School of Medicine, Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O. BOX 5539, Dar es Salaam, Tanzania.
Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
J Cardiothorac Surg. 2023 Apr 21;18(1):159. doi: 10.1186/s13019-023-02235-z.
BACKGROUND: The assessment of outcomes of interventions based on the patient's perspective using patient-reported outcome measures (PROMs) has been increasingly highlighted in clinical practice. However, health related quality of life (HRQoL), one of the common constructs measured by PROMs remain unknown among patients after heart valve replacement (HVR) in Tanzania. OBJECTIVES: To assess the HRQoL amongst patients operated on for rheumatic mitral stenosis at Jakaya Kikwete Cardiac Institute (JKCI). METHODS: A prospective study of patients operated on due to rheumatic mitral stenosis at JKCI from January 2020 to April 2021 was undertaken. The HRQoL was assessed by using the MacNew questionnaire, addressing three domains (physical, emotional, and social function); the score ranges from 0 to 7. We categorized HRQoL as low (mean score ≤ 4.9), moderate (5-6) and high (> 6). We analysed several sociodemographic and clinical variables for HRQoL. RESULTS: Out of 54 patients, there were 34 females and 20 males. Their mean (± SD) age was 37.98 (± 12.58) years. The reliability of translated Kiswahili version of MacNew was good. The mean (± SD) global scores were 3.47 ± 0.59, 4.88 ± 0.71 and 6.14 ± 0.50 preoperatively, at 3 months and 6 months respectively (p-values < 0.001 preoperatively vs. 3 months, preoperatively vs. 6 months and at 3 months vs. 6 months). The median of individual mean difference HRQoL score pre-operatively and at 6 months was 2.67. The preoperative and 6 months mean difference HRQoL scores were higher among patients with vs. without atrial fibrillation (2.95 ± 0.59 vs. 2.45 ± 0.53, p = 0.003) and those on anticoagulants (preoperatively) vs. not on anticoagulants (3.14 ± 0.58 vs. 2.57 ± 0.57, 0.009). The mean difference HRQoL scores were similar for sociodemographic and other clinical parameters, including those with stroke vs. without stroke. CONCLUSION: Six months after HVR the overall MacNew HRQoL scores improved markedly. This improvement in HRQoL was regardless of the presence of comorbidities (e.g. stroke and atrial fibrillation) which underscores the importance of considering valvular surgery if they fit the criteria. Clinicians and researchers in low-resource settings should collaborate to promote the utilization of PROMs in the routine care of patients.
背景：基于患者报告的结局测量（PROMs）从患者角度评估干预措施的结果已在临床实践中得到越来越多的强调。然而，坦桑尼亚心脏瓣膜置换术后（HVR）患者对健康相关生活质量（HRQoL），即 PROMs 常用的一个衡量指标，仍知之甚少。
目的：评估在 Jakaya Kikwete 心脏研究所（JKCI）接受风湿性二尖瓣狭窄手术的患者的 HRQoL。
方法：对 2020 年 1 月至 2021 年 4 月在 JKCI 因风湿性二尖瓣狭窄接受手术的患者进行前瞻性研究。使用 MacNew 问卷评估 HRQoL，涵盖三个领域（身体、情感和社会功能）；评分范围为 0 到 7。我们将 HRQoL 分为低（平均得分≤4.9）、中（5-6）和高（>6）。我们分析了几个社会人口统计学和临床变量与 HRQoL 的关系。
结果：54 例患者中，女性 34 例，男性 20 例。他们的平均（±标准差）年龄为 37.98（±12.58）岁。翻译后的斯瓦希里语 MacNew 版本具有良好的可靠性。术前、术后 3 个月和 6 个月的全球平均（±标准差）评分分别为 3.47±0.59、4.88±0.71 和 6.14±0.50（p 值均<0.001，术前 vs. 术后 3 个月，术前 vs. 术后 6 个月，术后 3 个月 vs. 术后 6 个月）。术前和术后 6 个月 HRQoL 评分中位数的个体平均差异为 2.67。有房颤（2.95±0.59 vs. 2.45±0.53，p=0.003）和服用抗凝剂（术前）与未服用抗凝剂（3.14±0.58 vs. 2.57±0.57，0.009）的患者的术前和术后 6 个月 HRQoL 评分均高于无房颤和未服用抗凝剂的患者。社会人口统计学和其他临床参数的 HRQoL 评分无差异，包括有中风与无中风的患者。
结论：HVR 后 6 个月，MacNew 总体 HRQoL 评分显著改善。这种 HRQoL 的改善与合并症（如中风和房颤）无关，这突出了如果符合标准，应考虑瓣膜手术的重要性。资源匮乏环境中的临床医生和研究人员应合作，促进在患者常规护理中使用 PROMs。
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