Aparna Balasubramanian, Brett Larive, Evelyn M. Horn, Hiliary M. DuBrock, Reena Mehra, Miriam Jacob, Anna R. Hemnes, Jane A. Leopold, Milena K. Radeva, Nicholas S. Hill, Serpil C. Erzurum, Erika Berman-Rosenzweig, Robert Frantz, Franz P. Rischard, Gerald Beck, Paul M. Hassoun, Stephen C. Mathai, PVDOMICS Study Group
Johns Hopkins University. Cleveland Clinic. Weill Cornell Medicine. Mayo Clinic. Vanderbilt University Medical Center. Brigham and Women’s Hospital and Harvard Medical School. Tufts Medical Center. Columbia University. University of Arizona.
United States
Chest
Chest 2024;
DOI: 10.1016/j.chest.2024.02.009
Abstract
Background: Health related quality of life (HRQOL) is frequently impaired in pulmonary arterial hypertension (PAH). However, little is known about HRQOL in other forms of pulmonary hypertension (PH).
Research question: Does HRQOL vary across groups of the World Symposium on Pulmonary Hypertension (WSPH) classification system?
Study design and methods: This cross-sectional study included PH patients from PVDOMICS (Pulmonary Vascular Disease Phenomics). HRQOL was assessed using emPHasis-10 (e-10), Medical Outcomes Survey Short Form-36 (SF-36; physical component (PCS) and mental component (MCS)), and Minnesota Living with Heart Failure Questionnaire (MLHF). Pearson’s correlations between HRQOL and demographic, physiologic, and imaging characteristics within each WSPH group were tested. Multivariable linear regressions compared HRQOL across WSPH groups adjusting for demographics, disease prevalence, functional class, and hemodynamics. Cox proportional hazard models were used to assess associations between HRQOL and survival across WSPH groups.
Results: Among 691 PH patients, HRQOL correlated with functional class and six-minute walk distance but not hemodynamics. HRQOL was severely depressed across WSPH groups for all measures except the SF-36 MCS. When compared to Group 1, Group 2 subjects had significantly worse HRQOL (e-10: 29 vs 24, p=0.001, PCS: 32.9 ± 8 vs 38.4 ± 10, p<0.0001, MLHF: 50 vs 38, p=0.003). Group 3 subjects similarly had worse e-10 (31 vs 24, p<0.0001) and PCS scores (33.3 ± 9 vs 38.4 ± 10, p<0.0001) compared to Group 1, which persisted in multivariable models (p<0.05). HRQOL was associated in adjusted models with survival across Groups 1, 2, and 3.
Interpretation: HRQOL is depressed in PH and particularly in Groups 2 and 3 despite less severe hemodynamics. HRQOL is associated with functional capacity, but hemodynamic disease severity poorly estimates the impact of PH on patient’s lives. Further studies are needed to better identify predictors and treatments to improve HRQOL across the spectrum of pulmonary hypertension.
Category
Quality of Life Associated with Pulmonary Vascular Disease
Age Focus: Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
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