Health-related quality of life is worse in individuals with hypertension under drug treatment: results of population-based study

Patients with hypertension usually report lower health-related quality of life (HRQoL), but it is unclear whether this is secondary to high blood pressure (BP) per se, drug treatment or awareness of disease. In a cross-sectional study using a multistage population-based sample, participants were interviewed and examined at home. Hypertension was defined by BP ≥140/90 mm Hg or use of BP-lowering drugs. HRQoL was assessed through the Short-Form Health Survey (SF-12) and presented as the physical component summary (PCS), mental component summary (MCS) and the SF-12 eight-domain scale. In total, 1858 individuals were evaluated, being 60.1% women, aged 52.5 ± 4.1 years old, and 39.9% men, aged 47.2 ± 9.1 years old. Prevalence of hypertension was 34.2% (95% CI 31.5-36.9). The PCS scores for hypertensive and normotensive participants were 49.4 (CI 48.6-50.2) and 51.06 (CI 50.4-51.7) (P=0.01), respectively, and the MCS scores were 49.1 (CI 47.9-50.3) and 50.5 (CI 49.6-51.2) (P=0.06), respectively. Participants with hypertension and not using BP drugs had higher HRQoL scores (PCS 49.6; MCS 51.9) than those using BP drugs either with uncontrolled (PCS 45.3; MCS 49.4) or controlled BP (PCS 46.2; MCS 47.7; P<0.05). We concluded that individuals with hypertension have worse quality of life, particularly when their BP is controlled by drugs. This perception may lead to lower rates of adherence to treatment.     

OSA and CPAP therapy: effect of gender,somnolence, and treatment adherence on health-related quality of life

Background

Obstructive sleep apnea (OSA) often has a significant impact on health-related quality of life (HRQoL) with social and psychological implications. For most OSA patients, a reduction in their HRQoL is due to symptoms such as poor sleep quality, excessive daytime somnolence, and fatigue with differences between gender.

Purpose

This study explores the CPAP treatment effect on self-perceived HRQoL related to gender, somnolence, and CPAP adherence.

Methods

Out of 1082 consecutive Italian outpatients, 125 (82 M) (60.3?±?9.6 years) completed the prospective observational study and were evaluated at the first visit (T0), and the follow-up visit (T1). Two self-reported HRQoL questionnaires were administered: six subscales Psychological General Well-Being Index (PGWBI) and 12-Item Short-Form Health Survey (SF-12).

Results

Scores of PGWBI and SF-12 MCS improved from T0 to T1. Patients with CPAP use ≥?4 h/night showed a significant improvement in all dimensions evaluated, except for SF-12 PCS. At T1, participants with ESS >?10 improved in all scores, except SF-12 PCS. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up visit. Variation of PGWBI was significantly correlated with CPAP use, ESS at T0 and T1 (p?<?0.0001; r²?=?0.26).

Conclusions

This study provides evidence on the effectiveness of CPAP treatment on perceived HRQoL. Participants with greater adherence to therapy, greater sleepiness, and greater improvement of daytime sleepiness with CPAP therapy, reported a higher quality of life improvement. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up, despite a more considerable improvement in females.

     

Asthma and health‐related quality of life – effect of adjusting for potential confounders

Background: Health‐related quality of life (HRQoL) is an increasingly important outcome measure in medical research. We wanted to evaluate how adjustment for potential confounders affected the relationship between HRQoL and asthma. Furthermore, we wanted to evaluate the relationship of environmental tobacco smoke (ETS) with HRQoL. Methods: We carried out a cross‐sectional Norwegian community study in 1996/1997 including 2306 randomly selected subjects aged 26 years–81 years. Data on HRQoL were measured by SF‐12. The data were analyzed by robust linear regression analyses with the physical component score (PCS) and the mental component score (MCS) as dependent variables. The effect of adjusting for the potential confounders was analyzed by bootstrap confidence intervals for differences between the adjusted and unadjusted models. Results: The difference in the asthma coefficients between the unadjusted and adjusted models for both PCS and MCS varied from 0.1 to 1.1. The confidence intervals for these differences for PCS were (?0.3, 1.6) and (0.4, 1.8), using the definition ‘asthma last 12 months’ and ‘physician's diagnosis of asthma’, respectively. The confidence intervals for the corresponding differences for MCS were (?0.01, 1.3) and (?0.6, 0.4), respectively. Univariately, PCS was lower among subjects reporting ETS at home compared to people not reporting ETS at home, but this difference did not persist in the multivariate analyses. ETS at home was associated with slightly improved MCS. Conclusion: Adjusting for potential confounders does not change the relationship between asthma and HRQoL overtly. Please cite this paper as: Voll‐Aanerud M, Eagan TML, Wentzel‐Larsen T, Gulsvik A and Bakke PS. Asthma and health‐related quality of life – effect of adjusting for potential confounders. The Clinical Respiratory Journal 2008; 2: 106–115.     

Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study

OBJECTIVE: to investigate the relationship between grip strength and health-related quality of life (HRQoL). DESIGN: cross-sectional survey within a cohort study design. SETTING: the county of Hertfordshire in the UK. PARTICIPANTS: a total of 2,987 community-dwelling men and women aged 59-73 years of age. MEASUREMENTS: grip strength was used as a marker of sarcopaenia and measured using a Jamar dynamometer. HRQoL was assessed using the eight domain scores of the Short Form-36 (SF-36) questionnaire, and subjects in the lowest sex-specific fifth of the distribution were classified as having 'poor' status for each domain. RESULTS: men and women with lower grip strength were significantly more likely to report a poor as opposed to excellent to fair overall opinion of their general health (GH) [odds ratio (OR) per kilogram decrease in grip strength = 1.13, 95% CI = 1.06-1.19, P < 0.001 in men, 1.13, 95% CI = 1.07-1.20, P < 0.001 in women]. Among men, after adjustment for age, size, physical activity and known co-morbidity, decreased grip strength was associated with increased prevalence of poor SF-36 scores for the physical functioning (PF) (OR per kilogram decrease in grip strength = 1.03, 95% CI = 1.01-1.06, P = 0.007) and GH domains (OR = 1.03, 95% CI = 1.01-1.05, P = 0.01). Similar associations were seen in women. CONCLUSIONS: our findings suggest that lower grip strength is associated with reduced HRQoL in older men and women. This does not appear to be explained by age, size, physical activity or co-morbidity and may reflect the link between sarcopaenia and generalised frailty. Individuals with sarcopaenia may benefit from interventions to improve muscle mass and strength before the onset of chronic disorders usually associated with impaired HRQoL.     

Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status.AimTo evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD.This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form?, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured.Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p = 0.06) and severe (p = 0.005) PEW had lower HRQoL score [68 (52–75), 55 (45–72), 46 (43–58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ² 58.2, p < 0.0001).As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.     

Assessment of health-related quality of life,anxiety and depression in patients with early rheumatoid arthritis

Aim of the workTo assess the effect of clinical manifestations, disease activity and medications on health-related quality of life (HRQoL) among patients with early rheumatoid arthritis (RA).Patients and methodsTwenty-six early RA patients (mean age 43.31 ± 10.51 years, disease duration: 16.5 ± 5.2 months) diagnosed according to the 2010 RA classification criteria were recruited from the outpatient clinic of the Rheumatology and Rehabilitation Department, Sohag University, and 22 age and sex matched healthy persons participated in a case control study. Demographic data were taken from all participants in the study. The 36-item short-form health survey (SF-36) and Hamilton Anxiety Rating Scale (HAM-A) were assessed as measures of HRQoL and psychiatric comorbidity for both patients and controls. Disease activity in RA was assessed using the disease activity score (DAS28). Scoring algorithms were applied to produce the physical and mental component scores (PCS and MCS).ResultsThere was statistically significant difference in the total SF36 score, anxiety and depression scores of HAM-A scale between patients and controls. The PCS showed the highest significant difference (p < 0.0001), followed by SF36 (p = 0.01) and MCS (p = 0.024). There were no significant differences according to the age, gender, occupation or level of education of the patients. Anxiety and depression scores significantly correlated with the bodily pain and DAS28 scores and inversely with the PCS and MCS. The DAS28 strongly negatively correlated with the PCS and MCS.ConclusionRheumatoid arthritis has a major impact on many areas of an individual’s life and tends to have a profound impact on the health-related quality of life.     

Changes in respiratory symptoms and health-related quality of life

BACKGROUND: For a number of chronic diseases, health-related quality of life (HRQoL) has become an important outcome measure. Little data are available on how incidence, remission, or persistence of respiratory symptoms affect HRQoL. METHODS: The Hordaland County Cohort Study was conducted between 1985 and 1997, and comprised 3,786 subjects, randomly selected, and aged 15 to 70 years in 1985. Respiratory symptoms were assessed both in 1985 and 1996/1997, and HRQoL was measured by the Short-Form 12 questionnaire in 1996/1997. Robust linear regression analysis was used to examine the relationship between changes in six respiratory symptoms and the physical component score (PCS) and mental component score (MCS). RESULTS: Among subjects with incidence or persistence of any of the six examined respiratory symptoms, PCS and MCS were significantly lower than among subjects without symptoms. The PCS was more reduced than the MCS in symptomatic subjects; however, this trend was reduced after adjustment for the confounder's gender, age, educational level, body mass index, and smoking status. Dyspnea attacks and dyspnea grade 2 had the largest negative impact on both PCS and MCS. CONCLUSIONS: This is the first longitudinal population study to show the negative impact of incidence and persistence of respiratory symptoms on HRQoL.     

Health-related quality of life in ankylosing spondylitis,fibromyalgia syndrome,and rheumatoid arthritis: a comparison with a selected sample of healthy ındividuals

In this study, we compared health-related quality of life (HRQoL) scores of patients with rheumatoid arthritis (RA), fibromyalgia syndrome (FS), or ankylosing spondylitis (AS), with those of a selected sample of healthy individuals. The study group comprised 530 patients (264 with RA, 149 with FS, and 117 with AS). Three hundred fifteen healthy controls were used for comparison. HRQoL scores were obtained using the Short-Form (SF)-36 Health Survey. Frequency, mean, correlation, and multiple regression analyses were performed; in addition to the Student's t test, one-way ANOVA test, Kruskal–Wallis test, and chi-square test. The average physical component summary (PCS) and mental component summary (MCS) scores of patients in the RA, FS, and AS groups were much lower than those in the control group (p < 0.05). In all three patient groups, the lowest PCS score was found in the RA group, and the lowest MCS score was found in the FS group. The PCS scores of RA patients with disease-related changes in daily activities and the MCS scores of FS patients were lower (p < 0.05). In the three patient groups, the quality of life (QoL) of university graduates and those with a high level of income was good, whereas the QoL of patients who lacked information about the disease was poor. This study shows that AS, FS, and RA have a negative impact on HRQoL. Evaluating the HRQoL of patients with these conditions may provide guidance on their treatment and care.     

Health-related quality of life in patients with primary sclerosing cholangitis: A longitudinal population-based cohort study

Background & Aims

Data regarding health-related quality of life (HRQoL) in primary sclerosing cholangitis (PSC) are sparse and have only been studied cross-sectionally in a disease which runs a fluctuating and unpredictable course. We aim to describe HRQoL longitudinally by using repeated measurements in a population-based cohort.

Methods

Every 3 months from May 2017 up to August 2020, patients received digital questionnaires at home. These included the EQ-5D, 5-D Itch, patient-based SCCAI and patient-based HBI. The SF-36, measuring HRQoL over eight dimensions as well as a physical component summary (PCS) and mental component summary (MCS) score, was sent annually. Data were compared with Dutch reference data and a matched IBD disease control from the population-based POBASIC cohort. Mixed-effects modelling was performed to identify factors associated with HRQoL.

Results

Three hundred twenty-eight patients completed 2576 questionnaires. A significant reduction of small clinical relevance in several mean HRQoL scores was found compared with the Dutch reference population: 46.4 versus 48.0, p = .018 for PCS and 47.5 versus 50.5, p = .004 for MCS scores. HRQoL outcomes were significantly negatively associated with coexisting active IBD (PCS −12.2, p < .001 and MCS −12.0, p < .001), which was not the case in case of quiescent IBD. Decreasing HRQoL scores were also negatively associated with increasing age (PCS −0.1 per 10 years, p = .002), female sex (PCS -2.8, p < .001), diagnosis of AIH overlap (PCS -3.7, p = .059), end-stage liver disease (PCS -3.7, p = .015) and presence of itch (PCS -9.2, p < .001 and MCS −3.1, p = .078). The odds of reporting a clinically relevant reduction in EQ-5D scores showed seasonal variation, being lowest in summer (OR = 0.48 relative to spring, p = .037). In patients with liver transplant, HRQoL outcomes were comparable to the Dutch general population.

Conclusions

PSC patients report impaired HRQoL of small clinical relevance compared with the general population. After liver transplantation, HRQoL scores are at comparable levels to the general population. HRQoL scores are associated with potentially modifiable factors such as itch and IBD activity.     

Validity and reliability of the 36-Item Short Form Health Survey questionnaire version 2 among people living with HIV in Brazil

BackgroundThe 36-Item Short Form Health Survey questionnaire (SF-36) is a widely used instrument for evaluating health-related quality-of-life (HRQoL). The psychometric validation of the SF-36 version 2.0 (SF-36v2) in HIV-infected patients had not yet conducted in Brazil.AimTo test data quality, reliability and validity of the SF-36v2 as a measure of HRQoL among Brazilian individuals living with HIV.MethodsA cross-sectional study included 393 HIV-infected patients in whom HRQoL was assessed by using the SF-36v2 questionnaire. Demographic characteristics, socioeconomic status and clinical data were also collected. The SF-36 version 1 translated into Brazilian-Portuguese was adapted and introduced version 2 improvements according to the instrument developers. SPSS version 21 was used for data analyses. Confirmatory factor analysis (CFA) and structural equation modelling were performed using AMOS SPSS version 18. T-test for independent samples was used to compare differences between mean levels of HRQoL components in different groups. Linear multiple regression techniques were used to analyze the relationship between Physical Component Summary (PCS), Mental Component Summary (MCS) and independent variables.ResultsWe performed the CFA and tested the hypothetical measurement model. We included five parameters to improve the adherence of data to the model. All indicators met the requirement suggested by specialized literature (χ2 (gl): 980.7 (527); CFI: 0.949; GFI: 0.873; TLI: 0.943; RMSEA: 0.047; 90% IC: 0.042-0.051). Multiple regression analyses revealed that depression (p = 0.001), family income (p = 0.007), sex (p = 0.001) and age (p< 0.021) were associated with MCS. Comorbidities (p = 0.001), health self-perception (p = 0.001), age (p = 0.001), and sex (p = 0.025) were associated with PCS.ConclusionsA consistent validation of the SF-36v2 in Brazilian HIV patients were shown. Further studies with SF-36v2 psychometric analyses would be required in other populations to establish Brazilian normative data.     

Gender differences in health-related quality of life at the time of a positive HIV test – a cross-sectional study in a resource-poor,high prevalence setting in Nairobi,Kenya

Few studies have examined gender differences in sub-Saharan Africa, where HIV disproportionately affects women. Objectives of this cross-sectional study were to determine gender differences in HRQoL at the time of a positive HIV test, and whether factors associated with HRQoL differed between men and women. Adults testing HIV-positive were recruited from two clinics located in informal settlements. HRQoL was measured with the SF-12. Multiple linear regression was used to test whether there were gender differences in physical (PCS) and mental composite summary (MCS) scores. Separate models were built for men and women to examine factors associated with HRQoL. Between April 2013 and June 2015, 775 individuals from were recruited. The mean PCS score was higher in women (adjusted mean difference 2.49, 95% CI 0.54 to 4.44, p?=?0.012). There was no significant gender difference in MCS scores. Similar factors were associated with better physical HRQoL in men and women: secondary education, younger age, higher CD4, and employment. Employment was the only factor associated with MCS in men, while less social support and low CD4 were associated with poorer MCS scores in women. Gender differences in factors related to HRQoL should be considered in broader policy and interventions to improve the HRQoL in those diagnosed with HIV.     

Respiratory symptoms, COPD severity, and health related quality of life in a general population sample

AIMS: The aim of this report from a general population sample was to examine the association of respiratory symptoms and COPD severity with HRQoL (health related quality of life). METHODS: In a general population study in 1996-1997, of 3181 invited subjects aged 26-81 years, a total of 2405 returned postal questionnaires on respiratory symptoms and attended a clinical examination. Altogether 2306 subjects completed the SF-12 questionnaire, a general HRQoL questionnaire. The univariate relationships between respiratory symptom burden, degree of bronchial obstruction, and HRQoL were investigated by the Wilcoxon test for trend and the Mann-Whitney U-test. Adjustment for gender, age, education, and smoking habits was done using linear regression with estimation of robust standard errors. RESULTS: In asymptomatic subjects the mean (SD) physical component scale (PCS) score was 51.8 (7.4) and the mean (SD) mental component scale (MCS) score was 52.6 (8.0). Having one to six symptoms gave mean (SD) PCS scores of 49.6 (8.8), 48.2 (9.7), 45.1 (10.4), 42.1 (11.9), 38.1 (11.4), and 34.7 (10.2), respectively. The corresponding numbers for MCS scores were 50.9 (8.0), 48.8 (9.6), 48.9 (10.6), 47.2 (10.2), 43.6 (10.4), and 44.2 (9.8), respectively. In the multivariate model, subjects in GOLD stages 3 and 4 had significantly reduced PCS scores, while subjects with COPD had a significantly higher MCS score than subjects without COPD, after adjustment for symptoms. Both the PCS and MCS scores declined significantly with increasing number of respiratory symptoms. CONCLUSION: In a general population sample, the burden of respiratory symptoms is more strongly associated with generic HRQoL than is lung function.     

Fatigue Affects Health Status and Predicts Mortality Among Subjects with COPD: Report from the Population-Based OLIN COPD Study

Background: COPD is associated to increased fatigue, decreased health status and mortality. However, these relationships are rarely evaluated in population-based studies. Aims: To describe the relationship between health status, respiratory symptoms and fatigue among subjects with and without COPD. Further, to evaluate whether fatigue and/or health status predicts mortality in these groups. Methods: Data were collected in 2007 from the population-based OLIN COPD study. Subjects participated in lung function tests and structured interviews, and 434 subjects with and 655 subjects without COPD were identified. Fatigue was assessed by FACIT-Fatigue and health status by the generic SF-36 questionnaire including physical (PCS) and mental (MCS) components. Mortality data until February 2012 were collected. Results: Fatigue greatly impacts the physical and mental dimensions of health status, both among subjects with and without COPD. Among subjects with clinically significant fatigue, COPD subjects had significantly lower PCS-scores compared to non-COPD subjects. Fairly strong correlations were found between FACIT-F, SF-36 PCS and MCS, respectively. In multivariate models adjusting for covariates, increased fatigue, decreased physical and mental dimensions of health status were all associated to mortality in subjects with COPD (OR 1.06, CI 1.02–1.10, OR 1.04, CI 1.01–1.08 and OR 1.06, CI 1.02–1.10), but not in non-COPD. Conclusions: Fatigue and decreased health status were closely related among subjects with and without COPD. Not only physical health status, but also fatigue and mental health predicted mortality among subjects with COPD. Fatigue assessed by FACIT-F, can be a useful instrument of prognostic value in the care of subjects with COPD.     

Health-related quality of life of institutionalized older adults: Influence of physical,nutritional and self-perceived health status

IntroductionInstitutionalized older adults have higher risks of diseases and worse health-related quality of life (HRQoL) than noninstitutionalized.ObjectiveTo evaluate the influence of physical state, nutritional status and self-perceived general health and oral health on the quality of life of institutionalized older adults in two Brazilian cities.MethodsA multicenter cross-sectional study was conducted in 17 homes for the aged of two Brazilian cities. Six trained researchers interviewed 344 older adults. The performance of activities of daily living (Katz scale) and frailty status (Fried scale) were applied to evaluate the physical state. The Mini Nutritional Assessment Short-Form (MNA-SF®) and the body composition were used to screening the nutritional status. A hand dynamometer was used to measure the dominant hand grip strength. The 12-Item Short Form Survey for self-perceived health (SF-12) was used to determine the HRQoL. A Likert scale was used to assess the general and oral health self-perception. Multiple Poisson regression model was applied to analyze the data (α = 0.05).ResultsThe mean (SD) score of the SF-12 was 60.89 (14.50) points. The factors associated with the highest SF-12 score were being able to walk, being nonfrail, being normal nourished, taking fewer medications, having greater dominant hand grip strength and higher self- perceived general health (p < 0.05).ConclusionBetter HRQoL in institutionalized older adults was associated with better physical state, nutritional status and self-perceived general health.     

Infliximab improves health related quality of life and physical function in patients with psoriatic arthritis

OBJECTIVES: To evaluate the effect of infliximab on health related quality of life (HRQoL) and physical function in patients with active psoriatic arthritis (PsA) in the IMPACT 2 trial. METHODS: 200 patients with PsA unresponsive to conventional treatment were randomised to intravenous infusions of infliximab 5 mg/kg or placebo at weeks 0, 2, 6, 14, and 22; patients with inadequate response entered early escape at week 16. HRQoL was assessed using the Short Form-36 (SF-36) at weeks 0, 14, and 24. Functional disability was assessed using the Health Assessment Questionnaire (HAQ) at every visit through week 24. Associations between changes in quality of life (SF-36) and articular (American College of Rheumatology (ACR)) and dermatological (Psoriasis Area and Severity Index (PASI)) responses were examined. RESULTS: Mean percentage improvement from baseline in HAQ was 48.6% in the infliximab group compared with worsening of 18.4% in the placebo group at week 14 (p < 0.001). Furthermore, 58.6% and 19.4% of infliximab and placebo treated patients, respectively, achieved a clinically meaningful improvement in HAQ (that is, > or = 0.3 unit decrease) at week 14 (p < 0.001). Increases in physical and mental component summary (PCS and MCS) scores and all eight scales of the SF-36 in the infliximab group were greater than those in the placebo group at week 14 (p < or = 0.001). These benefits were sustained through week 24. Patients achieving ACR20 and PASI75 responses had the greatest improvements in PCS and MCS scores. CONCLUSIONS: In patients with PsA, infliximab 5 mg/kg significantly improved HRQoL and physical function compared with placebo through 24 weeks.     

Health status and quality of life in patients with diabetes in Switzerland

AimsWe aimed to assess the health status and quality of life (QoL) of patients with diabetes and explore the associated factors in a French-speaking region of Switzerland.MethodsThis cross-sectional study analyzed self-reported data from 585 patients with diabetes. We ran univariate and multivariate regressions analyses on health status (Physical and Mental Component Summary scores (PCS, MCS) of the SF-12) and diabetes-specific QoL (ADDQoL score).ResultsMean PCS was 43.1 ± 10.4 and mean MCS was 46.7 ± 11.1. The overall ADDQoL score was ?1.6 ± 1.6; the life domains of the ADDQoL with the lowest scores were freedom to eat, sex life and freedom to drink. Being older was independently and significantly associated with higher mental health and QoL, while lower income was associated with lower physical health, mental health, and QoL. Having diabetes for over 10 years was associated with lower QoL, while insulin treatment and complications were correlated with lower physical health and QoL.ConclusionsThis study provides key information on the health status and QoL of patients with diabetes in Switzerland and their associated factors, which can help healthcare providers to identify patients at higher risk of lower health and QoL.     

Impact of duration in a cardiac rehabilitation program on coronary risk profile and health-related quality of life outcomes

BACKGROUND: Optimal cardiac rehabilitation (CR) program length and the time course of changes in relevant outcomes are unknown. The purpose of this study was to assess changes in coronary risk factors and health-related quality of life (HRQoL) after 3 months and 6 months of cardiac rehabilitation. METHODS: This is an observational study of a cohort of 126 consecutive cardiac rehabilitation patients who completed baseline, 3-month, and 6-month evaluations of coronary risk factors and HRQoL. The coronary risk factors included lipid profile, blood pressure, body mass index (BMI), and physical activity level. HRQoL was assessed using the Short Form-36 questionnaire (SF-36) comprising eight health concepts and two component scales (physical [PCS] and mental [MCS]). RESULTS: There was significant improvement in all coronary risk factors and HRQoL measures, except BMI, over the 6-month period (P < 0.001). Significant changes in blood pressure, physical activity, PCS, and high-density lipoprotein cholesterol (HDL-C) were apparent at 3 months, and no additional significant changes in these variables occurred between 3 and 6 months. For total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and MCS, significant change was achieved between 3 and 6 months but not between baseline and 3 months. CONCLUSIONS: Secondary prevention and HRQoL outcomes improved at variable rates. Physical activity and physical function peaked at 3 months and were maintained at program completion. Significant improvements occurred in mental health recovery beyond the traditional 12-week CR program length. Outcomes furthest from normative values showed the most rapid improvement. Optimal duration of participation may vary according to the outcome of interest.     

Health-related quality of life and productivity impact in haemophilia patients with inhibitors

Summary.  To measure health-related quality of life (HRQL), its determinants, and its association with patient and caregiver productivity among a sample of haemophilia patients with inhibitors in the United States (US). Data on demographical and clinical characteristics, treatment patterns, HRQL (SF-12v2), and productivity outcomes were reported for 53 patients. Mean SF-12v2 domain and mental (MCS) and physical (PCS) component summary scores were assessed and compared with US norms. Regression analyses explored the association of patient and treatment factors with HRQL and productivity. Patients' mean age was 20.7 years (SD = 18.8), 88.5% were type A, and 39.6% received on-demand therapy as their only mode of treatment. Mean PCS was significantly lower than the US norm (PCS, 39.9, P  < 0.01) and mean MCS showed no significant difference (MCS, 49.9, P  = ns). On-demand treatment ( B  = −0.336, P <  0.05) and number of haemorrhages ( B  = −0.366, P <  0.05) were negatively associated with PCS; and PCS was associated with patients' missed work or school days [incidence rate ratio (IRR) = 0.93, P <  0.001] and perceived impact on daily activities (OR = 0.72, P <  0.05). Younger age (IRR = 0.91, P <  0.01), lower PCS (IRR = 0.94, P <  0.01), more haemorrhages (IRR = 1.05, P < 0.05), and surgery (IRR = 2.74, P  < 0.05) were associated with fewer patients' productive days. Physical functioning among inhibitor patients in the US is compromised and is negatively associated with their daily activities and productivity. These data suggest a positive association of prophylactic and immunotolerance therapy with HRQL, specifically physical impairment.     

Abatacept improves both the physical and mental health of patients with rheumatoid arthritis who have inadequate response to methotrexate treatment

OBJECTIVE: To examine the impact of added abatacept treatment on health related quality of life (HRQoL) in patients with rheumatoid arthritis (RA) who have inadequate response to methotrexate (MTX). METHODS: The impact of abatacept treatment on HRQoL was examined in a longitudinal, randomised double blind, placebo controlled clinical trial. Effects of treatment on HRQoL were examined using repeated measures analysis of covariance and comparing rates of change in HRQoL across treatment groups. The relationship between American College of Rheumatology (ACR) clinical markers and disease duration with changes in HRQoL indicators was also examined. Finally, a responder analysis was used to examine the percentage of patients who improved by 0.5 SD in 12 months or who reached the normative levels seen in the US general population. RESULTS: Statistically significant improvements in the abatacept group relative to controls were observed across a range of HRQoL measures, including physical function, fatigue, all eight domains of the SF-36, and the physical and mental component summaries (PCS and MCS). Improvements were seen as early as day 29 for fatigue and for five out of eight SF-36 domains. By day 169, all HRQoL measures were significantly better with abatacept than with placebo. HRQoL gains were associated with greater ACR clinical improvement, and the effects were consistent for patients with different disease duration. A significantly greater percentage of patients treated with abatacept reached normative levels of PCS, MCS, physical functioning, and fatigue compared with patients treated with MTX alone. CONCLUSION: Combined abatacept and MTX treatment produces significant improvements across a wide range of HRQoL domains in patients with RA.