Regional variation in quality of life in patients with a Fontan circulation: A multinational perspective
Journal
American Heart Journal
Journal Volume
193
Pages
55-62
Date Issued
2017
Author(s)
Fogleman N.D.
Apers S.
Moons P.
Morrison S.
Wittekind S.G.
Tomlin M.
Gosney K.
Sluman M.A.
Johansson B.
Enomoto J.
Dellborg M.
Subramanyan R.
Luyckx K.
Budts W.
Jackson J.
Kovacs A.
Soufi A.
Eriksen K.
Thomet C.
Berghammer M.
Callus E.
Fernandes S.M.
Caruana M.
Cook S.C.
Mackie A.S.
White K.S.
Khairy P.
Kutty S.
Veldtman G.
Abstract
Background Impaired quality of life (QOL) is associated with congenital heart disease (CHD) and country of residence; however, few studies have compared QOL in patients with differing complexities of CHD across regional populations. The current study examined regional variation in QOL outcomes in a large multinational sample of patients with a Fontan relative to patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). Methods From the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease—International Study (APPROACH-IS), 405 patients (163 Fontan and 242 ASD/VSD) across Asia, Europe, and North America provided consent for access to their medical records and completed a survey evaluating QOL (0 to 100 linear analog scale). Primary CHD diagnosis, disease complexity, surgical history, and documented history of mood and anxiety disorders were recorded. Differences in QOL, medical complications, and mood and anxiety disorders between Fontan and ASD/VSD patients, and across geographic regions, were examined using analysis of covariance. Hierarchical regression analyses were conducted to identify variables associated with the QOL ratings. Results Patients with a Fontan reported significantly lower QOL, and greater medical complications and mood and anxiety disorders relative to patients with ASD/VSD. Inpatient cardiac admissions, mood disorders, and anxiety disorders were associated with lower QOL among patients with a Fontan, and mood disorders were associated with lower QOL among patients with ASD/VSD. Regional differences for QOL were not observed in patients with a Fontan; however, significant differences were identified in patients with ASD/VSD. Conclusions Regional variation of QOL is commonplace in adults with CHD; however, it appears affected by greater disease burden. Among patients with a Fontan, regional variation of QOL is lost. Specific attempts to screen for QOL and mood and anxiety disorders among CHD patients may improve the care of patients with the greatest disease burden. ? 2017 Elsevier Inc.
SDGs
Other Subjects
adult; anxiety disorder; Article; congestive heart failure; controlled study; cross-sectional study; female; follow up; Fontan procedure; heart arrhythmia; heart atrium septum defect; heart catheterization; heart surgery; heart ventricle septum defect; human; life satisfaction; major clinical study; male; mood disorder; patient information; patient-reported outcome; postoperative complication; priority journal; quality of life; anxiety disorder; clinical trial; complication; global health; heart septum defect; incidence; multicenter study; prevalence; psychology; quality of life; Adult; Anxiety Disorders; Cross-Sectional Studies; Female; Follow-Up Studies; Global Health; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Incidence; Male; Prevalence; Quality of Life
Publisher
Mosby Inc.
Type
journal article