Comparison of cardiac and pulmonary-specific quality-of-life measures in pulmonary arterial hypertension

Abstract

Studies systematically comparing the performance of health-related quality-of-life (HRQL) instruments in pulmonary arterial hypertension (PAH) are lacking. We sought to address this gap by comparing cardiac and respiratory-specific measures of HRQL in PAH. We prospectively assessed HRQL in 128 patients with catheterization-confirmed PAH at baseline and at 6, 12, and 24+ months. Cardiac-specific HRQL was assessed using the Minnesota Living with Heart Failure Questionnaire (LHFQ); respiratory-specific HRQL using the Airways Questionnaire 20 (AQ20); and general health status using the 36-item Short Form physical component summary (SF-36 PCS). The LHFQ and AQ20 were highly intercorrelated. Both demonstrated strong internal consistency and converged with the SF-36 PCS. Both discriminated among patients based on World Health Organization functional class (FC), 6-minute walk distance (6MWD), and Borg Dyspnea Index (BDI), except for a potential floor effect associated with low 6MWD. The LHFQ was more responsive than the AQ20 to changes over time in FC, 6MWD, and BDI. In multivariate analyses, the LHFQ and AQ20 were each longitudinal predictors of general health status, independent of FC, 6MWD and BDI. In conclusion, both cardiac-specific and respiratory-specific measures appropriately assess HRQL in most patients with PAH. Overall, the LHFQ demonstrates stronger performance characteristics than the AQ20.

Ausência de estreita associação entre qualidade de vida e capacidade de exercício na hipertensão arterial pulmonar

“…The tendency that we observed of a more impressive depression in physical domains is in agreement with the literature 29 . In the graph shown in Figure 2, the intercept indicates that for any given score associated with physical health, the corresponding mental component score tends to be higher.…”

“…On the other hand, our observation of most scores above 50 is in contrast with other studies 13,15,29 , and may be explained by differences between patient populations. Notoriously, PAH associated with congenital heart disease (the majority of patients in this study) is a more insidious disease, and patients tend to be more adapted to their illness.…”

“…There has been general agreement that HRQOL does not correlate with hemodynamic abnormalities in PAH [13][14][15]29 . Even …”

“…Having in mind these methodological difficulties and limitations 28 , HRQOL has been shown to be severely depressed in PAH 13,15,29 . The tendency that we observed of a more impressive depression in physical domains is in agreement with the literature 29 .…”

“…On the other hand, associations between HRQOL and measures of the functional status (namely, the functional class, the Six-minute walk distance and Borg dyspnea index) have been demonstrated more consistently, even though they are not so tight if one considers the coefficients of correlation [13][14][15]29 . Again, in PAH, it is the physical component of HRQOL that best correlates with measures such as the Six-minute walk distance 13 .…”