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Global perceived health and ten-year cardiovascular mortality in elderly primary care patients with possible heart failure
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0001-7431-2873
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0001-6353-8041
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
2008 (English)In: European Journal of Heart Failure, ISSN 1388-9842, Vol. 10, no 10, 1040-1047 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Although multi-item health-related quality of life (HRQoL) instruments provide prognostic information, they are rarely used in routine clinical practice.

Aim: To examine whether a single question about global perceived health (GPH) was a prognostic indicator of cardiovascular (CV) mortality over 10 years of follow-up in elderly patients with possible heart failure (HF) in primary care.

Method: GPH was measured using the first question on the Short-Form-36 concerning current health status. Of the 510 patients who underwent baseline evaluation, 448 patients were included.

Results: Cox proportional regression hazard analysis controlled for age, sex, NYHA class, diabetes, ischaemic heart disease, left ventricular ejection fraction and B-type natriuretic peptide plasma concentrations, showed that patients with GPH rated as “poor” or “good” were at four (HR 4.1 CI 95% 1.8–9.4) and three times (HR 3.4 CI 95% 1.4–7.8) the risk of CV mortality, respectively.

Conclusion: GPH is an independent predictor of CV mortality in elderly patients with possible HF. As a complement to clinical factors when evaluating severity of HF, GPH could be an important tool for identifying patients at risk of adverse CV events and in need of improved treatment.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. Vol. 10, no 10, 1040-1047 p.
Keyword [en]
Health status indicator, Mortality, Aging, Chronic heart failure
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-15781DOI: 10.1016/j.ejheart.2008.07.003OAI: oai:DiVA.org:liu-15781DiVA: diva2:127270
Available from: 2008-12-04 Created: 2008-12-03 Last updated: 2013-09-26Bibliographically approved
In thesis
1. Health‐related quality of life, depression, sleep and breathing disorders in the elderly: With focus on those with impaired systolic function/heart failure
Open this publication in new window or tab >>Health‐related quality of life, depression, sleep and breathing disorders in the elderly: With focus on those with impaired systolic function/heart failure
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe the prevalence of depressive symptoms, sleep disordered breathing (SDB) and sleep complaints, as well as to investigate the prognostic value of health-related quality of life (Hr-QoL) and depressive symptoms on mortality in an elderly community living population with a focus on those with impaired systolic function/heart failure (HF). Descriptive, prognostic and explorative study designs were used to examine if a single question about global perceived health (GPH) is associated with the domains of Hr-QoL as assessed by the SF-36 (I), as well as to evaluate whether GPH provided prognostic information concerning cardiovascular mortality (II). The aim was also to evaluate if depressive symptoms are associated with mortality (III), and to describe the prevalence of SDB and its relationship to impaired systolic function, different insomnia symptoms, as well as excessive daytime sleepiness (IV).

In primary care elderly patients with HF, GPH correlated to the physical and mental aspects of Hr-QoL. Patients who rated poor GPH also scored worse physical and mental Hr-QoL compared to patients with good GPH, but the mental aspect of Hr-QoL was however not significant (p<0.07) (I). Moreover, GPH also had an independent association with cardiovascular mortality during a ten-year follow-up. Compared to patients with good GPH, those who scored poor GPH had a four times increased risk for cardiovascular mortality (II). A total of 24% of the patients with HF suffered from depressive symptoms, not significantly different compared to 19% among those without HF. Depressive symptoms were a poor prognostic sign during the six-year follow-up and HF patients with depressive symptoms had the highest risk for cardiovascular mortality compared to HF patients without depressive symptoms (III). SDB is common among elderly people living in the community, almost one quarter (23%) had moderate or severe SDB. However, people with moderate impaired systolic function had a median apnea hypopnea index that was more than twice as high compared to those with normal systolic function (10.9 vs. 5.0, p<0.001). No obvious associations between SDB and excessive daytime sleepiness or the insomnia symptoms; difficulties maintaining sleep; non-restorative sleep; or early morning awakenings were detected. Difficulties initiating sleep were however more common in those with moderate or severe SDB (IV).

GPH can be used as a simple tool in clinical routine practice as an aid in identifying patients in need of additional management. SDB is a common phenomenon among elderly people and associated with impaired systolic function, but with a limited impact on subjective sleep complaints. Depressive symptoms were shown to be a poor prognostic sign and may amplify the patient’s experience of suffering. Screening for depressive symptoms could therefore be an important action in the management of patients with HF.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. 62 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1089
Keyword
Elderly, cardiac function, chronic heart failure, health-related quality of life, depressive symptoms, prognosis, sleep disturbances, sleep disordered breathing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15784 (URN)978-91-7393-749-8 (ISBN)
Public defence
2008-12-19, Berzelius salen, Campus US, Hälsouniversitetet, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2008-12-03 Created: 2008-12-03 Last updated: 2013-09-26Bibliographically approved

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Johansson, PeterBroström, AndersDahlström, UlfAlehagen, Urban

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Cardiac and Cardiovascular Systems

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