Health-Related Quality of Life in Cardiovascular Patients

Health-Related Quality of Life in Cardiovascular Patients

Kalina Kawecka-Jaszcz Marek Klocek Beata Tobiasz-Adamczyk Christopher J. Bulpitt Editors Health-Related Quality of Life in Cardiovascular Patients 123

Kalina Kawecka-Jaszcz Professor of Cardiology and Internal Medicine I Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland e-mail: mckaweck@cyf-kr.edu.pl Marek Klocek Associate Professor of Internal Medicine I Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland Beata Tobiasz-Adamczyk Professor of Sociology Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland Christopher J. Bulpitt Professor of Geriatric and Cardiovascular Medicine Experimental Medicine (Care of the Elderly), Division of Medicine, Imperial College London, Hammersmith Campus, London, UK e-mail: c.bulpitt@imperial.ac.uk Contributors Bogumiła Bacior, Leszek Bryniarski, Danuta Czarnecka, Magdalena Loster, and Katarzyna Styczkiewicz I Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland ISBN 978-88-470-2768-8 ISBN 978-88-470-2769-5 DOI 10.1007/978-88-470-2769-5 Springer Milan Dordrecht Heidelberg London New York Library of Congress Control Number: 2012943048 Springer-Verlag Italia 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. 9 8 7 6 5 4 3 2 1 2012 2013 2014 2015 Cover design: Ikona S.r.l., Milan, Italy Typesetting: Ikona S.r.l., Milan, Italy Printing and binding: Esperia S.r.l., Lavis (TN), Italy Printed in Italy Springer-Verlag Italia S.r.l., Via Decembrio 28, I-20137 Milan Springer is a part of Springer Science+Business Media (www.springer.com)

Preface This book provides a unique overview of quality of life (QoL) in cardiovascular medicine. It provides much information on QoL: in hypertension; in coronary artery disease and its treatment (with drugs and interventions); in heart failure; if there are disturbances in cardiac rhythm; if implantable cardiac devices are employed; in post-stroke patients. Thus, the book is useful for the practising physician, cardiac surgeon or stroke physician. Moreover, it is an invaluable resource for anyone considering research in these areas. In addition, the Appendix provides appreciable detail and full citations on generic and disease-specific QoL questionnaires. We hope and expect that the book will help researchers to move forward in the scientific areas detailed above. There isout of necessary, an element of repetition, but we hope this is not excessive and helps to reinforce many important points. The first chapter by Beata Tobiasz-Adamczyk sets the theoretical framework for QoL. She emphasizes that we limit the discussion of QoL to health-related Qualityof-Life (HRQoL), and that measures of QoL must reflect the views of patients rather than their carers. She predicts that HRQoL measures will be applied universally despite conceptual difficulties and theoretical uncertainties. The second chapter, by Marek Klocek and Kalina Kawecka-Jaszcz, considers HRQoL in subjects with hypertension. They emphasize that QoL measures, although considered to be soft endpoints compared with biochemical or physical measures, must be scientifically determined, valid, repeatable, and provide quantitative data. The problem with reduced HRQoL in hypertension is that it may arise from: the disease; telling patients that they have hypertension (thereby engendering anxiety and adoption of a sick role); poor control of blood pressure despite treatment. The authors state that women are more likely to report impaired HRQoL than men, and discuss the HRQoL on different anti-hypertensive treatments. The third chapter is by the same authors and considers coronary artery disease v

vi Preface (CAD). Very interestingly, in this condition (and probably other conditions) a poor measure of HRQoL predicts poor survival for reasons that have yet to be determined. Allowance for the severity of coronary heart disease, other co-morbidities, as well as psychological and demographic factors do not destroy this relationship. Factors improving HRQoL in CAD include a positive affect, rehabilitation, surgery for CAD, percutaneous intervention, and drug treatment. HRQoL in this condition is reduced by coronary pain, lack of social support, depression, and cognitive dysfunction (the latter being more common than expected in CAD). In young survivors with CAD, HRQoL is equivalent to the reduced QoL of the general population that is 20 years older. Leszek Bryniarski and Marek Klocek, in the fourth chapter, discuss HRQoL in patients after percutaneous coronary intervention (PCI). They provide more detail on the effects of PCI and coronary artery bypass grafting (CABG) on HRQoL. PCI has been associated with better HRQoL than medical treatment over a 6 24-month period, but not after 36 months. This appears to be especially true in those aged > 80 years. There is evidence that HRQoL is improved with CABG rather than PCI, especially in men. Off-pump CABG improves HRQoL immediately after the procedure compared with conventional CABG, but long-term HRQoL appears to be identical in both procedures. The authors also discuss the use of bare-metal and drug-eluting stents as well as their use in acute coronary syndrome in the very elderly. The fifth chapter is on HRQoL in heart failure (HF) and is written by Marek Klocek and Danuta Czarnecka. HRQoL is particularly poor in patients with HF. This is especially true if the individual: is young; is female; has a large burden of symptoms and severe restrictions on physical activity; has concomitant diseases: is under considerable stress. Interestingly, HRQoL in HF is not closely associated with ejection fraction. Beta-blockers do not improve HRQoL in HF, but sartans and ivabradine may do so, as may increased nursing support, intravenous administration of iron, and exercise. The chapter on HRQoL with disturbances in cardiac rhythm is written by Bogumiła Bacior and Katarzyna Styczkiewicz. HRQoL in atrial fibrillation (AF) is dependent upon whether or not the condition is symptomatic and whether it is permanent rather than paroxysmal (the latter probably being associated with a less good HRQoL). There appears to be no evidence that electrical cardioversion improves HRQoL although radiofrequency ablation with subsequent pacing may do so, as may surgical treatment. In supraventricular tachycardia, ablation appears to be superior to pharmacotherapy for improving HRQoL. In vasovagal syncope, HRQoL is reduced but no drug therapy has yet to be shown to improve this situation. Bogumiła Bacior and Magdalena Loster co-author the seventh chapter: HRQoL with implantable cardiac devices. A pacemaker improves HRQoL, and dual pacing

Preface vii may prove to be better than ventricular pacing. Pacemakers with a rate-response function reduce symptoms, and cardiac resynchronization therapy reduces mortality in HF and improves HRQoL (especially in those with severe HF symptoms). Implantable cardioverter-defibrillators reduce HRQoL during the first 6 months, often due to anxiety and especially if the device discharges. After this period, HRQoL does not appear to be high and, on average, is similar to that seen for amiodarone. The last chapter, on HRQoL after stroke, is written by Marek Klocek. In this condition, HRQoL is dependent upon the degree of disability, psychological state (especially depression), cognitive functioning, communication difficulties and, most importantly, the level of independence. The QoL of carers is also reduced. When considering HRQoL after stroke, attention must be paid to fatigue and to pain (especially in paralyzed limbs), and to the effects of treatment (such as use of anticoagulants). Marek Klocek also provides a very useful table of HRQoL in various conditions. He concludes with an extensive and very useful Appendix on available questionnaires. Christopher J. Bulpitt

Contents 1 The Genesis of Health: Evolution of the Concept of Health-Related Quality of Life............................... 1 Beata Tobiasz-Adamczyk 2 Quality of Life in Hypertensive Patients.......................... 9 Marek Klocek and Kalina Kawecka-Jaszcz 3 Quality of Life in Patients with Coronary Artery Disease.......... 31 Marek Klocek and Kalina Kawecka-Jaszcz 4 Quality of Life in Patients After Coronary Interventional Treatment.................................................... 45 Leszek Bryniarski and Marek Klocek 5 Quality of Life in Patients with Chronic Heart Failure............. 61 Marek Klocek and Danuta Czarnecka 6 Quality of Life in Patients with Cardiac Rhythm Disturbances.... 75 Bogumiła Bacior and Katarzyna Styczkiewicz 7 Quality of Life in Patients with Implantable Cardiac Devices...... 91 Bogumiła Bacior, Magdalena Loster and Marek Klocek 8 Quality of Life After Stroke..................................... 103 Marek Klocek Appendix: Questionnaires Used for the Assessment of Quality of Life in Patients with Cardiovascular Diseases with Relevant References....................................... 119 Marek Klocek ix