Quality of life as a prognostic marker in pulmonary arterial hypertension

Abstract

BackgroundImprovement in quality of life together with better survival are the ultimate goals in the treatment of pulmonary arterial hypertension (PAH) patients. The objective of this study was to evaluate the health-related quality of life (HRQL) of pulmonary arterial hypertension (PAH) patients with the SF-36 generic questionnaire and to identify the prognostic implication of this assessment.MethodsFifty-four consecutive newly diagnosed PAH patients (WHO classification group I) in a single PAH reference center were included. Patients were evaluated at baseline for clinical and hemodynamic parameters, and they subsequently received first-line therapy with either an endothelin receptor antagonist or a phosphodiesterase-5 inhibitor. After 16 weeks of specific PAH therapy, all patients were re-evaluated using a 6MWT and a SF 36 questionnaire, and then they were followed up for at least 36 months.ResultsAfter treatment, the patients demonstrated an improved 6MWT (414 ± 124 m vs. 440 ± 113 m, p = 0.001). Specific PAH therapy also improved the HRQL scores.Patients with a baseline Physical Component Score (PCS) higher than 32 had a better survival rate than those who had a score under 32 (p = 0.04). Similarly, patients with a PCS of at least a 38 after the 16 week therapy period had a better survival rate when compared with those who did not achieve this value (p = 0.016). Unlike the absolute PCS values, the post-treatment PCS variability was unable to predict better survival rates (p = 0.58).ConclusionsOur findings suggest that HRQL is associated with prognosis in PAH. Furthermore, achieving pre-determined PCS scores might represent a specific goal to be reached in treatment-to-target strategies.

Effects of Surgical and Medical Treatment on Quality of Life for Patients With Chronic Thromboembolic Pulmonary Hypertension

“…25 Our results are similar to those reports in that we observed an association between low QOL and poor survival. In addition, we demonstrated that PAH-specific therapy improved survival even in patients with a lower PF at baseline.…”

Health-related Quality of Life and Survival in Pulmonary Arterial Hypertension

“…Fernandes and colleagues recently reported on a Brazilian cohort of patients with various forms of PAH in whom SF-36 at baseline and after 16 weeks of PAHspecific therapy was associated with longterm (3-yr) survival (26). The Brazilian cohort differs significantly from the current cohort, however, based on age (younger) and disease type (.80% IPAH or schistosomiasis-related PAH).…”

“…A two-tailed P value with a significance level of 0.05 was used to detect statistically significant ORIGINAL RESEARCH differences between groups. Subjects were stratified by median PCS score based on prior data showing the predictive value of this parameter in PAH (26).…”

“…One recent study by Fernandes and colleagues in 54 patients with various forms of PAH in which HRQOL was assessed at baseline and after 16 weeks of therapy demonstrated the predictive value of baseline and follow-up values in the physical component summary score of the SF-36 at 36 months (26). However, the authors did not conduct multivariable analyses to assess the relationship between HRQOL and outcomes in this cohort.…”

A Nomogram based on a Patient-reported Outcomes Measure: Predicting the Risk of Readmission for Patients with Chronic Heart Failure

“…[5] A number of clinical studies predicting hospitalization for the deterioration of HF have been summarized in detail by Rahimi K et al [6,7] The majority of effective models were built based on clinical data collected from discharge records of patients; [8] however, research indicates that high health-related quality of life (HRQOL) predicts a more favorable prognosis in patients with cardiovascular disease. [9] Thus, HRQOL should be used as a new prognostic indicator for HF patients, [10,11] and as an independent predictive factor of readmission with HF. [12,13] The patient-reported outcomes measure (PROM) evaluates a patient's quality of life by the way of scales to promote communication, inspect and identify HRQOL issues, enhance patient-centered treatment, and increase patient satisfaction.…”