12-month Health-related Quality Of Life Research Articles

Long-stay medical-surgical intensive care unit patients in South Africa: Quality of life and mortality 1 year after discharge

Background. Although mortality is the primary measure of critical care outcome, the health-related quality of life (HRQOL) of survivors is often diminished. There is a paucity of South African research on HRQOL in intensive care unit (ICU) survivors. Objectives. To evaluate the 1-year post-discharge data of long-stay ICU patients, a group known to consume 20 - 40% of ICU resources. Methods. A 1-year prospective observational study was conducted in a multidisciplinary medical-surgical ICU. Adult patients who were mechanically ventilated beyond 6 days were included. Clinical and mortality data were collected. Pre-admission and 6- and 12-month HRQOL were measured with the Short Form-36 questionnaire. Physical and mental component summary scores (PCS and MCS) were calculated. Associations between 12-month mortality and poor HRQOL scores were determined. Results. Of 119 patients enrolled, 40.3% had sustained trauma, 19.3% were post-surgical and 40.3% had medical conditions; 29.2% were HIV-positive (HIV status was known for 74.8% of the cohort). The hospital and 12-month mortality rates were 42.9% and 57.4% (n=66/115), respectively. Age, longer ICU stay, higher disease severity scores and vasopressor use were associated with 12-month mortality. The survivors’ median PCS and MCS at 6 and 12 months were significantly lower compared with pre-admission scores (both p<0.001). At 12 months, 53.1% of survivors demonstrated a poor PCS and 42.9% a poor MCS. Associations with poor 12-month PCS included longer ICU stay, male gender and trauma, while trauma and sepsis were associated with a poor 12-month MCS. Among the 19 trauma survivors, 78.9% had a poor MCS and/or PCS. Of previously employed patients, 54.8% were unemployed at 12 months. Conclusions. Patients ventilated beyond 6 days in a multidisciplinary ICU had a high mortality. Poor HRQOL at 12 months post discharge was frequently observed among survivors. Trauma was associated with poor 12-month outcomes. These findings highlight the need to further explore the outcomes of long-stay ICU patients in Africa.

Health-related quality of life at 3months following head and neck cancer treatment is a key predictor of longer-term outcome and of benefit from using the patient concerns inventory.

IntroductionDuring clinical follow‐up it can be difficult to identify those head and neck cancer (HNC) patients who are coping poorly and could benefit from additional support. Health‐related quality of life (HRQOL) questionnaires and prompt lists provide a means by which patients can express their perceived outcomes and raise concerns. The first aim of this secondary analysis following a randomized trial was to explore which patient characteristics, at around 3 months following treatment completion (baseline), best predict HRQOL 12 months later. The second aim was to attempt to ascertain which patients were most likely to benefit from using prompt list.MethodsCluster‐controlled pragmatic trial data were analyzed. HRQOL was measured by the University of Washington Quality of life questionnaire (UW‐QOLv4). The prompt list was the Patient Concerns Inventory (PCI‐HN).ResultsThe trial involved 15 eligible consultants and a median (inter‐quartile range) of 16 (13–26) primary HNC patients per consultant, with 140 PCI patients and 148 controls. Baseline HRQOL was the dominant predictor of 12‐month HRQOL with other predictors related to social, financial, and lifestyle characteristics as well as clinical stage and treatment. Although formal statistical tests for interaction were non‐significant the trend in analyses over a range of outcomes suggested that patients with worse baseline HRQOL could benefit more from the PCI‐HN.DiscussionHRQOL early post‐treatment is a key predictor of longer‐term outcome. Measuring and using HRQOL and the PCI‐HN are not only surrogates for predicting HRQOL at 15 months post‐treatment, but also tools to help guide interventions.

SupPoRtive Exercise Programmes for Accelerating REcovery after major ABdominal Cancer surgery trial (PREPARE-ABC): Pilot phase of a multicentre randomised controlled trial.

PREPARE-ABC is a pragmatic multicentre randomised controlled trial including an internal pilot designed to assess the clinical and cost-effectiveness of pre- and postoperative exercise in relation to short- and longer-term postoperative recovery outcomes in colorectal cancer patients undergoing surgical resection. Here, we report on internal pilot phase data for the first 200 patients randomised to the trial, which included prespecified stop-go criteria used to inform the decision to progress to the fully powered trial by the funder. Eligible and consenting patients are randomly assigned (1:1:1) to hospital-supervised exercise, home-supported exercise or treatment as usual (TAU). Randomisation is concealed but clinical teams providing treatment and participants are unmasked. Primary outcomes are 30-day morbidity (Clavien-Dindo) and 12-month health-related quality of life (Medical Outcomes Study Health Questionnaire). Here, we present findings from the prespecified pilot phase which assessed feasibility of site set up, recruitment, adherence and acceptability of trial processes to patients and site staff. Between 9 November 2016 and 18 May 2018, 18sites were set up, with 200 patients randomised to either hospital-supervised exercise (68), home-supported exercise (69) or treatment as usual (TAU) (63). Across the groups, 19 patients did not proceed to surgery or withdrew and 52% experienced a complication. Over half of the participants (57%) in the hospital-supervised group attended ≥6 preoperative sessions and 50% attended ≥5monthly postoperative exercise "booster sessions". In the home-supported group, 70% patients engaged with ≥2 telephone support sessions in the preoperative phase and 80% engaged in ≥5monthly telephone support "booster sessions". Adverse events were reported by 22 patients and three patients reported a serious adverse event. The majority of complications were Clavien-Dindo grades 1-2; however, 16 patients experienced one or more Clavien-Dindo grade 3-4 complication(s). Results of the internal pilot phase confirm the feasibility of site set-up and patient recruitment, representativeness of the sample population and adequate adherence to hospital-supervised and home-supported exercise. On the basis of these positive results, progression to the fully-powered trial was authorised by the funder.

Prediction of Heart Failure Symptoms and Health-Related Quality of Life at 12 Months From Baseline Modifiable Factors in Patients With Heart Failure.

In patients with heart failure (HF), good health-related quality of life (HRQOL) is as valuable as, or more valuable than, longer survival. However, HRQOL is remarkably poor, and HF symptoms are strongly associated with poor HRQOL. Yet, the multidimensional, modifiable predictors have been rarely examined. The aim of this study was to examine the baseline psychosocial, behavioral, and physical predictors of HF symptoms and HRQOL at 12 months and the mediator effect of HF symptoms in the relationship between depressive symptoms and HRQOL. We collected data from 94 patients with HF (mean ± SD age, 58 ± 14 years). Data included sample characteristics, depressive symptoms, perceived control, social support, New York Heart Association (NYHA) functional class, medication adherence, sodium intake, self-care management, and HF symptoms at baseline, as well as HF symptoms and HRQOL at 12 months. Multiple regression analyses were performed to address the purpose. Baseline depressive symptoms (P < .001), medication adherence (P = .010), sodium intake (P = .032), and NYHA functional class (P = .040) significantly predicted 12-month HF symptoms, controlling for covariates (F = 7.363, R = 47%, P < .001). Baseline medication adherence (P = .001), NYHA functional class (P < .001), and HF symptoms (P = .013) significantly predicted 12-month HRQOL (F = 10.701, R = 59%, P < .001). Baseline HF symptoms fully mediated the relationship between baseline depressive symptoms and 12-month HRQOL. Symptoms of HF and HRQOL could be improved by targeting multidimensional, modifiable predictors, such as self-care, depressive symptoms, and NYHA functional class.

Factors associated with return to work among survivors of out-of-hospital cardiac arrest

BackgroundAlthough out-of-hospital cardiac arrest (OHCA) is a major cause of global mortality, survival rates have increased over the last decade. As such, there is an increasing need to explore long-term functional outcomes of survivors, such as return to work (RTW). MethodologyWe analysed baseline and 12-month follow-up data from the Victorian Ambulance Cardiac Arrest Registry for patients that arrested between 2010 and 2016 who were working prior to their arrest. We also conducted more detailed RTW interviews in a subset of OHCA survivors who arrested between July and September 2017. Factors associated with RTW were assessed using multivariable logistic regression analysis. ResultsA total of 884 previously working survivors were included in the analysis, 650 (73%) of whom RTW. Male sex (AOR 1.80; 95%CI: 1.10–2.94), arrests witnessed by emergency medical services (AOR 2.72; 95%CI: 1.50–9.25), discharge directly home from hospital (AOR 4.13; 95%CI: 2.38–7.18) and favourable 12-month health-related quality of life according to the EQ-5D were associated with RTW. Increasing age (AOR 0.97; 95%CI: 0.95–0.98), traumatic arrest aetiology (AOR 0.18; 95%CI: 0.04–0.77), and labour-intensive occupations (AOR 0.44; 95%CI: 0.29–0.66) were associated with decreased odds of RTW. Of the 23 OHCA survivors that participated in the more detailed RTW telephone-interview, 87% RTW. Flexible work hours or modified duties were offered to 74% of participants. Fatigue was the most frequently reported barrier to RTW. ConclusionThis is the largest study to collectively examine factors associated with RTW among survivors of OHCA. Although larger qualitative studies are needed, our findings highlight which patients are at risk of not RTW and who may benefit from targeted rehabilitation strategies.

Abstract 270: Prediction of Health-Related Quality of Life at 12 Months From Baseline Modifiable Factors in Patients With Heart Failure

Introduction: Patients with heart failure (HF) report that good health-related quality of life (HRQOL) is more valuable than longer survival, and improvement in HRQOL after discharge has been associated with lower rates of hospitalization. However, HRQOL in patients with HF is remarkably poorer than that in patients with other chronic diseases. To improve HRQOL effectively, it is critical to examine comprehensive modifiable predictors. However, to our knowledge, this has not been examined in patients with HF. Purpose: To examine baseline psychosocial, behavioral, and physical predictors of HRQOL at 12 months in patients with HF. Methods: We collected data on HRQOL at 12 months using the Minnesota Living with Heart Failure Questionnaire and other data at baseline from 94 patients with HF (mean age 58 ± 14 years). We collected data on all psychosocial variables, one behavioral variable, and one physical variable using questionnaires: depressive symptoms (Patient Health Questionnaire), perceived control (Control Attitudes Scale-Revised), social support (Multidimensional Scale of Perceived Social Support), self-care management (Self-care management subscale of the Self-Care of Heart Failure Index), and HF symptoms (Symptom Status Questionnaire-HF). We assessed one physical factor (New York Heart Association [NYHA] functional class) using in-depth interview. We assessed two behavioral factors using objective measures: medication adherence (Micro-Electro-Mechanical Systems) and sodium intake (24-hour urine). Covariates were age and comorbidity. Multiple regression analysis was used to address the purpose. Results: After controlling for covariates, among multidimensional psychosocial, behavioral, and physical variables, 3 modifiable factors (medication adherence [p = .001], HF symptoms [p = .011], and NYHA functional class [p &lt; .001]) significantly predicted 12-month HRQOL (F = 11.853, R 2 = .59, p &lt; .001). Conclusion: The findings of this study demonstrate multidimensional, modifiable predictors that interventions can target to improve HRQOL. Clinicians and researchers can target improvement in self-care, HF symptoms, and NYHA functional class to improve HRQOL, and, in turn, to reduce hospitalization rates.

The influence of comorbidity on survival and long-term outcomes after out-of-hospital cardiac arrest

IntroductionComorbid conditions have been associated with morbidity, functional status and quality of life for patients with a wide range of diseases. Previous studies have attempted to elucidate the influence of pre-arrest comorbidities on survival and neurological recovery following out-of-hospital cardiac arrest (OHCA), however the findings are conflicting. MethodsBaseline comorbidities recorded within prehospital patient care records were linked with baseline and 12-month follow-up data from the Victorian Ambulance Cardiac Arrest Registry for adult (≥16 years) non-traumatic OHCA patients. Dates of death from the Victorian death registry were also obtained for patients surviving to hospital discharge. Multivariable logistic, linear and Cox proportional hazards regression models were used to assess the influence of the Charlson Comorbidity Index (CCI) on survival to hospital discharge, 12-month functional recovery and health-related quality of life (HR-QOL), and long-term mortality over an eight-year period. ResultsA total of 15,953 patients were included. Increasing CCI was independently associated with reduced odds of survival to hospital discharge (CCI=1: OR=0.87 [95% CI 0.76–1.00]; CCI=2: OR=0.80 [95% CI 0.68–0.94]; CCI=3: OR=0.62 [95% CI 0.50–0.78]; CCI≥4: OR=0.53 [95% CI 0.41–0.68]). Additionally, increasing CCI was associated with reduced odds of 12-month functional recovery, a reduced chance of favourable 12-month HR-QOL, and an increased hazard of mortality after discharge from hospital. ConclusionConsideration of a patient’s baseline comorbidity may assist prognostication decisions for cardiac arrest patients. Exploration of the effect of additional rehabilitation on HR-QOL and long-term survival outcomes for OHCA patients with a high baseline comorbidity burden may be warranted.

Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis.

BackgroundSelf-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most.MethodsRandomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models.ResultsFourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95% confidence interval [CI] 0.00–0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95% CI 0.66–0.94) and all-cause hospitalization (hazard ratio 0.80, 95% CI 0.69–0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes.ConclusionSelf-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended.

Health-related quality of life in patients with acute coronary syndromes and treated with ticagrelor or clopidogrel

Evaluation of: Levin LA, Wallentin L, Bernfort L et al. Health-related quality of life of ticagrelor versus clopidogrel in patients with acute coronary syndromes results from the PLATO trial. Value Health 16(4), 574–580 (2013).Antiplatelet therapy is considered essential treatment for acute coronary syndromes with or without ST-segment elevation and after stent procedures. The PLATelet inhibition and patient Outcomes (PLATO) trial compared ticagrelor or clopidogrel for the prevention of cardiovascular events. Prespecified substudies included a health-related quality of life (HRQL) study; the EQ-5D, a self-report, standardized, nondisease-specific utility measure with a single index value for health status, was used to assess HRQL. In the primary HRQL analysis, the mean 12-month HRQL score in 15,212 patients was reported to be 0.840 in the ticagrelor group and 0.832 in the clopidogrel group (p = 0.046). Excluding patients who died resulted in no difference in HRQL between patients treated with ticagrelor or clopidogrel (0.864 and 0.863, respectively; p = 0.69). The improved survival and reduction in cardiovascular events with ticagrelor as demonstrated in the main PLATelet inhibition and patient Outcomes trial are apparently obtained with no difference in quality of life.

One-year cardiovascular risk and quality of life changes in participants of a health trainer service

To explore 12-month changes in cardiovascular disease (CVD) risk and health-related quality of life (HRQoL) in participants of a health trainer (HT) programme. Participants were 994 adults with at least one established CVD risk factor who were referred to a HT programme. The primary outcome was 12-month change in Framingham 10 year CVD risk score. Secondary outcomes included change in individual risk factors and HRQoL. Intention to treat analysis was used to explore 12-month changes for the overall population and those classified 'high risk' (≥20% CVD risk) at baseline. At baseline, 33.6% of participants were classified as 'high CVD risk' and 95.7% were overweight or obese. There were modest 12-month improvements in most modifiable CVD risk factors, but not overall CVD risk (-0.25±6.50%). In 'high-risk' participants significant reductions were evident for overall CVD risk (-2.34±8.13%) and individual risk factors. Small, significant 12-month HRQoL improvements were observed, but these were not associated with CVD risk change. Significant CVD risk reductions in participants in this HT programme with high baseline CVD risk (.20%) in HRQoL in the population as a whole indicated that the programme in its current form should target high-risk patients.

Dose-dependent relationship of physical and depressive symptoms with health-related quality of life in patients with heart failure

Patients with heart failure (HF) have poor health-related quality of life (HRQOL). The vast majority of patients have physical symptoms, and about 30-40% have depressive symptoms. The combined effects of physical and depressive symptoms on HRQOL have not been examined fully in HF. To examine the combined effects of physical and depressive symptoms on HRQOL using repeated measures, controlling for covariates (i.e. age, education level, New York Heart Association (NYHA) functional class, financial status, and health perception). Patients (N = 224, 62 ± 12 years old, 67% male, 38% NYHA functional class III/IV) provided data on physical (Symptom Status Questionnaire) and depressive symptoms (Beck Depression Inventory II) at baseline and HRQOL (Minnesota Living with Heart Failure Questionnaire) at baseline and 12 months. Patients were divided into three groups based on presence of physical and depressive symptoms: a) no symptom group, b) one symptom group (dyspnea or fatigue), and c) two symptom group (physical and depressive symptoms). Repeated measures ANOVA was used to analyze the data. The least squares mean scores of baseline and 12-month HRQOL differed significantly in the three groups after controlling for the covariates (26.4 vs. 36.6 vs. 53.1, respectively, all pairwise p values < 0.001). There was no time-by-group interaction or time main effect. Physical and depressive symptoms have a dose-response relationship with HRQOL. Further research is needed to provide effective interventions to improve physical and depressive symptoms, in turn, HRQOL.

Effects of 12-month exercise on health-related quality of life: A randomized controlled trial

ObjectiveWe investigated exercise effects on health-related quality of life (HRQOL) and exercise self-efficacy, and tested effect modification by baseline body mass index (BMI) and gender. MethodsMiddle-aged women (n=100) and men (n=102) were randomly assigned to either exercise (360 min/week of moderate-to-vigorous aerobic exercise) or control in Seattle, WA, from 2001 to 2004. Demographics, anthropometrics, exercise self-efficacy (5-item self-efficacy questionnaire) and HRQOL (SF-36) were assessed at baseline and 12months. Analysis of covariance adjusting for baseline scores was used to compare HRQOL and exercise self-efficacy scores between the exercise and control groups. ResultsAt 12months, exercisers demonstrated higher exercise self-efficacy than controls (percent change from baseline: −6.5% vs. −15.0%, p<0.01), without differences in HRQOL. Baseline BMI category and gender did not modify these effects. In exploratory analyses comparing exercisers and controls within subgroups defined by gender and BMI, 12-month HRQOL scores [role–physical (+7.0% vs. −13.1%), vitality (+15.6% vs. −4.2%), social functioning (+10.0% vs. −3.5%), and mental health (+6.8% vs. −2.9%)] were higher only among overweight male exercisers (p<0.05, vs. control). ConclusionThree hundred and sixty minutes per week of exercise, recommended for weight maintenance, did not have negative effects on exercise self-efficacy or HRQOL. This level of exercise may increase HRQOL among overweight men.Trial registration. NCT00668161.

Determinants of Quality of Life After Stroke in China

Limited information exists on the long-term consequences of stroke in China. We aimed to describe the profile and determinants of health-related quality of life among 12-month survivors of stroke. The ChinaQUEST (QUality Evaluation of Stroke care and Treatment) study was a prospective 62-hospital registry study of patients with acute stroke (ischemic stroke and intracerebral hemorrhage). Health-related quality of life was determined in 12-month survivors using a 35-item quality-of-life questionnaire (QOL-35) designed specifically for use in Chinese people. Proxy responses were used in those who were unable to personally complete the QOL-35. A total of 4283 12-month stroke survivors completed assessments directly (1730 [40.4%]) or by a proxy (2553 [59.6%]). Mean (SD) health-related quality of life scores were higher in self-responders (70 [0.3] out of a best possible 100 score) than in proxy responders (60 [0.3]; P<0.001). The strongest baseline variables that predicted "low" (below median) health-related quality of life scores in self-responders were having a lower income (income <10 000 Chinese Yuan Renminbi [CNY, approximately US $1428] versus >19 000 CNY [approximately US $2714]; OR, 2.06; 95% CI, 1.37 to 3.10) and being disabled at discharge (OR, 3.65; 95% CI, 2.72 to 4.91). Proxy responders had similar predictive factors, including being disabled at discharge (OR, 4.99; 95% CI, 4.00 to 6.21), but income was not significant. In China, the strongest predictor of 12-month health-related quality of life after stroke is level of disability at hospital discharge. Level of income was another important factor. Health insurance schemes that offset the economic impact of stroke could help improve the health and well-being of Chinese people affected by stroke.

Health‐related quality of life and satisfaction with care among older men treated for prostate cancer with either radical prostatectomy or external beam radiation therapy

To analyse health-related quality of life (HRQoL) and satisfaction with care across potential curative treatments for older patients newly diagnosed with prostate cancer. In a prospective cohort study we recruited 115 older patients (> or =65 years) newly diagnosed with prostate cancer from the urology clinics of an urban academic and a Veterans' Administration (VA) hospital. Patients completed generic (Short Form-36), prostate-specific (University of California Los Angeles Prostate Cancer Index) HRQoL, and Client Satisfaction with Care (CSQ-8) surveys before treatment with either radical prostatectomy (RP) or external beam irradiation (EBRT) and at 3, 6 and 12 months afterward. Clinical and demographic data were obtained via medical chart review. A repeated-measures analysis of variance was used to examine changes in generic and prostate cancer-specific HRQoL between treatments. Log-linear regression was used to analyse the factors associated with 12-month HRQoL scores, and Kaplan-Meier survival curves were used to compare the return to baseline values for HRQoL. The RP group had significantly higher income, education and better general health than the EBRT group. Age (odds ratio 0.5, 95% confidence interval 0.32-0.82), non-VA hospital (28.8, 2-402) and prostate-specific antigen level at diagnosis (2.8, 1.05-7.5) were associated with RP. The analysis results indicated that the RP group had higher scores for generic HRQoL subscales of physical function (P = 0.019), role emotional (P = 0.037), vitality (P = 0.033) and general health (P = 0.05) than the EBRT group. A log-linear regression model for predicting the 12-month scores showed that RP was associated with higher scores for most of the generic HRQoL and bowel function (odds ratio 1.12, P = 0.03), urinary bother (1.6, P = 0.014) and bowel bother (1.5, P = 0.013). Being older was associated with a lower score on bowel function (0.98, P = 0.05) and sexual function (0.92, P = 0.05). Satisfaction with care was comparable between treatment groups at baseline and at the follow-up. Older patients tolerate RP well from the HRQoL perspective and thus decisions for therapy in this age cohort should not be based primarily on age.

Health related quality of life after percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with acute coronary syndromes without ST-segment elevation. 12-month follow up☆

The efficacy of percutaneous and surgical revascularization in acute coronary syndromes without ST-segment elevation is similar. Therefore, other factors, like health-related quality of life, should play an important role in choosing the revascularization method. We compared 12-month health-related quality of life for high-risk patients with acute coronary syndromes without ST-segment elevation assigned to percutaneous coronary intervention (group A) versus coronary artery bypass graft surgery (group B). Patients had an episode of rest angina within 24h prior to admission and had to fulfil at least one of the criteria: (1) ST-segment depression (>or=0.05mV), (2) transient (<20min) ST-segment elevation or T-wave inversion (>or=0.1mV), (3) positive serum cardiac markers. Four hundred and ninety-six (91.34%) of 543 patients alive 12-months after index hospitalization completed a Short Form-36 (SF-36) health status survey. Group A comprised 392 patients and group B comprised 104 patients. We compared mental component summary (MCS) and physical component summary (PCS) scores from the SF-36 survey between analyzed groups. There were no significant differences in MCS scores (47.21+/-12.30 vs. 46.60+/-11.3 in group A and group B, respectively, NS). PCS scores were lower in group A (38.30+/-11.10 vs. 42.64+/-9.76; p=0.003). Patients of group A had a higher rate of unstable angina (22.45 vs. 5.77%, p=0.0002) and repeated revascularization (12.76 vs. 1.92%, p=0.001) at 1 year. Patients of group A also had higher systolic and diastolic blood pressure during follow-up (138.17+/-20.41 vs. 133.47+/-19.21, p=0.04 and 82.48+/-11.32 vs. 77.25+/-16.17, p=0.0003, respectively). Systolic blood pressure was inversely associated with PCS scores in group A (Spearman's R= -0.18 p=0.0007). This study has shown that there is a significant difference in health-related quality of life 12-months after percutaneous coronary intervention and coronary artery bypass graft surgery. This difference arises from better physical function (physical component summary) for coronary artery bypass graft surgery patients compared with percutaneous coronary intervention patients. Despite impairment of the physical health status (physical component summary), the mental health status (mental component summary) remained similar in both groups.

Social support and health-related quality of life in chronic heart failure patients.

Objectives of this study were to: (1) describe perceived social support during a baseline hospitalization and 12 months later among heart failure patients; (2) examine differences in social support as a function of gender and age (less than 65 and 65 years or older); and (3) examine social support as a predictor of health-related quality of life. Social support is a predictor of well-being and mortality, but little is known about support patterns among heart failure patients and how they influence quality of life. The sample included 227 hospitalized patients with heart failure who completed the Social Support Survey and the Chronic Heart Failure Questionnaire at baseline; 147 patients completed these questionnaires again 12 months after baseline. Mean baseline and 12-month total support scores were 56 and 53, respectively, with a score of 76 indicating the most positive perceptions of support. The ANOVA indicated significant interactions of gender by age for total (F = 5.04; p = 0.03) and emotional/informational support (F = 4.87; p = 0.03) and for positive social interactions (F = 4.43; p = 0.04), with men under age 65 perceiving less support than men aged 65 and older and women in either age group. Baseline support did not predict 12-month health-related quality of life, but changes in social support significantly predicted changes in health-related quality of life (R2 = 0.14). Overall, perceptions of support were moderate to high, but there was wide variation in perceptions over time. Men under age 65 reported less support than other groups of patients. Importantly, changes in social support were significant predictors of changes in health-related quality of life.