Impaired health status and care dependency in patients with advanced COPD or chronic heart failure
Daisy J. A. Janssen
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Frits M. E. Franssen
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Emiel F. M. Wouters
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Jos M. G. A. Schols
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Martijn A. Spruit
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D. J. A. Janssen Proteion Thuis, Horn,
The Netherlands
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D. J. A. Janssen CAPHRI,
Maastricht University
, Maastricht,
The Netherlands
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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
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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
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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).
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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
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