Quality of life in adult patients with congenital heart disease and aortic valve prostheses. Outcome, determinants and predictors.

Huis in ’t Veld, A. (Anna) (2013) Quality of life in adult patients with congenital heart disease and aortic valve prostheses. Outcome, determinants and predictors. thesis, Medicine.

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Abstract

Background: Due to major improvements in surgical care for patients born with congenital heart defects (CHD), this population is growing steadily and nowadays most patients reach adulthood. In patients with CHD, aortic valve anomalies are common anatomic lesions and patients often require surgical aortic valve replacement (AVR). Besides assessing outcome regarding mortality and morbidity in patients with CHD, quality of life (QOL) has emerged as important focus of research. However, data on QOL after AVR in this group is lacking. Aim: We aimed to assess QOL in adult patients with CHD and AVR and compare this with a general reference group. Secondly, we aimed to determine which sociodemographic, clinical and surgical variables were correlated to QOL and thirdly to identify predictors of QOL. Methods: In this multicenter cross-sectional observational study we identified all patients with CHD and AVR through a national registry. We retrospectively analyzed patients’ medical history including valve type, size, type of procedure and the incidence of valve related complications. A telephone questionnaire was conducted to identify their recent health status and sociodemographic factors. QOL was assessed using a generic, validated questionnaire (RAND36). Dutch reference scores were used as control group. Results: A total of 207 patients were included. Of these, 177 patients (mean age 44 years (±12, 21-69), 69% male) returned the RAND36 questionnaire (response rate 86%). CHD patients with AVR reported significantly worse scores on the QOL domains social functioning (p < 0.01), physical problems (p = 0.01), vitality (p < 0.01) and general health (p < 0.01). However, effect sizes were low (Cohen’s d = 0.02-0.37), except for general health (Cohen’s d = 0.56). The strongest predictors for worse QOL were poor NYHA functional class, unemployment, a more severe CHD diagnosis and the presence of cardiac symptoms. Variables assessed in this study accounted for approximately 50% of the variation in QOL. Conclusions: Patients after AVR experience impaired QOL, especially in the general health domain. Patients with poor NYHA class or more severe cardiac diagnoses were more likely to report impaired QOL, whereas being employed appeared to have a positive effect on QOL. As our models only explained 10-50% of the variance in QOL, more determinants of QOL still need to be investigated in the future in order to improve medical and psychological care for patients with CHD after AVR.

Item Type:	Thesis (Thesis)
Supervisor name:	Melle, Dr. J.P. van
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:07
Last Modified:	25 Jun 2020 11:07
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2646

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