Impaired health status and care dependency in patients with advanced COPD or chronic heart failure

Quality of Life Research, Dec 2011

Purpose Aims of this cross-sectional study were to assess health status and care dependency in patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) and to identify correlates of an impaired health status. Methods The following outcomes were assessed in outpatients with advanced COPD (n = 105) or CHF (n = 80): clinical characteristics; general health status (EuroQol-5 Dimensions (EQ-5D); Assessment of Quality of Life instrument (AQoL); Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)); disease-specific health status (St. Georges Respiratory Questionnaire (SGRQ), Minnesota Living with Heart Failure Questionnaire (MLHFQ)); physical mobility (timed ‘Up and Go’ test); and care dependency (Care Dependency Scale). Results Patients with advanced COPD or CHF have an impaired health status and may be confronted with care dependency. Multiple regression analyses have shown that physical and psychological symptoms, care dependency and number of drugs were correlated with impaired health status in advanced COPD or CHF, while demographic and clinical characteristics like age, gender, disease severity and co-morbidities were not correlated. Conclusions Clinical care should regularly assess symptom burden and care dependency to identify patients with advanced COPD or CHF at risk for an impaired health status.

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Impaired health status and care dependency in patients with advanced COPD or chronic heart failure

Daisy J. A. Janssen 0 1 2 3 4 Frits M. E. Franssen 0 1 2 3 4 Emiel F. M. Wouters 0 1 2 3 4 Jos M. G. A. Schols 0 1 2 3 4 Martijn A. Spruit 0 1 2 3 4 0 D. J. A. Janssen Proteion Thuis, Horn, The Netherlands 1 D. J. A. Janssen CAPHRI, Maastricht University , Maastricht, The Netherlands 2 D. J. A. Janssen (&) F. M. E. Franssen E. F. M. Wouters M. A. Spruit Program Development Centre , CIRO ? , centre of expertise for chronic organ failure , Hornerheide 1, 6085 NM Horn, The Netherlands 3 J. M. G. A. Schols Department of General Practice, Nursing home medicine, Faculty of Health Medicine and Life sciences/CAPHRI, Maastricht University , Maastricht, The Netherlands 4 E. F. M. Wouters Department of Respiratory Medicine, Maastricht University Medical Centre ? (MUMC ?) , Maastricht, The Netherlands Purpose Aims of this cross-sectional study were to assess health status and care dependency in patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) and to identify correlates of an impaired health status. Methods The following outcomes were assessed in outpatients with advanced COPD (n = 105) or CHF (n = 80): clinical characteristics; general health status (EuroQol-5 Dimensions (EQ-5D); Assessment of Quality of Life instrument (AQoL); Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)); disease-specific health status (St. Georges Respiratory Questionnaire (SGRQ), Minnesota Living with Heart Failure Questionnaire (MLHFQ)); physical mobility (timed 'Up and Go' test); and care dependency (Care Dependency Scale). - Abbreviations AQoL Assessment of Quality of Life instrument BMI Body mass index CDS Care Dependency Scale COPD Chronic obstructive pulmonary disease CHF Chronic heart failure EQ-5D EuroQol-5 Dimensions FEV1 Forced expiratory volume in the first second GOLD Global initiative for chronic Obstructive Lung Disease HADS Hospital Anxiety and Depression Scale LTOT Long-term oxygen therapy SF-36 Medical Outcomes Study 36-Item Short-Form Health Survey MLHFQ Minnesota Living with Heart Failure Questionnaire NYHA New York Heart Association SGRQ St. Georges Respiratory Questionnaire Timed Up and Go Visual analogue scale Patients self-reported health status, defined as the impact of health on a persons ability to perform and derive fulfilment from the activities of daily life, is an important outcome [1]. Patients with advanced chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) often have an impaired health status [2, 3]. Previous studies suggest that health status of patients with advanced COPD or CHF is equally or even more affected than health status of patients with incurable cancer [4, 5]. Furthermore, a decreased disease-specific health status is associated with reduced rates of survival in COPD and CHF [68]. Management plans of patients with advanced COPD or CHF should strive to optimize daily functioning and stabilize disease-specific health status [911]. Identifying clinical correlates of an impaired health status may allow clinicians to better monitor health status and intervene more effectively in patients with advanced COPD or CHF. Several correlates of diminished general or disease-specific health status in COPD or CHF have been suggested before, like gender, age, educational level, symptoms, psychological symptoms, disease severity, body mass index (BMI), co-morbidities, smoking status and number of physicianprescribed drugs [2, 3, 1219]. However, currently available literature does not provide definitive evidence; hence, it is still unknown whether and to what extent these clinical correlates are interrelated in advanced COPD or CHF. Health status includes patients self-reported quality of life and functional status [1]. Functional impairment may have significant consequences for patients and their families, such as social isolation of the patient and their loved ones in the case of impaired mobility [20, 21]. One observational study showed that patients with COPD or CHF admitted to the hospital may experience disability in basic and instrumental activities of daily living [22]. Impairment in the ability to perform normal daily tasks can lead to patients becoming dependent on caregivers [20]. A qualitative study of patients with end-stage COPD, CHF or renal disease and their family caregivers showed that increased dependency may lead to frustration, depression and social isolation and increases the burden on family caregivers [20]. Finally, there is some suggestion that care dependency is associated with increased mortality in patients hospitalized for an acute exacerbation of COPD [8]. However, quantitative studies comparing care dependency in clinically stable outpatients with advanced COPD or CHF are lacking. Moreover, it remains unknown whether and to what extent care dependency and health status are interrelated in patients with advanced COPD or CHF. Aims of this cross-sectional study were to assess health stat (...truncated)


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Daisy J. A. Janssen, Frits M. E. Franssen, Emiel F. M. Wouters, Jos M. G. A. Schols, Martijn A. Spruit. Impaired health status and care dependency in patients with advanced COPD or chronic heart failure, Quality of Life Research, 2011, pp. 1679-1688, Volume 20, Issue 10, DOI: 10.1007/s11136-011-9892-9