Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiology, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
PLoS One. 2021 Oct 29;16(10):e0259340. doi: 10.1371/journal.pone.0259340. eCollection 2021.
Measurement of health-related quality of life (HRQOL) of people with chronic illnesses has become extremely important as the mortality rates associated with such illnesses have decreased and survival rates have increased. Thereby, such measurements not only provide insights into physical, mental and social dimensions of patient's health, but also allow monitoring of the results of interventions, complementing the traditional methods based on morbidity and mortality.
The present study was conducted to describe the HRQOL of patients suffering from Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD), and to identify socio-demographic and clinical factors as predictors of HRQOL.
A cross-sectional study was conducted to assess the HRQOL among 702 RF and RHD patients using EuroQol 5-dimensions 5-levels instrument (EQ-5D-5L), EuroQol Visual Analogue Scale and Time Trade off method. Mean EQ-5D-5L quality of life scores were calculated using EQ5D index value calculator across different stages of RF and RHD. Proportions of patients reporting problems in different attributes of EQ-5D-5L were calculated. The impact of socio-economic determinants on HRQOL was assessed.
The mean EQ-5D-5L utility scores among RF, RHD and RHD with Congestive heart failure patients (CHF) were estimated as 0.952 [95% Confidence Interval (CI): 0.929-0.975], 0.820 [95% CI: 0.799-0.842] and 0.800 [95% CI: 0.772-0.829] respectively. The most frequently reported problem among RF/RHD patients was pain/discomfort (33.8%) followed by difficulty in performing usual activities (23.9%) patients, mobility (22.7%) and anxiety/depression (22%). Patients with an annual income of less than 50,000 Indian National Rupees (INR) reported the highest EQ-5D-5L score of 0.872, followed by those in the income group of more than INR 200,000 (0.835), INR 50,000-100,000 (0.832) and INR 100,000-200,000 (0.828). Better HRQOL was reported by RHD patients (including RHD with CHF) who underwent balloon valvotomy (0.806) as compared to valve replacement surgery (0.645).
RF and RHD significantly impact the HRQOL of patients. Interventions aiming to improve HRQOL of RF/RHD patients should focus upon ameliorating pain and implementation of secondary prevention strategies for reducing the progression from ARF to RHD and prevention of RHD-related complications.
随着与慢性病相关的死亡率下降和存活率提高，衡量慢性病患者的健康相关生活质量（HRQOL）变得非常重要。因此，这些测量不仅提供了患者健康的身体、心理和社会维度的见解，还允许监测干预措施的结果，补充了基于发病率和死亡率的传统方法。
本研究旨在描述风湿热（RF）和风湿性心脏病（RHD）患者的 HRQOL，并确定社会人口统计学和临床因素作为 HRQOL 的预测因素。
采用欧洲五维健康量表 5 级（EQ-5D-5L）、欧洲五维健康量表视觉模拟量表和时间权衡法对 702 例 RF 和 RHD 患者进行了横断面研究，评估了 HRQOL。使用 EQ5D 指数值计算器计算了不同 RF 和 RHD 阶段的平均 EQ-5D-5L 生活质量评分。计算了报告 EQ-5D-5L 不同属性存在问题的患者比例。评估了社会经济决定因素对 HRQOL 的影响。
RF、RHD 和 RHD 合并充血性心力衰竭（CHF）患者的平均 EQ-5D-5L 效用评分分别估计为 0.952[95%置信区间（CI）：0.929-0.975]、0.820[95%CI：0.799-0.842]和 0.800[95%CI：0.772-0.829]。RF/RHD 患者最常报告的问题是疼痛/不适（33.8%），其次是日常活动困难（23.9%）、行动不便（22.7%）和焦虑/抑郁（22%）。年收入低于 50,000 印度卢比（INR）的患者报告的 EQ-5D-5L 评分最高，为 0.872，其次是年收入超过 200,000 INR（0.835）、50,000-100,000 INR（0.832）和 100,000-200,000 INR（0.828）的患者。与瓣膜置换术（0.645）相比，接受球囊瓣膜成形术（0.806）的 RHD 患者报告的 HRQOL 更好。
RF 和 RHD 显著影响患者的 HRQOL。旨在改善 RF/RHD 患者 HRQOL 的干预措施应侧重于改善疼痛，并实施二级预防策略，以减少 ARF 向 RHD 的进展，预防 RHD 相关并发症。
