Health-related Quality of Life and Survival in Pulmonary Arterial Hypertension
Health-related Quality of Life and Survival in Pulmonary Arterial Hypertension
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DOI：
10.1513/annalsats.201412-572oc
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发表时间：
2016-01-01
影响因子：
8.3
通讯作者：
Hassoun, Paul M.
中科院分区：
文献类型：
--
作者：
Mathai, Stephen C.;Suber, Tomeka;Hassoun, Paul M.
依据：肺动脉高压是一种进行性疾病，尽管药物治疗取得了进展，但发病率和死亡率仍很高。患者相关结果之间的关系，如健康相关的生活质量（HRQOL），和survival.Objective：评估HRQOL和结果之间的关系在patients with pulmonary arterial hypertension.Methods：完成医学结局调查简表-36调查（SF-36）的右心导管证实的肺动脉高压患者包括在内。在基线时收集人口统计学、临床、生理学和血流动力学数据。从诊断肺动脉高压开始评估生存率。构建考克斯比例风险模型，以评估HRQOL和transplant-free survival. Measures和主要结果之间的关系：87例肺动脉高压患者入选，并进行前瞻性随访，中位数为3.8年。基线时，SF-36的8个领域中有6个领域的HRQOL显著差于美国正常值。几个领域与6分钟步行距离和世界卫生组织功能分级中度相关（r值>= 0.40）;与血流动力学无显著相关性。在单变量考克斯比例风险模型中，8个领域中的6个和两个总评分与生存率显著相关。在多变量模型中，调整年龄，疾病类型，和心脏功能，这些关系在很大程度上stressed.Conclusions：在这个队列的肺动脉高压患者，HRQOL，评估SF-36，与无移植生存率密切相关。当控制潜在的混杂因素如疾病类型和疾病严重程度时，这些关系持续存在。这些结果表明，HRQOL可能是肺动脉高压结局的重要预测因素，因此是未来治疗干预的目标。
Rationale: Pulmonary arterial hypertension is a progressive disease with high morbidity and mortality despite advances in medical therapy. The relationship between patient-related outcomes, such as health-related quality of life (HRQOL), and survival is not well described.Objective: To assess the relationship between HRQOL and outcomes in patients with pulmonary arterial hypertension.Methods: Consecutive patients with right heart catheterization-proven pulmonary arterial hypertension who completed the Medical Outcomes Survey Short Form-36 survey (SF-36) were included. Demographic, clinical, physiological, and hemodynamic data were collected at baseline. Survival was assessed from the time of diagnosis of pulmonary arterial hypertension. Cox proportional hazard models were constructed to assess the relationship between HRQOL and transplant-free survival.Measurements and Main Results: Eighty-seven patients with pulmonary arterial hypertension were enrolled and followed prospectively for a median of 3.8 years. At baseline, HRQOL was significantly worse than U.S. normal values for six of eight domains of the SF-36. Several domains demonstrated moderate correlation (r value >= 0.40) with 6-minute-walk distance and World Health Organization functional class; there were no significant associations with hemodynamics. In univariable Cox proportional hazard models, six of eight domains and both summary scores were significantly associated with survival. In multivariable models, adjusted for age, disease type, and cardiac function, these relationships largely persisted.Conclusions: In this cohort of patients with pulmonary arterial hypertension, HRQOL, as assessed by the SF-36, was strongly associated with transplant-free survival. These relationships persisted when controlling for potential confounders such as disease type and disease severity. These findings suggest that HRQOL may be an important predictor of outcomes in pulmonary arterial hypertension and therefore a target for future therapeutic interventions.