Surgery tops drug therapy in boosting CHD patients’ quality of life
Adults with congenital heart disease (CHD) report better health-related quality of life (HRQoL) when treated with surgical or catheter interventions rather than drug therapy or surveillance, according to research published Jan. 8 in the American Journal of Cardiology.
Study author Myrto Boukovala, MD, and colleagues at the Technical University of Munich said in the journal rates of long-term survival in CHD patients are rising, but with that positive trend comes a clinical challenge. More infants with CHD than ever are surviving into adolescence and adulthood, making the biggest marker of their success not mortality rates, but instead factors associated with functional health, like exercise capacity and HRQoL.
Recent research has examined HRQoL in CHD patients, the authors wrote, but that research has mainly taken the form of cross-sectional studies involving only children and a single treatment method.
Boukovala et al. helped bridge the knowledge gap with a retrospective study of 1,014 patients aged 14 and up, all of whom had CHD and had completed the SF-36 questionnaire on HRQoL at least twice prior to a cardiopulmonary exercise test. The researchers measured exercise capacity as peak oxygen uptake (peak VO2) and assigned each patient to one of four treatment groups: surgery, catheter intervention, drug therapy or surveillance.
After an average four years of follow-up, the authors said patients with surgery and catheter interventions showed an increase in the physical summary score of HRQoL compared to the other treatment groups. The effect was modest and remained significant across models that were adjusted for anthropometric and baseline data, but results weren’t mirrored in the objectively measured peak VO2 data.
“Patients with CHD are admittedly a quite heterogenous group, as there is a great variety of diagnoses and grades of severity,” Boukovala and coauthors wrote. “In our analysis, we saw that the severity of the patient’s condition has an influence on the baseline scores of most investigated components of HRQoL. This is consistent with part of the existing literature and especially with the review studies of Fteropouli et al. and Kahr et al., which suggest that more complex conditions are associated with poorer HRQoL, mainly with regard to its physical components.”
Since the positive physical effect the authors found was dependent on a subjective source—the SF-36—the authors’ results need to be corroborated by similar studies. Moving forward, they said patient exams should involve both subjective and objective evaluations.
“The need for parallel assessment of patient-reported HRQoL and objectively measured outcome such as exercise capacity is imperative in the evaluation of individual patients with CHD,” the team wrote. “This holds also true for cross-sectional studies, as well as treatment studies on adolescents and adults with CHD.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.