scholarly journals 1033 Sleep and Patient-Reported Outcomes in Persons With Heart Failure With Preserved Ejection Fraction

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A392-A393
Author(s):  
L M Baniak ◽  
C W Atwood ◽  
P J Strollo ◽  
D E Forman ◽  
E R Chasens
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Patient Reported Outcomes ◽  
Summary Score ◽  
Poor Sleep ◽  
Preserved Ejection Fraction ◽  
Patient Reported

Abstract Introduction Sleep quality has a significant bearing on disease. A better understanding of sleep quality may help identify opportunities to improve patient-reported outcomes (PROs) in persons with heart failure with preserved ejection fraction (HFpEF). We aimed to explore the association between sleep and PROs in patients clinically diagnosed with HFpEF. Methods Cross-sectional study of 22 participants (71.2±7.2 years, 95% male, 86.4% white) with HFpEF, recruited from a heart failure (n=14) and sleep clinic (n=8). Sleep disordered breathing was measured objectively using one-night in-home obstructive sleep apnea (OSA) testing (ApneaLink). Actigraphy (7 days) was used to assess sleep duration, efficiency, and wake after sleep onset (WASO). Subjective sleep measures included the Insomnia Severity Index (ISI), Epworth Sleepiness scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). PROs included functional status (Functional Outcomes Sleep Questionnaire [FOSQ]), depression (PROMIS Depression), fatigue (PROMIS Fatigue), and heart failure specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]; overall summary score [KCCQ-os] and clinical summary score [KCCQ-cs]). The KCCQ-cs includes physical function and symptom scores to corresponds with NYHA Classification. Results Fifty percent of the participants had poor sleep quality (PSQI >5) and 2 (9.1%) had ISI scores >14. The majority (64%; n=14) had OSA; 10 currently on OSA therapy. Mean oxygen desaturation index (ODI) was 20.8±17.8. Mean actigraphy data indicated poor sleep (sleep duration 302±116 minutes, sleep efficiency 70.0±18.6%, and WASO 52±28 minutes) despite only 5 (22.7%) participants reporting excessive daytime sleepiness (ESS>10). Greater insomnia symptom severity was associated with lower heart failure specific quality of life (KCCQ-os) and functional status, and, greater fatigue and depression (all p-values <.05). FOSQ was negatively associated with PSQI (r= -.710, p= <.001) and positively with sleep efficiency (r=.496, p=.026). The KCCQ-cs was positively associated with sleep duration (r=.496, p=.026) and negatively but not significantly associated with ODI (r= -.453, p=.07). Conclusion Impaired sleep and OSA are highly prevalent in patients with HFpEF and both are adversely associated with PROs. Goals to improve sleep is important for effective symptom management and for potential improvements in PROs. Support American Nurses Foundation, Preventative Cardiovascular Nurses Association

scholarly journals Quality of life trajectories during the first three years after diagnosis of breast cancer: the NEON-BC study

2019 ◽  
Author(s):  
Luisa Lopes-Conceição ◽  
Mariana Brandão ◽  
Natália Araújo ◽  
Milton Severo ◽  
Teresa Dias ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Sleep Quality ◽  
Patient Reported Outcomes ◽  
Life Questionnaire ◽  
European Organization ◽  
Life Trajectories ◽  
Patient Reported ◽  
Anxiety Depression

Abstract Background We aimed to identify and characterize quality of life trajectories up to 3 years after breast cancer diagnosis. Methods A total of 460 patients were evaluated at baseline (before treatments), and after 1- and 3-years. Patient-reported outcomes, including quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, QLQ-C30), anxiety, depression and sleep quality, were assessed in all evaluations. Model-based clustering was used to identify quality of life trajectories. Results We identified four trajectories without intersection during 3 years. The two trajectories characterized by better quality of life depicted relatively stable scores; in the other trajectories, quality of life worsened until 1 year, though in one of them the score at 3 years improved. Sociodemographic and clinical characteristics at baseline did not differ between trajectories, except for mastectomy, which was higher in the worst trajectory. Anxiety, depression and poor sleep quality increased from the best to the worst trajectory. Conclusions The type of surgery and the variation of other patient-reported outcomes were associated with the course of quality of life over 3 years. More research to understand the heterogeneity of individual trajectories within these major patterns of variation is needed.

scholarly journals Empagliflozin, Health Status, and Quality of Life in Patients with Heart Failure and Preserved Ejection Fraction: The EMPEROR-Preserved Trial

Circulation ◽  
2021 ◽  
Author(s):  
Javed Butler ◽  
Gerasimos Filippatos ◽  
Tariq Jamal Siddiqi ◽  
Martina Brueckmann ◽  
Michael Böhm ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Health Status ◽  
Ejection Fraction ◽  
Kansas City ◽  
Cardiovascular Death ◽  
Summary Score ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Background: Patients with heart failure and preserved ejection fraction (HFpEF) have significant impairment in health-related quality of life (HRQoL). In EMPEROR-Preserved, we evaluated the efficacy of empagliflozin on HRQoL in patients with HFpEF and whether the clinical benefit observed with empagliflozin varies according to baseline health status. Methods: HRQoL was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline, 12, 32 and 52 weeks. Patients were divided by baseline KCCQ Clinical Summary Score (CSS) tertiles and the effect of empagliflozin on outcomes were examined. The effect of empagliflozin on KCCQ-CSS, Total Symptom Score (TSS) and Overall Summary Score (OSS) were evaluated. Responder analyses were performed to compare the odds of improvement and deterioration in KCCQ related to treatment with empagliflozin. Results: The effect of empagliflozin on reducing the risk of time to cardiovascular death or HF hospitalization was consistent across baseline KCCQ-CSS tertiles (HR 0.83 [0.69-1.00], HR 0.70 [0.55-0.88] and HR 0.82 [0.62-1.08] for scores <62.5, 62.5-83.3 and ≥83.3, respectively; P trend=0.77). Similar results were seen for total HF hospitalizations. Patients treated with empagliflozin had significant improvement in KCCQ-CSS versus placebo (+1.03, +1.24 and +1.50 at 12, 32 and 52 weeks, respectively P<0.01); similar results were seen for TSS and OSS. At 12 weeks, patients on empagliflozin had higher odds of improvement ≥5 points (OR 1.23; 95%CI 1.10, 1.37), ≥10 points (1.15; 95%CI 1.03, 1.27), and ≥15 points (1.13; 95%CI 1.02, 1.26) and lower odds of deterioration ≥5 points in KCCQ-CSS (0.85; 95%CI 0.75, 0.97). A similar pattern was seen at 32 and 52 weeks, and results were consistent for TSS and OSS. Conclusions: In patients with HFpEF, empagliflozin reduced the risk for major HF outcomes across the range of baseline KCCQ scores. Empagliflozin improved HRQoL, an effect that appeared early and was sustained for at least one year.

scholarly journals Patient-Reported Outcomes from Heart Failure Patients Participating in the Future Patient Telerehabilitation Program: Data From the Intervention Arm of a Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Cathrine Skov Schacksen ◽  
Anne-Kirstine Dyrvig ◽  
Nanna Celina Henneberg ◽  
Josefine Dam Gade ◽  
Helle Spindler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Patient Reported Outcomes ◽  
Well Being ◽  
Heart Failure Patients ◽  
Patient Reported ◽  
The Future ◽  
One Year ◽  
Future Patient

BACKGROUND More than 37 million people throughout the world are diagnosed with heart failure that is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients’ recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation and making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox with the aim of enabling HF patients to monitor and evaluate their own current status has been developed and tested via data from a questionnaire (patient reported outcomes) that the patient has answered every other week (patient -reported outcomes) for one year. OBJECTIVE The aim of this sub-study is to evaluate the changes in quality of life and well-being for heart failure patients participating in the FPT Program over the course of one year. METHODS In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). The patients in the telerehabilitation group answered patient reported outcomes that consisted of three components: Questions regarding the patients’ sleep patterns using the Spiegel Sleep Questionnaire. Measurements of physical limitations, symptoms, self-efficacy, social interaction and quality of life were assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ). In addition, five additional questions regarding psychological well-being were developed by the research group. Of the 70 patients in the TR group, 56 answered the PRO questionnaire and completed the program, and it is these 56 patients who constitute the population for this study. RESULTS The changes in scores during one year of the study were examined using one-sample Wilcoxon signed-rank tests with a hypothesized median being 0. There were statistically significant differences in the scores in most of the slopes and intersections of the scores from the dimensions from the KCCQ and in the slopes of the patients’ overall well-being (p < 0.05). Only one dimension, the symptom stability, showed a decrease in scores over a one-year period. CONCLUSIONS The overall well-being of heart failure patients increased during one year of participating in a telerehabilitation program. There was a statistically significant increase in clinical and social well-being and quality of life during the one-year intervention period. The increase in the scores over time may indicate that the patients became more aware of their own symptoms and became better equipped to cope with disease in their everyday lives. These results suggest that patient-reported-outcome questionnaires may be used as a tool for patients in a telerehabilitation program that can both monitor and guide the patients in mastering their own symptoms CLINICALTRIAL ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918

Quality of life after pelvic radiotherapy with hypofractionated IMRT boost and long-term hormone therapy for locally advanced prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 75-75
Author(s):  
H. C. Quon ◽  
P. Cheung ◽  
D. A. Loblaw ◽  
G. Morton ◽  
E. Szumacher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Hormonal Therapy ◽  
Patient Reported Outcomes ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Summary Score ◽  
Patient Reported

75 Background: Combined radiotherapy (RT) and long-term hormonal therapy (HT) is a standard treatment option for high-risk prostate cancer. Dose escalated RT alone has been shown to improve disease free survival. Increased sensitivity of prostate cancer to high doses per fraction has led to hypofractionation as a method to radiobiologically escalate dose.We report on the quality of life of patients treated with combined hypofractionated RT and HT. Methods: A prospective phase I/II study enrolling patients with any of: clinical T3, PSA ≥20, or Gleason 8-10. Forty-five Gy (1.8 Gy/fraction) was delivered to the pelvic nodes with a concomitant 22.5 Gy intensity-modulated RT boost to the prostate, for a total of 67.5 Gy (2.7 Gy/fraction) in 25 fractions over 5 weeks. Hormonal therapy was administered for 2-3 years. Patient reported outcomes were measured at baseline and every 6 months using the validated Expanded Prostate Cancer Index Composite (EPIC) questionnaire, which measures urinary, bowel, sexual, and hormonal domains. Results: Sixty patients with a minimum 24 months of patient-reported outcomes were analyzed. Mean scores comparing baseline to 24 month values are reported. There were no statistically significant changes in the urinary summary scores (86.3 vs. 86.0, p=0.45) or any of the urinary subscales (function, bother, incontinence, irritative/obstructive). Domain summary score decreases were observed in: bowel by 4.4% (94.7 vs. 90.3, p<0.01), sexual by 27% (44.5 vs. 17.5, p<0.01), and hormonal by 11.9% (93.1 vs. 81.2, p<0.01). Examining time trends in outcomes, most changes occurred within the first 6 months with smaller changes thereafter. Conclusions: Hypofractionated RT combined with long-term HT is associated with good patient-reported urinary and bowel outcomes at 24 months. Sexual and hormonal summary scores are affected, largely due to continued androgen deprivation therapy. Further follow-up is needed to document patient reported outcomes after testosterone recovery. No significant financial relationships to disclose.

Sleep Quality and Quality of Life Among Healthy High School Athletes

2019 ◽  
Vol 59 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Morgan N. Potter ◽  
David R. Howell ◽  
Katherine S. Dahab ◽  
Emily A. Sweeney ◽  
Jay C. Albright ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High School ◽  
Sleep Quality ◽  
Measurement Information ◽  
Poor Sleep ◽  
High School Athletes ◽  
Patient Reported ◽  
Measurement Information System ◽  
Good Sleep

We examined the association between sleep quality and quality of life (QOL) among uninjured high school athletes. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 questionnaire. One hundred ten athletes reported poor sleep quality (mean PSQI: 6.6 ± 2.0; mean age: 15.3 ± 1.1; 62% female); 162 athletes reported good sleep quality (mean PSQI: 2.3 ± 1.3; mean age: 15.1 ± 1.7; 33% female). After adjusting for sex and age, worse sleep quality was associated with higher physical function/mobility (β = 0.034; 95% confidence interval [CI] = 0.007-0.060; P = .01), anxiety (β= 0.391; 95% CI = 0.263-0.520; P < .001), depressive symptom (β = 0.456; 95% CI = 0.346-0.565; P < .001), fatigue (β = 0.537; 95% CI = 0.438-0.636; P < .001), pain interference (β = 0.247; 95% CI = 0.119-0.375; P < .001), and pain intensity (β = 0.103; 95% CI = 0.029-0.177; P = .006) ratings. Poor self-reported sleep quality among adolescent athletes was associated with worse QOL ratings. Clinicians should consider assessing sleep hygiene to provide guidance on issues pertaining to reduced QOL.

scholarly journals Sleep Quality, Quality of Life, and Patient-Reported Outcomes

2019 ◽  
Author(s):  
Daniel Ceballos
Keyword(s):  
Quality Of Life ◽  
Sleep Quality ◽  
Health Outcomes ◽  
Patient Reported Outcomes ◽  
Short Term ◽  
Patient Reported

Abstract Measuring health outcomes through patient-reported outcomes is a feasible scenario in the short term, more human, and more linked to the situation that the patient cares about, overcoming limitations of the classic activity scores.

scholarly journals Influence of self-management on patient-reported outcomes for individuals with chronic heart failure: a multilevel model approach from a longitudinal study

2020 ◽  
Author(s):  
Jing Tian ◽  
Jinghua Zhao ◽  
Qing Zhang ◽  
Jia Ren ◽  
Linai Han ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Clinical Significance ◽  
Patient Reported Outcomes ◽  
Management Strategies ◽  
Self Management ◽  
Converting Enzyme Inhibitors ◽  
Patient Reported

Abstract Purpose: Self-management is highly heterogenous in quality of life in individuals with chronic heart failure. The distributions, the extents of self-management strategies and changes over time of these may play a role in this uncertainty. The aim of this study was to identify clinically meaningful strategies that improve quality of life reflected by patient-reported outcomes in those with chronic heart failure.Methods: A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from May 2017 to May 2019. Self-management advice was provided in written form at discharge to all patients. Information regarding chronic heart failure in patient-reported outcomes and self-management were collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of self-management strategies for patient-reported outcome of chronic heart failure (CHF-PRO) scores, as well as its physical and psychological domains. Minimal clinically important difference was introduced to further evaluate clinical significance.Results: Scores for CHF-PRO improved significantly after discharge. A regular schedule, avoidance of over-eating, and a low-sodium diet increased scores on patient-reported outcomes, including overall scores and physical and psychological scores. In addition, exercise improved patient-reported outcomes and its physical domain. The use of angiotensin-converting enzyme inhibitors also increased physical scores. Among these variables, a regular daily schedule and avoidance of over-eating almost every day reached clinical significance for CHF-PRO scores, as well as its physical and psychological domains. Conclusions: Self-management, especially the avoidance of over-eating and maintenance of a regular schedule will improve patient-reported outcomes in those with chronic heart failure.Trial registration: 2018LL128, January 2, 2018.

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