Patients with pulmonary hypertension (PH) may have unchanged high levels of symptom severity that negatively affect health-related quality of life (HRQoL), according to a study published in BMJ Open Respiratory Research.
Researchers conducted a prospective longitudinal cohort study at 8 centers in the United Kingdom of 185 individuals diagnosed with PH who at baseline reported significant impairment of HRQoL, anxiety, depression, dyspnea, and severe fatigue. Individuals were observed for a total of 18 months, with 126 participants completing the study (68%). The purpose of the study was to observe HRQoL measurements over the course of 18 months in individuals diagnosed with PH in an effort to identify factors that predict a decline in HRQoL over time.
Baseline scores for fatigue were more than double the normal scores, and even higher than cutoff values in individuals with chronic fatigue syndrome. The only difference in HRQoL scores over time was a reduction in the Hospital Anxiety and Depression Scale (HADS)-Anxiety score, indicating a small decrease in emotional distress in participants from their baseline values. There were no other significant changes in test or questionnaire scores during the study.
Individuals with a higher HADS-Depression score had a statistically significant higher risk of dropping out of the study (OR, 1.14; 95% CI, 1.05-1.24), and both depression and dyspnea were found to be the only statistically significant predictors of HRQoL (P =.002 and P =.03, respectively).
Although the need for oxygen did not significantly affect the sleep patterns of the participants, the multilevel regression found those who used oxygen had reportedly higher emPHasis-10, Fatigue Severity Scale, HADS-Anxiety, HADS-Depression, and Dyspnoea-12 scores compared with those who did not use oxygen (P ≤.001).
Researchers concluded that despite the statistically significant improvement in anxiety scores, the negative effect on HRQoL did not change during the 18-month study. Furthermore, strong relationships between HRQoL scores and factors such as breathlessness, fatigue, depression, anxiety, and sleep were demonstrated during the study, with even stronger relationships observed with breathlessness and depression. In addition, researchers found the use of oxygen therapy to be associated with a significantly higher impairment in HRQoL scores in all symptoms assessed during the study, with the exception of sleep. Clinicians should consider assessing and intervening where appropriate to help individuals with PH maintain or improve their HRQoL long term.
Yorke J, Denton C, Campbell M, et al. Symptom severity and its effect on health-related quality of life over time in patients with a pulmonary hypertension: a multisite longitudinal cohort study. BMJ Open Respir Res. 2018;5(1):e000263.