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Predictors of quality of life after cardiac procedures: a mixed-methods study
Niki Medendorp1, Hilda Rijnhart-de Jong2, Ilse Verstraaten3
1Netherlands Heart Registration, Utrecht, The Netherlands. medendorp.nm@gmail.com.
Insights
Psychological and social factors significantly predict health-related quality of life (HRQoL) changes after cardiac procedures. Addressing these factors in consultations can improve shared decision-making and optimize treatment choices for patients.
Area of Science:
- Cardiology
- Health Psychology
- Health Services Research
Background:
- Cardiovascular disease significantly impacts patients' lives.
- Cardiac procedures aim to improve health-related quality of life (HRQoL), but outcomes vary.
- Understanding factors influencing HRQoL changes is crucial for patient care.
Purpose of the Study:
- To explore determinants predictive of HRQoL changes in patients undergoing cardiac procedures.
- To identify factors influencing post-procedural HRQoL for better patient outcomes.
- To enhance shared decision-making in cardiac procedure selection.
Main Methods:
- A stepwise, mixed-methods approach combining literature search, Delphi study, and cross-sectional survey.
- Identified 19 key determinants through literature review and expert consensus.
- Assessed the impact of determinants on HRQoL changes using validated questionnaires (SF36-2/SF12-2, AFEQT) in 1016 patients.
Main Results:
- In the Coronary Artery Bypass Graft (CABG), Percutaneous Coronary Intervention (PCI), or Surgical Aortic Valve Replacement (SAVR) group (n=731), 9 determinants predicted physical HRQoL and 9 predicted mental HRQoL.
- In the Percutaneous Valve Implantation (PVI) group (n=285), significant determinants were identified across all four AFEQT domains.
- Multiple psychological and social factors demonstrated significant associations with HRQoL changes.
Conclusions:
- Psychological and social factors are significant predictors of post-cardiac procedure HRQoL.
- Integrating these factors into patient consultations can improve shared decision-making.
- Addressing these determinants may enhance patient expectations and lead to more optimal, individualized treatment choices.
Purpose:
Cardiovascular disease has a major impact on patients' lives. Cardiac procedures aim to improve patient health-related quality of life (HRQoL); however, some patients show little to no improvement afterwards. Changes in HRQoL are used to evaluate quality of care, and to enhance shared decision-making. We aimed to explore determinants predictive of HRQoL changes in patients undergoing a cardiac procedure.
Methods:
A stepwise, mixed-methods study was conducted. First, relevant determinants were identified and selected by performing a literature search and Delphi study. Next, a cross-sectional survey study was conducted among patients who underwent a cardiac procedure. The impact of determinants on changes in HRQoL (measured with the SF36-2/SF12-2, or Effect On Quality-Of-Life Questionnaire (AFEQT)) was examined.
Results:
Based on the literature search and Delphi study, 19 determinants were selected and subsequently observed among patients. In total, 1016 patients participated; 731 undergoing a CABG, PCI or SAVR (CPS-group), and 285 undergoing a PVI (PVI-group). In the CPS-group, 9 determinants were associated with significant changes in physical HRQoL and 9 determinants for mental HRQoL were found. In the PVI-group, significant determinants in the four AFEQT domains were found.
Conclusion:
This study shows that several psychological and social factors are significant predictors for patients' HRQoL after cardiac procedures. Addressing these factors in consultations is considered important when deciding about cardiac procedures. This may allow shared decision making, enhance patient expectations and be beneficial for choosing the most optimal treatment choice for the individual patient.