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CC BY 4.0 · Aorta (Stamford) 2013; 01(03): 153-161
DOI: 10.12945/j.aorta.2013.13-028
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Health-Related Quality of Life in Thoracic Aortic Disease

Part I. Cases Managed Non-operatively
Christian Olsson
1   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2   Department of Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
,
Anders Franco-Cereceda
1   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2   Department of Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
› Author Affiliations
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Publication History

20 June 2013

12 July 2013

Publication Date:
28 September 2018 (online)

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Abstract

Background: The health-related quality of life (HRQOL) in subjects with chronic thoracic aortic disease (TAD) not scheduled for intervention has not been previously reported. Such information may aid counseling, management, and clinical decision-making. We report HRQOL in TAD, its main subtypes (aneurysm versus dissection and proximal versus distal), compare it to a reference group from the general population, and explore independent predictors.

Methods: The short-form 36-item (SF-36) questionnaire was used, as part of a self-reporting health survey, to measure HRQOL in eight domains and a physical component summary (PCS) and a mental component summary (MCS) score. Median differences (Δ) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures. Multivariable techniques were used to evaluate independent predictors.

Results: In 178 TAD subjects, the HRQOL was reduced (versus the reference group) in the PCS, Δ −6.4 [95% confidence limits −8.8, −4.0] and in three out of eight SF-36 domains: physical functioning (PF), Δ −10 [−15, −4.5]; physical role (RP), Δ −25 [−34, −16]; general health (GH), Δ −5.0 [−9.7, −0.27]. There were no statistically significant differences in HRQOL scores in type (aneurysm versus dissection) or location (proximal versus distal) of TAD. Multivariable analyses identified symptoms of exertional dyspnea, exertional calf pain, joint pain, and angina pectoris as predictors of lower SF-36 component summary scores.

Conclusions: The HRQOL in subjects with chronic TAD is reduced compared to a matched reference group. Differences, however, are comparably small and limited to physical domains. There were no differences according to type or location of TAD. Present symptoms and conditions were influential on the physical and mental component summary scores. HRQOL could be a useful part of thoracic aortic disease surveillance and could help guide interventional decision-making.

Key Words

Thoracic aorta - Quality of life - SF-36
 

  • References

  • 1 Olsson C, Thelin S. Quality of life in survivors of thoracic aortic surgery. Ann Thorac Surg 1999; 67: 1262-1267 . 10.1016/S0003-4975(99)00165-4
    CrossrefPubMedSearch in Google Scholar
  • 2 Immer FF, Krähenbühl ES, Immer-Bansi AS, Berdat PA, Kipfer B, Eckstein FS. , et al. Quality of life after interventions on the thoracic aorta with deep hypothermic circulatory arrest. Eur J Cardiothorac Surg 2002; 21: 10-14 . 10.1016/S1010-7940(01)01067-3
    CrossrefPubMedSearch in Google Scholar
  • 3 Immer FF, Lippeck C, Barmettler H, Berdat PA, Eckstein FS, Kipfer B. , et al. Improvement of quality of life after surgery on the thoracic aorta. Circulation 2004; 110 [suppl II]: II-250-II-255
    PubMedSearch in Google Scholar
  • 4 Crawford RS, Pedraza JD, Chung TK, Corey M, Conrad MF, Cambria RP. Functional outcome after thoracoabdominal aneurysm repair. J Vasc Surg 2008; 48: 828-835 . 10.1016/j.jvs.2008.05.018
    CrossrefPubMedSearch in Google Scholar
  • 5 Dick F, Hinder D, Immer FF, Hirzel C, Do DD, Carrel TP. , et al. Outcome and quality of life after surgical and endovascular treatment of descending aortic lesions. Ann Thorac Surg 2008; 85: 1605-1612 . 10.1016/j.athoracsur.2008.01.027
    CrossrefPubMedSearch in Google Scholar
  • 6 Zierer A, Melby SJ, Lubahn JG, Sicard GA, Damiano Jr RJ, Moon MR. Elective surgery for thoracic aortic aneurysms: late functional status and quality of life. Ann Thorac Surg 2006; 82: 573-578 . 10.1016/j.athoracsur.2006.03.042
    CrossrefPubMedSearch in Google Scholar
  • 7 Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation 2006; 114: 2611-2618 . 10.1161/CIRCULATIONAHA.106.630400
    CrossrefPubMedSearch in Google Scholar
  • 8 Winnerkvist A, Brorsson B, Rådegran K. Quality of life in patients with chronic type B aortic dissection. Eur J Vasc Endovasc Surg 2006; 32: 34-37 . 10.1016/j.ejvs.2005.12.010
    CrossrefPubMedSearch in Google Scholar
  • 9 Sullivan M, Karlsson J, Taft C. SF-36 Hälsoenkät: Svensk Manual och Tolkningsguide, 2:a upplagan. (Swedish Manual and Interpretation Guide, 2nd Edition). 2002. Gothenburg: Sahlgrenska University Hospital;
    Search in Google Scholar
  • 10 Taft C, Karlsson J, Sullivan M. Do SF-36 summary component scores accurately summarize subscale scores?. Qual Life Res 2001; 10: 395-404 . 10.1023/A:1012552211996
    CrossrefPubMedSearch in Google Scholar
  • 11 Blackstone EH. Generating knowledge from information, data, and analyses. In Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Kirklin/Barratt-Boyes Cardiac Surgery. Third edition. New York: Churchill Livingstone; 2003: 303-305
    Search in Google Scholar
  • 12 Bland JM, Altman DG. Cronbach's alpha. BMJ 1997; 314: 572 . 10.1136/bmj.314.7080.572
    CrossrefPubMedSearch in Google Scholar
  • 13 Coady MA, Rizzo JA, Hammond GL, Mandapati D, Darr U, Kopf GS. , et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms?. J Thorac Cardiovasc Surg 1997; 113: 476-491 . 10.1016/S0022-5223(97)70360-X
    CrossrefPubMedSearch in Google Scholar
  • 14 Schoormans D, Sprangers MAG, Budts W, Mulder BJM, Apers S, Moons P. Perceived health is partially associated with the symptomatological profile in patients with benign and severe conditions: the case of congenital heart disease. Qual Life Res. 2012 Published online July 31, 2012. 10.1007/s11136-012-0241-4
    PubMedSearch in Google Scholar
  • 15 Diaz-Ledezma C, Lichstein PM, Maltenfort M, Restrepo C, Parvizi J. Pattern of impact of femoroacetabular impingement upon health-related quality of life: the determinant role of extra-articular factors. Qual Life Res. Published online Feb. 8, 2013. 10.1007/s11136-013-0359-z
    PubMed
  • 16 Lyons RA, Lo SV, Littlepage BN. Comparative health status of patients with 11 common illnesses in Wales. J Epidemiol Comm Health 1994; 48: 388-390 . 10.1136/jech.48.4.388.
    CrossrefPubMedSearch in Google Scholar
  • 17 Coteur G, Feagan B, Keininger DL, Kosinski M. Evaluation of the meaningfulness of health-related quality of life improvements as assessed by the SF-36 and the EQ-5D VAS in patients with active Crohn's disease. Aliment Pharmcol Ther 2009; 29: 1032-1041 . 10.1111/j.1365-2036.2009.03966.x
    CrossrefPubMedSearch in Google Scholar
  • 18 Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimally clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 2008; 8: 968-974 . 10.1016/j.spinee.2007.11.006
    CrossrefPubMedSearch in Google Scholar