Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

Mirjam H. Mastenbroek, Susanne S. Pedersen, Mathias Meine, Henneke Versteeg*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

PURPOSE: It is well known that a significant proportion of heart failure patients (10-44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation.

METHODS: A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12-14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time.

RESULTS: All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12-20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation.

CONCLUSIONS: Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients' psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.

Original languageEnglish
JournalQuality of Life Research
Volume25
Issue number6
Pages (from-to)1451-1460
ISSN0962-9343
DOIs
Publication statusPublished - 2016

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Cardiac Resynchronization Therapy
Type D Personality
Depression
Smoking

Keywords

  • Cardiac resynchronization therapy
  • Health status
  • Heart failure
  • KCCQ
  • Trajectories

Cite this

@article{891df35857534c9d81c37f1cbc83c7ae,
title = "Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy",
abstract = "PURPOSE: It is well known that a significant proportion of heart failure patients (10-44 {\%}) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation.METHODS: A cohort of 139 patients with a CRT-defibrillator (70 {\%} men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12-14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time.RESULTS: All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12-20 {\%}) who experienced poor health status at baseline improved to stable good health status levels after implantation.CONCLUSIONS: Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients' psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.",
keywords = "Cardiac resynchronization therapy, Health status, Heart failure, KCCQ, Trajectories",
author = "Mastenbroek, {Mirjam H.} and Pedersen, {Susanne S.} and Mathias Meine and Henneke Versteeg",
year = "2016",
doi = "10.1007/s11136-015-1176-3",
language = "English",
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pages = "1451--1460",
journal = "Quality of Life Research",
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}

Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy. / Mastenbroek, Mirjam H.; Pedersen, Susanne S.; Meine, Mathias; Versteeg, Henneke.

In: Quality of Life Research, Vol. 25, No. 6, 2016, p. 1451-1460.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

AU - Mastenbroek, Mirjam H.

AU - Pedersen, Susanne S.

AU - Meine, Mathias

AU - Versteeg, Henneke

PY - 2016

Y1 - 2016

N2 - PURPOSE: It is well known that a significant proportion of heart failure patients (10-44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation.METHODS: A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12-14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time.RESULTS: All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12-20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation.CONCLUSIONS: Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients' psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.

AB - PURPOSE: It is well known that a significant proportion of heart failure patients (10-44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation.METHODS: A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12-14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time.RESULTS: All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12-20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation.CONCLUSIONS: Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients' psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.

KW - Cardiac resynchronization therapy

KW - Health status

KW - Heart failure

KW - KCCQ

KW - Trajectories

U2 - 10.1007/s11136-015-1176-3

DO - 10.1007/s11136-015-1176-3

M3 - Journal article

C2 - 26563250

VL - 25

SP - 1451

EP - 1460

JO - Quality of Life Research

JF - Quality of Life Research

SN - 0962-9343

IS - 6

ER -