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Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy
Mastenbroek,M.H. Pedersen,S.S. Meine,M.M. Versteeg,H.
Mastenbroek,M.H.
Pedersen,S.S.
Meine,M.M.
Versteeg,H.
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.
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2016
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Research Projects
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Mastenbroek, M H, Pedersen, S S, Meine, M M & Versteeg, H 2016, 'Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy', Quality of Life Research, vol. 25, no. 6, pp. 1451–1460. https://doi.org/10.1007/s11136-015-1176-3