argues for mental illness interventions alongside routine clinical care provided to patients diagnosed with PAH or CTEPH.
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Affiliation(s)
- Elena Pfeuffer
- Department of Internal Medicine, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Medical Mission Hospital, Salvatorstrasse 7, 97074, Würzburg, Germany.,Medical Clinic I, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany
| | - Holger Krannich
- Department of Quality Management and Clinical Risk Management, Hospital of Julius Maximilian University of Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany
| | - Michael Halank
- Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Heinrike Wilkens
- Department of Internal Medicine V, Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University, Kirrberger Strasse, Homburg, 66424, Homburg Saar, Germany
| | - Philipp Kolb
- Department of Medicine, Firestone Institute for Respiratory Health, Pathology & Molecular Medicine, McMaster University, 50 Charlton Ave East, T2131, Hamilton, ON, L8N 4A6, Canada
| | - Berthold Jany
- Department of Internal Medicine, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Medical Mission Hospital, Salvatorstrasse 7, 97074, Würzburg, Germany
| | - Matthias Held
- Department of Internal Medicine, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Medical Mission Hospital, Salvatorstrasse 7, 97074, Würzburg, Germany.
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Ivarsson B, Rådegran G, Hesselstrand R, Kjellström B. Information, social support and coping in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension-A nationwide population-based study. PATIENT EDUCATION AND COUNSELING 2017; 100:936-942. [PMID: 28041647 DOI: 10.1016/j.pec.2016.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/16/2016] [Accepted: 12/17/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) decrease life expectancy for affected patients. The aim was to describe the perceptions of received information regarding diagnosis, treatment and management, as well as social support and coping perceived by patients with PAH or CTEPH. METHODS A descriptive, national cohort survey that included patients from all PAH-centres in Sweden. A quantitative methodology was employed where all patients received three questionnaires, QLQ-INFO25, Mastery Scale and Social Network & Support Scale. RESULTS The response rate was 74% (n=325), mean age 66±14years, 71% were female and 69% were diagnosed with PAH and 31% with CTEPH. Sixty percent of respondents were satisfied with the received information and felt it was helpful. Best experiences were of information in the areas of medical tests (70%) and the disease (61%). Forty-five percent wanted more information. Men described their social network as more accessible than women (p=0.004). Those living alone had a lower coping ability. CONCLUSION Despite a high level of satisfaction with the received information, almost half of the patients wanted more information. PRACTICE IMPLICATIONS Regular repeating or giving new information should be an ongoing process in the care of patients at the PAH-centres.
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Affiliation(s)
- Bodil Ivarsson
- Lund University, Department of Clinical Sciences, Lund, Cardiothoracic Surgery, and Skåne University Hospital, and Medicine Services University Trust, Region Skåne, Lund, Sweden.
| | - Göran Rådegran
- Lund University, Department of Clinical Sciences, Lund, Cardiology, and The Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Roger Hesselstrand
- Lund University, Department of Clinical Sciences, Lund, Rheumatology, and The Clinic for Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Barbro Kjellström
- Department of Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Graarup J, Ferrari P, Howard LS. Patient engagement and self-management in pulmonary arterial hypertension. Eur Respir Rev 2017; 25:399-407. [PMID: 27903662 DOI: 10.1183/16000617.0078-2016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/13/2016] [Indexed: 11/05/2022] Open
Abstract
Improved care in pulmonary arterial hypertension has led to increased longevity for patients, with a paralleled evolution in the nature of their needs. There is more focus on the impact of the disease on their day-to-day activities and quality of life, and a holistic approach is coming to the front of pulmonary arterial hypertension management, which places the patient at the centre of their own healthcare. Patients are thus becoming more proactive, involved and engaged in their self-care, and this engagement is an important factor if patient outcomes are to improve. In addition, involvement of the patient may improve their ability to cope with pulmonary arterial hypertension, as well as help them to become effective in the self-management of their disease. Successful patient engagement can be achieved through effective education and the delivery and communication of timely, high-quality information. A multidisciplinary approach involving healthcare professionals, carers, patient associations and expert patient programmes can also encourage patients to engage. Strategies that promote patient engagement can help to achieve the best possible care and support for the patient and also benefit healthcare providers.
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Affiliation(s)
| | - Pisana Ferrari
- PHA Europe, European Pulmonary Hypertension Association, Udine, Italy
| | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Chia KSW, Wong PKK, Faux SG, McLachlan CS, Kotlyar E. The benefit of exercise training in pulmonary hypertension: a clinical review. Intern Med J 2017; 47:361-369. [DOI: 10.1111/imj.13159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/27/2016] [Accepted: 06/08/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Karen S. W. Chia
- Department of Medicine; University of New South Wales Rural Clinical School; Coffs Harbour New South Wales Australia
- Department of Medicine; Coffs Harbour Health Campus; Coffs Harbour New South Wales Australia
| | - Peter K. K. Wong
- Department of Medicine; University of New South Wales Rural Clinical School; Coffs Harbour New South Wales Australia
- Department of Medicine; Coffs Harbour Health Campus; Coffs Harbour New South Wales Australia
- Mid-North Coast Arthritis Clinic; Coffs Harbour New South Wales Australia
| | - Steven G. Faux
- Department of Rehabilitation, Sacred Heart Rehabilitation; St Vincent's Health; Sydney New South Wales Australia
- Department of Medicine; University of New South Wales; Sydney New South Wales Australia
- Department of Medicine; St Vincent's Hospital; Sydney New South Wales Australia
| | - Craig S. McLachlan
- Department of Medicine; University of New South Wales Rural Clinical School; Coffs Harbour New South Wales Australia
| | - Eugene Kotlyar
- Department of Medicine; University of New South Wales; Sydney New South Wales Australia
- Department of Medicine; St Vincent's Hospital; Sydney New South Wales Australia
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Mehta S, Sastry BKS, Souza R, Torbicki A, Ghofrani HA, Channick RN, Delcroix M, Pulido T, Simonneau G, Wlodarczyk J, Rubin LJ, Jansa P, Hunsche E, Galiè N, Perchenet L, Sitbon O. Macitentan Improves Health-Related Quality of Life for Patients With Pulmonary Arterial Hypertension. Chest 2017; 151:106-118. [DOI: 10.1016/j.chest.2016.08.1473] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/29/2016] [Accepted: 08/24/2016] [Indexed: 01/22/2023] Open
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Health-related quality of life of patients with pulmonary arterial hypertension associated with CHD: the multicentre cross-sectional ACHILLE study. Cardiol Young 2016; 26:1250-9. [PMID: 26980152 DOI: 10.1017/s1047951116000056] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of this study was to assess health-related quality of life in patients with pulmonary arterial hypertension associated with CHD and correlations with clinical status. METHODS This prospective cross-sectional observational study included CHD patients with pulmonary arterial hypertension in 14 tertiary-care centres in France. We used two health-related quality of life questionnaires - SF-36 and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) - and one anxiety/depression Hospital Anxiety and Depression Scale (HADS) questionnaire. RESULTS Clinical data were collected for the 208 included patients (mean age: 42.6 years, range from 15.1 to 85.8 years, 69.7% female). Most patients were in NYHA functional class II (48.1%) and III (37.5%). Patients' phenotype was classified as Eisenmenger syndrome (70.7%), pulmonary arterial hypertension associated with systemic-to-pulmonary shunts (12.0%), with small defects (3.4%), or after corrective cardiac surgery (13.9%). In total, 76.4% of the patients were receiving pulmonary arterial hypertension-specific treatments. SF-36 scores showed impairment compared with normalised data. Health-related quality of life scores were significantly lower in females than in males for most dimensions of both questionnaires and were independent of the patients' phenotype, even after gender adjustment - except for CAMPHOR functioning - but significantly depended on NYHA functional class. The Hospital Anxiety and Depression Scale (HADS) scores suggested anxiety and depression associated with increasing NYHA functional class but independent of patients' phenotype. NYHA functional class, 6-minute walk distance, HADS, gender, and recent stressful event significantly affected quality of life in the multivariate analysis. CONCLUSIONS This study showed impairment of quality of life in a large cohort of patients with pulmonary arterial hypertension associated with CHD with both generic and specific questionnaires. NYHA functional class and HADS scores were predictive of most quality of life scores.
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Gu S, Hu H, Dong H. Systematic Review of Health-Related Quality of Life in Patients with Pulmonary Arterial Hypertension. PHARMACOECONOMICS 2016; 34:751-770. [PMID: 26951248 DOI: 10.1007/s40273-016-0395-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The increasing survival of patients with pulmonary arterial hypertension (PAH) has shifted attention towards the disease burden that PAH imposes on patients and healthcare systems. Most studies emphasize epidemiology and medications, while large observational studies reporting on the health-related quality of life (HRQOL) of patients with PAH are lacking. OBJECTIVE Our objective was to study the HRQOL of patients with PAH and to summarize the factors that influence it. METHODS We conducted systematic literature searches in English (PubMed, Web of Knowledge, ScienceDirect and OVID) and Chinese (China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP and SinoMed) databases to identify studies published from 2000 to 2015 assessing the HRQOL of patients with PAH. Search results were independently reviewed and extracted by two reviewers. RESULTS Of 3392 records identified in the initial search, 20 eligible papers (19 English, 1 Chinese) were finally included. Studies used a range of instruments; the generic 36-item Short Form Survey (SF-36) was the most widely used, and the disease-specific Cambridge Pulmonary Hypertension Outcome Survey (CAMPHOR) was the second mostly widely used. Mean HRQOL scores assessed via the SF-36 (physical component summary [PCS] 25.4-80.1; mental component summary [MCS] 33.2-76.0) and CAMPHOR (symptom scores 3.1-17; total HRQOL 2.8-12.6; activity scores 3.8-18.1) varied across studies, reporting decreased HRQOL in patients. Mental health (depression, anxiety, stress), physical health (exercise capacity, symptoms) and medical therapies were reported to affect HRQOL. CONCLUSION We found that PAH places a substantial burden on patients, particularly in terms of HRQOL; however, the paucity of large observational studies in this area requires the attention of researchers, especially in China.
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Affiliation(s)
- Shuyan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
| | - Huimei Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
- Department of Public Health, Zhejiang Medical College, Hangzhou, Zhejiang Province, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China.
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Somaini G, Hasler ED, Saxer S, Huber LC, Lichtblau M, Speich R, Bloch KE, Ulrich S. Prevalence of Anxiety and Depression in Pulmonary Hypertension and Changes during Therapy. Respiration 2016; 91:359-66. [PMID: 27189373 DOI: 10.1159/000445805] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/23/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) leads to reduced health-related quality of life (HRQoL). OBJECTIVE To investigate the prevalence and course of anxiety and depression and their association with HRQoL, disease severity and survival in PH. METHODS 131 PH patients (91 pulmonary arterial, 30 chronic thromboembolic, 10 due to lung disease; 84 female, 47 male) had repeated assessments with the Hospital Anxiety and Depression Scale (HADS), HRQoL, six-minute walk distance and WHO functional class during a mean course of 16 ± 12 months. RESULTS Among the 49 incident and 82 prevalent PH patients, the HADS score was positive in 53%/21% (depression), 51%/24% (anxiety) and 63%/26% (total score) (all p < 0.05). The HADS score was improved at the second assessment in incident patients. The HADS score correlated with HRQoL at all consecutive assessments and with functional class until the third assessment, but not with baseline hemodynamics, age or gender. CONCLUSION Mood disorders remain underdiagnosed in PH. The higher prevalence of anxiety/depression in incident versus prevalent patients and the improvement over time may indicate an amelioration of mood disorders after PH diagnosis and treatment.
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Affiliation(s)
- Gina Somaini
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
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Patients', relatives', and practitioners' views of pulmonary arterial hypertension: A qualitative study. Presse Med 2016; 45:e11-27. [PMID: 26775203 DOI: 10.1016/j.lpm.2015.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 05/26/2015] [Accepted: 06/11/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION To study practitioners', patients' with PAH, and relatives' views regarding pulmonary arterial hypertension (PAH) and identify potential improvements in medical care strategies. METHODS A qualitative study based on semi-structured interviews involving 16 patients, 4 relatives, and 9 practitioners. RESULTS Patients with PAH, their relatives, and physicians who treat persons with PAH had divergent perspectives on PAH. The discrepancies identified concerned their perceptions of the illness and its impact on patients' with PAH daily lives. Patients with PAH had a broader view, including social, identity, financial, and functional dimensions of PAH's impact on their lives, whereas practitioners were more focused on functional aspects. The study also pointed out divergent approaches among physicians to assessing patients' New York Heart Association functional class. The expectations of patients with PAH, relatives, and physicians also differed. Patients with PAH expected improvement in PAH diagnosis and better coordination between primary care physicians and PAH medical centers. They also valued reducing side effects, less restrictive medications, and greater consideration of their views in the medical decision making process. Physicians' expectations focused more on identifying and validating therapeutic strategies. CONCLUSION Our results suggest several potential improvements in patient management, especially in order to better tailor treatment to patients' needs and to achieve a more uniform approach to the PAH functional impact assessment process. The findings may also be useful in enhancing therapeutic education for patients and their relatives, and in enabling practitioners to better interpret dyspnea in patients with PAH. Finally, this qualitative database will help in developing patient-reported outcome measures with better content validity. It lays the groundwork for developing new instruments to investigate the impact of PAH on patients' daily lives in terms of symptom assessment and functional impact.
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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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Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, Spruit MA, Masefield S, Casaburi R, Clini EM, Crouch R, Garcia-Aymerich J, Garvey C, Goldstein RS, Hill K, Morgan M, Nici L, Pitta F, Ries AL, Singh SJ, Troosters T, Wijkstra PJ, Yawn BP, ZuWallack RL. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med 2015; 192:1373-86. [DOI: 10.1164/rccm.201510-1966st] [Citation(s) in RCA: 432] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Somaini G, Stamm A, Müller-Mottet S, Hasler E, Keusch S, Hildenbrand FF, Furian M, Speich R, Bloch KE, Ulrich S. Disease-Targeted Treatment Improves Cognitive Function in Patients with Precapillary Pulmonary Hypertension. Respiration 2015; 90:376-83. [PMID: 26447714 DOI: 10.1159/000439227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/24/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with pulmonary hypertension (PH) may suffer from cognitive deficits that potentially relate to reduced oxygen delivery and cerebral tissue oxygenation (CTO). OBJECTIVE To evaluate the hypothesis that cognitive function improves with therapy, along with improved CTO. METHODS Twenty incident patients with arterial or chronic thromboembolic PH had CTO monitoring by near-infrared spectroscopy during diagnostic right heart catheterization. Cognitive tests [Trail Making Tests (TMTs), Victoria Stroop tests and the Five-Point Test (5PT)], the 6-min walk distance (6MWD) test, New York Heart Association (NYHA) class and health-related quality of life (HRQoL) were assessed and repeated after 3 months of disease-targeted medication. RESULTS At baseline, 45% of PH patients had cognitive deficits. At 3 months, the patients had improved on the TMT A and the Stroop 2 test [37 s (27; 55) versus 30 s (24; 42), p < 0.05, and 18 s (16; 22) versus 16 s (15; 20), p < 0.01], whereas CTO remained unchanged. Arterial oxygen saturation, NYHA class, 6MWD and HRQoL had also improved. Baseline CTO was the strongest predictor of cognitive function, even in multivariate analysis including age, 6MWD and HRQoL. Improvements in cognitive function were not associated with changes in CTO. CONCLUSIONS In patients with PH, 3 months of disease-targeted medication resulted in better cognitive function. Although CTO was the strongest predictor of cognitive function at baseline, it did not change during target therapy. The results of this pilot study should be confirmed in an adequately powered controlled trial.
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Affiliation(s)
- Gina Somaini
- Pulmonology Clinic, University Hospital Zurich, Zurich, Switzerland
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Naglaa B, El-Korashy R, Soliman Y. Searching for the least invasive parameters used as predictors of survival in idiopathic pulmonary arterial hypertension. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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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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Ivarsson B, Ekmehag B, Hesselstrand R, Rådegran G, Sjöberg T. Perceptions of received information, social support, and coping in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2014; 8:21-8. [PMID: 25374462 PMCID: PMC4213136 DOI: 10.4137/ccrpm.s18586] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 08/17/2014] [Accepted: 08/25/2014] [Indexed: 01/25/2023]
Abstract
Patients with a life-limiting diagnosis of pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) need disease-specific information, ability to cope, and functioning social networks. This cohort study investigated the experiences of PAH and CTEPH patients who received information about their diagnosis, treatment, and management, in addition to coping and social support. Sixty-eight adult patients (mean ± SD, age 67 ± 14; 66% women) were included. A total of 54% of the patients wanted more information. Patients received information mostly in areas concerning medical test procedures, the diagnosis, disease severity, possible disease causes, and how to manage their disease. Coping ability was significantly better in patients who were satisfied with the received information (P = 0.0045). The information given to PAH or CTEPH patients and their communication with healthcare professionals can be greatly improved. Gaps in information and misunderstandings can be avoided by working in cooperation with the patients, their relatives, and within the PAH team.
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Affiliation(s)
- Bodil Ivarsson
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden. ; The clinic for Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden. ; Medical Services, University Healthcare, Skåne, Sweden
| | - Björn Ekmehag
- Department of Public Health and Caring Science, Uppsala University, and Uppsala University Hospital, Uppsala, Sweden
| | - Roger Hesselstrand
- Department of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden. ; The clinic for Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Göran Rådegran
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden. ; The Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Trygve Sjöberg
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden. ; The clinic for Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
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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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Information experiences and needs in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. Nurs Res Pract 2014; 2014:704094. [PMID: 25197567 PMCID: PMC4150537 DOI: 10.1155/2014/704094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/03/2014] [Indexed: 11/20/2022] Open
Abstract
Background. Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are fatal, noncurable, but treatable diseases that strongly affect the patients. Objective. To describe patients' experience of information relating to PAH or CTEPH. Methods. A qualitative method using content analysis was applied. Seventeen patients (thirteen women and four men) aged 28–73 years from a regional PAH centre were individually interviewed. Results. Three categories that describe patients' experiences of information emerged: handling of information, struggling with feelings that also affect others, and vulnerability associated with uncertainty. The patients would have welcomed more information to relatives from the healthcare professionals. Shortcomings on communicating a prognosis were experienced. The mediated information and knowledge gave the patients insight into physical or psychosocial problems. Mutual exchange of information between patients and healthcare professionals were marred by different experiences of attitudes, behaviour, and ownership. Conclusions. In the future, healthcare organizations must struggle to achieve a holistic healthcare by making it more person-centred, and they must also promote cooperation between PAH centres and local healthcare providers. It is essential to determine the most appropriate and valuable path of information and communication and, thereby, the most cost-effective management of PAH or CTEPH.
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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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Verma S, Cardenas-Garcia J, Mohapatra PR, Talwar A. Depression in pulmonary arterial hypertension and interstitial lung diseases. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:240-9. [PMID: 25006558 PMCID: PMC4083524 DOI: 10.4103/1947-2714.134368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advanced lung diseases such as pulmonary arterial hypertension (PAH) and interstitial lung diseases (ILD) are chronic diseases that cause significantly high morbidity and mortality. As a result, patients can undergo some psychological changes leading to a poor quality of life and depression. Diagnosis of depression is often obscured because fatigue and apathy, two common symptoms of depression, frequently overlap with PAH and ILD. Healthcare providers are sometimes reluctant to ask or mistakenly believe that these symptoms are part of the ongoing disease process, rather than a serious condition like depression. Screening tools are available for physicians to be well positioned in recognizing clinical depression in PAH and ILD. A MedLine/PubMED search was performed identifying all relevant articles with “PAH”, “ILD”, “screening tools” and/or “Depression” in the title. The aim of this review is to provide a brief description of some of the instruments used to screen patients and classes of psychotropic medications accessible to physicians. While pulmonary rehabilitation programs can have a positive impact on patients, physicians should also utilize cognitive behavioral therapy (CBT) as part of regular care.
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Affiliation(s)
- Sameer Verma
- Department of Pulmonary, Critical Care and Sleep Medicine, North Shore - Long Island Jewish Health System, New York, USA
| | - Jose Cardenas-Garcia
- Department of Pulmonary, Critical Care and Sleep Medicine, North Shore - Long Island Jewish Health System, New York, USA
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, India
| | - Arunabh Talwar
- Department of Pulmonary, Critical Care and Sleep Medicine, North Shore - Long Island Jewish Health System, New York, 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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M M Vanhoof J, Delcroix M, Vandevelde E, Denhaerynck K, Wuyts W, Belge C, Dobbels F. Emotional symptoms and quality of life in patients with pulmonary arterial hypertension. J Heart Lung Transplant 2014; 33:800-8. [PMID: 24854567 DOI: 10.1016/j.healun.2014.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/05/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited evidence exists on the nature and degree of emotional problems in pulmonary arterial hypertension (PAH) and their association with patients' health-related quality of life (HRQOL). METHODS This cross-sectional study examined the presence of depression, anxiety, and stress symptoms, and their association with disease-specific and generic HRQOL. A total of 101 patients (73% women) with PAH (age, 55.4 ± 16.4 years; 42.6% in New York Heart Association [NYHA] class II) completed the Depression, Anxiety, and Stress Scale, the generic Medical Outcomes Study Short-Form 36-Item (SF-36) Health Survey, and the disease-specific Minnesota Living With Heart Failure Questionnaire (MLHFQ) HRQOL instrument. The association between emotional problems and HRQOL was determined using multivariable linear regression analyses, controlling for demographic and disease-related characteristics. RESULTS Of the patients, 32.6%, 48%, and 27.6% experienced depressive, anxiety or stress symptoms, respectively. HRQOL was >1 standard deviation below population norms for the SF-36 Physical Component Summary. Depressive symptoms, NYHA class, and being disabled explained 46% of the total variance of the MLHFQ. Emotional problems did not contribute to the SF-36 Physical Component Summary but explained part of the variance of the physical sub-scales of the SF-36 role limitations due to physical problems, bodily pain, and general health. CONCLUSIONS The high presence of emotional problems warrants regular screening and appropriate psychotherapeutic and/or pharmacological treatment. Which strategies could improve PAH patients' HRQOL remains to be investigated.
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Affiliation(s)
- Jasper M M Vanhoof
- Health Services and Nursing Research, Department of Public Health and Primary Care
| | - Marion Delcroix
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Ellen Vandevelde
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | | | - Wim Wuyts
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Catharina Belge
- Respiratory Division, University Hospitals, and Department of Clinical and Experimental Medicine, University of Leuven, (KU Leuven) Leuven, Belgium
| | - Fabienne Dobbels
- Health Services and Nursing Research, Department of Public Health and Primary Care.
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