scholarly journals Prospective cohort study of elderly patients with coronary artery disease: impact of frailty on quality of life and outcome

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001314
Author(s):  
Shouaib Qayyum ◽  
Jennifer Ann Rossington ◽  
Raj Chelliah ◽  
Joseph John ◽  
Benjamin J Davidson ◽  
...  

BackgroundElderly, frail patients are often excluded from clinical trials so there is lack of data regarding optimal management when they present with symptomatic coronary artery disease (CAD).ObjectiveThe aim of this observational study was to evaluate an unselected elderly population with CAD for the occurrence of frailty, and its association with quality of life (QoL) and clinical outcomes.MethodsConsecutive patients aged ≥80 years presenting with CAD were prospectively assessed for frailty (Fried frailty phenotype (FFP), Edmonton frailty scale (EFS)), QoL (Short form survey (SF-12)) and comorbidity (Charlson Comorbidity Index (CCI)). Patients were re-assessed at 4 months to determine any change in frailty and QoL status as well as the clinical outcome.ResultsOne hundred fifty consecutive patients with symptomatic CAD were recruited in the study. The mean age was 83.7±3.2 years, 99 (66.0%) were men. The clinical presentation was stable angina in 68 (45.3%), the remainder admitted with an acute coronary syndrome including 21 (14.0%) with ST-elevation myocardial infarction. Frailty was present in 28% and 26% by FFP and EFS, respectively, and was associated with a significantly higher CCI (7.5±2.4 in frail, 6.2±2.2 in prefrail, 5.9±1.6 in those without frailty, p=0.005). FFP was significantly related to the physical composite score for QoL, while EFS was significantly related to the mental composite score for QoL (p=0.003). Treatment was determined by the cardiologist: percutaneous coronary intervention in 51 (34%), coronary artery bypass graft surgery in 15 (10%) and medical therapy in 84 (56%). At 4 months, 14 (9.3%) had died. Frail participants had the lowest survival. Cardiovascular symptom status and the mental composite score of QoL significantly improved (52.7±11.5 at baseline vs 55.1±10.6 at follow-up, p=0.04). However, overall frailty status did not significantly change, nor the physical health composite score of QoL (37.2±11.0 at baseline vs 38.5±11.3 at follow-up, p=0.27).ConclusionsIn patients referred to hospital with CAD, frailty is associated with impaired QoL and a high coexistence of comorbidities. Following cardiac treatment, patients had improvement in cardiovascular symptoms and mental component of QoL.

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lucas Molinari Veloso da Silveira ◽  
Adriana Silveira Almeida ◽  
Felipe C. Fuchs ◽  
Aline Gonçalves Silva ◽  
Marcelo Balbinot Lucca ◽  
...  

Abstract Background Clinical, surgical, and percutaneous strategies similarly prevent major cardiovascular events in patients with stable coronary artery disease (CAD). The possibility that these strategies have differential effects on health-related quality of life (HRQoL) has been debated, particularly in patients treated outside clinical trials. Methods We assigned 454 patients diagnosed with CAD during an elective diagnostic coronary angiography to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical treatment (OMT), and followed them for an average of 5.2 ± 1.5 years. HRQoL was assessed using a validated Brazilian version of the 12-Item Short-Form Health Survey questionnaire. The association between therapeutic strategies and quality of life scores was tested using variance analysis and adjusted for confounders in a general linear model. Results There were no differences in the mental component summary scores in the follow-up evaluation by therapeutic strategies: 51.4, 53.7, and 52.3 for OMT, PCI, and CABG, respectively. Physical component summary scores were higher in the PCI group than the CABG and OMT groups (46.4 vs. 42.9 and 43.8, respectively); however, these differences were no longer different after adjustment for confounding variables. Conclusion In a long-term follow-up of patients with stable CAD, HRQoL did not differ in patients treated by medical, percutaneous, or surgical treatments.


2021 ◽  
Author(s):  
Lucas Molinari Veloso da Silveira ◽  
Adriana Silveira Almeida ◽  
Felipe C. Fuchs ◽  
Aline Gonçalves Silva ◽  
Marcelo Balbinot Lucca ◽  
...  

Abstract Background: Clinical, surgical and percutaneous strategies have been shown similar effectiveness in the prevention of major cardiovascular events in patients with stable coronary artery disease (CAD). The possibility that these strategies have differential effects over health-related quality of life (HRQoL) has been debated, particularly in patients treated outside clinical trials.Methods: 454 patients diagnosed with coronary artery disease during an elective diagnostic coronary angiography were assigned to Coronary Artery Bypass Grafting (CABG), Percutaneous Coronary Intervention (PCI) or optimal medical treatment (OMT), and followed on average for 6.0 ± 1.9 years. HRQoL was assessed by a validated Brazilian version of the 12-Item Short-Form Health Survey (SF-12) questionnaire. The association between therapeutic strategies and scores of QoL were tested by ANOVA and adjusted for confounding in a general linear model. Results: There was no difference in the Mental Component Summary (MCS) scores in the follow-up evaluation by therapeutic strategies: 51.4, 53.7 and 52.3, respectively, for MT, PCI, and CABG. Physical Component Summary (PCS) scores were higher in the PCI group, when compared to the CABG and MT (46.4 vs. 42.9 and 43.8, respectively), but these differences were no longer different after adjustment for confounding variables.Conclusion: In a long-term follow-up of patients with stable CAD, HRQoL was not different in patients treated by medical, percutaneous or surgical treatments.


2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Shahram Tofighi ◽  
Aliasghar Ahmad Kiadaliri ◽  
Jamil Sadeghifar ◽  
Mehdi Raadabadi ◽  
Jahanara Mamikhani

Objective.To examine the changes in health-related quality of life (HRQoL) in patients with coronary artery disease (CAD) in terms of age, gender, and treatment strategy in Iran.Methods and Materials.Forty-nine patients responded to the Iranian version of the 36-item short form (SF-36) questionnaire to evaluate the HRQoL at first and third year after treatment. The paired and independent Wilcoxon rank-sum tests were used for within and between comparisons, respectively. Multivariate regression analysis was used to analyze the predictors of changes at HRQoL.Results.In general, during followup, the mental component summary scale improved, and the physical component summary scale declined. The results of multiple regression showed that the score at the first year post-treatment was the main predictor of HRQoL at follow up. Moreover, after adjusting for other covariates, receiving PTCA and being at older age were related to lower scores at followup, but these were not statistically significant in most cases.Conclusion.The HRQoL significantly changed from one to three years after treatment in patients with CAD. While, the physical health deteriorated during two-year follow up, mental health improved at the same time period. Generally, there were no significant differences at changes of HRQoL in terms of treatment, age, and gender.


2020 ◽  
Vol 26 (1) ◽  
pp. 48-55
Author(s):  
Masoomeh Barsaei ◽  
Hossein Feizollahzadeh ◽  
Faranak Jabbarzadeh ◽  
Hadi Hasankhani ◽  
Reza Shabanloei

PurposeFollowing angioplasty for coronary artery disease, patients may search for a new meaning of life. The purpose of this study was to determine patients' meaning of life related to heart disease and its relationship to quality of life after repeat coronary artery angioplasty.MethodsThe current descriptive-correlation study recruited 144 patients with coronary artery disease admitted to hospitals in Karaj, Iran. Data were collected using a demographics questionnaire, the Meaning in Heart Disease (MHD) instrument, and the Iranian version of the Short Form Health Survey (SF-12), and were analyzed with descriptive statistics and the Pearson correlation.FindingsThere was a significant relationship between the meaning of life related to heart disease (creating illusions, changing goals, reattribution, and meaning congruence) and quality of life scores (p <.05).ConclusionThe majority of the patients undergoing repeat angioplasty used the creation of illusions to support a positive attitude toward their heart disease. Nursing interventions based on the individual patient's meaning of life can promote health and life quality.


2021 ◽  
Vol 25 (4) ◽  
pp. 64
Author(s):  
A. S. Klinkova ◽  
O. V. Kamenskaya ◽  
I. Yu. Loginova ◽  
A. M. Chernyavskiy ◽  
V. V. Lomivorotov

<p><strong>Aim.</strong> To study the quality of life and how it is influenced by different factors in the long term after myocardial re-vascularisation in patients with coronary artery disease who had acute coronary syndrome during the coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Methods.</strong> We examined 658 patients with coronary artery disease and acute coronary syndrome (mean age 66.4 ± 4.3 years). Percutaneous coronary intervention (600 patients) and coronary artery bypass grafting with cardio-pulmonary bypass (58 patients) were performed. Six months after myocardial re-vascularisation, we assessed patients' quality of life using the SF-36 questionnaire. We identified factors that affect the quality of life using multivariate regression analysis.</p><p><strong>Results.</strong> After myocardial revascularisation, the patients had a reduced overall indicator of physical health (&lt; 40 points). The overall indicator of psycho-emotional health was higher than physical (p &lt; 0.002) but did not exceed 50 points. We noted the adverse effect of COVID-19 (regardless of disease severity) on the assessment. Also, COVID-19 was associated with increased anxiety. A history of concomitant diabetes mellitus, obesity, stroke and percutaneous coronary intervention had a negative effect on the overall indicators of physical and mental health.</p><p><strong>Conclusion. </strong>Patients with coronary artery disease who had acute coronary syndrome after myocardial re-vascularisation are characterised by reduced indicators of physical and average indicators of mental health in the long term. COVID-19, regardless of disease severity, has a negative impact on patients' general state of health, social activity and emotional background. A history of diabetes mellitus, obesity, stroke and percutaneous coronary intervention adversely affects the physical and mental health indicators.</p><p>Received 4 August 2021. Revised 31 August 2021. Accepted 1 September 2021.</p><p><strong>Funding:</strong> This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation (No. 121031300225-8).</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: O.V. Kamenskaya, V.V. Lomivorotov<br /> Data collection and analysis: A.S. Klinkova<br /> Statistical analysis: A.S. Klinkova<br /> Drafting the article: A.S. Klinkova, I.Yu. Loginova<br /> Critical revision of the article: O.V. Kamenskaya, A.M. Chernyavskiy<br /> Final approval of the version to be published: A.S. Klinkova, O.V. Kamenskaya, I.Yu. Loginova, A.M. Chernyavskiy, V.V. Lomivorotov</p>


2001 ◽  
Vol 24 (8) ◽  
pp. 556-563 ◽  
Author(s):  
Deborah A. Buchner ◽  
Thomas B. Graboys ◽  
Kiel Johnson, Pharm ◽  
Margaret Mcgrath Mordin ◽  
Linda Goodman ◽  
...  

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1315
Author(s):  
Paul Windisch ◽  
Jörg-Christian Tonn ◽  
Christoph Fürweger ◽  
Felix Ehret ◽  
Berndt Wowra ◽  
...  

Background: Most existing publications on quality of life (QoL) following stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) gather information retrospectively by conducting surveys several years after treatment. The purpose of this study is therefore to provide longitudinal QoL data and assess how changes in hearing impact QoL. Methods: Patients completed the 12-item short-form (SF-12) health survey prior to treatment and at every follow-up visit. One hundred and seventy-five patients who had complete forms prior to treatment as well as at an early and at a late follow-up were included in the analysis. For 51 of these patients, longitudinal audiometry data were available. Results: Median follow-up was 7.2 years. Patients experienced a significant reduction in the physical composite score (PCS, p = 0.011) compared to before treatment. The mental composite score (MCS) increased significantly (p = 0.032). A decrease in PCS was not significantly correlated with an increased hearing threshold on the affected but rather on the unaffected ear (r(49) = −0.32, p = 0.023). Conclusions: It is unclear whether the decline in the PCS is due to treatment-related toxicity or the normal decline of PCS with age. Ensuring proper hearing on the untreated ear might be crucial to ensure good QoL for patients treated with SRS for VS, though this association should be confirmed in additional studies.


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