Exercise tolerance and quality of life in patients with known or suspected coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) is known to impact on patients' physical and mental health. The relationship between performance on treadmill exercise tolerance test (ETT) and health-related quality of life (HRQL)has never been specifically investigated in the setting of CAD. METHODS: Consecutive patients undergoing an ETT with the Bruce protocol during a diagnostic workup for CAD (n = 1,631, age 55 ± 12 years) were evaluated. Exercise-related indices were recorded. Detailed information on cardiovascular risk factors and past medical history were obtained. HRQLwas assessed with the use of the validated 36-Item Short Form Survey (SF-36) questionnaire. RESULTS: Increasing age and the presence of cardiovascular risk factors and comorbidities correlated with lower scores on the physical and mental health component of SF-36(all P < 0.05). Subjects with arrhythmias during exercise and slow recovery of systolic blood pressure had lower scores on the physical health indices or the Social Role Functioning component (P < 0.05). Achieved target heart rate and good exercise tolerance were independently associated with better scores of the physical and mental health domains of SF-36 and overall HRQLscores (ß = 0.05 for target HR and PCS-36, ß = 1.86 and ß = 1.66 per increasing stage of exercise tolerance and PCS-36 and MCS-36, respectively, P < 0.001 for all associations). Ischemic ECG changes were associated with worse scores on Physical Functioning (ß = - 3.2, P = 0.02) and Bodily Pain (ß = - 4.55, P = 0.026). CONCLUSION: ETT parameters are associated with HRQL indices in patients evaluated for possible CAD. Physical conditioning may increase patient well-being and could serve as a complementary target in conjunction with cardiovascular drug therapy.

Health-related quality of life of patients with severe heart failure. A cross-sectional multicentre study.

BACKGROUND: Heart failure is a serious chronic syndrome that is accompanied by significant physical and psychological burdens, resulting in poor quality of life. AIM: To assess the quality of life of patients with severe heart failure and its correlation with patient demographic, socio-economic and clinical characteristics. METHOD: We studied 199 patients with heart failure who were hospitalized in the Cardiology Department of three general hospitals of Greece during a 1-year period. Demographic and socio-economic data were obtained using a short questionnaire, while clinical data were obtained from medical record review. The assessment of the patients' quality of life was performed using Minnesota Life with Heart Failure Questionnaire (MLWHFQ). FINDINGS: The mean MLWHFQ score was 62.7 (±20.3). Significantly lower quality of life was found in patients with diabetes mellitus (Coefficient beta (ß)=11.4; 95% Confidence Interval (CI), 5.2-17.5), hypertension (ß=10.3; CI, 1.4-19.1), chronic renal failure (ß=13.9; CI, 5.9-21.9), chronic respiratory failure (ß=11.2; CI, 4.7-17.7), cancer (ß=12.3; CI, 2.3-22.4), psychiatric disease (ß=10.5; CI, 0.6-20.4) and those patients who were classified in New York Heart Association class IV (ß=10.6, CI=4.1-17.0). CONCLUSIONS: The average score of the MLWHFQ was high, and this reflects the poor quality of life of patients. Higher scores in specific patient groups show the negative influence of these factors in quality of life. The holistic care of patients with heart failure by a multidisciplinary team of healthcare professionals could improve their quality of life.

Translation and validation of the Greek "Minnesota Living with Heart Failure" questionnaire.

INTRODUCTION: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is an important measurement instrument for assessing the health-related quality of life (HRQOL) among heart failure patients. The purpose of this study was to translate and validate the MLHFQ in the Greek language. METHODS: Three hundred forty-four consecutive adult patients from three General Hospitals, two in Athens and one in another part of the country, who were diagnosed with chronic heart failure, and 347 healthy controls were enrolled in the study from March 2009 to March 2010. The questionnaire instrument was translated from English, back-translated, and reviewed by a committee of experts. The psychometric measurements that were performed included reliability coefficients and Explanatory Factor Analysis (EFA), using a Varimax rotation and Principal Components Method. In a further step, confirmatory analysis (CFA)--known as structural equation modeling--of the principal components was conducted. RESULTS: The internal consistency of the Greek MLHFQ version was found to be 0.97, using Cronbach's alpha coefficient. An exploratory factor analysis identified two domains that accounted for 72.5% of the variance of MLHFQ items; the area under the ROC curve was calculated at 0.942 and the logistic estimate for the threshold score of 24.50 provided the model with 95.1% sensitivity and 99.8% specificity. Additionally, the CFA demonstrated that the two-factor model offered a very good fit to our data. CONCLUSIONS: Our data indicate that the Greek MLHFQ is a reliable and valid tool for assessing HRQOL among patients with heart failure. Health professionals can use it in their clinical practice to improve their evaluation of these patients.

Translation and validation of the Greek chronic liver disease questionnaire.

AIM: To translate into Greek and validate the chronic liver disease questionnaire (CLDQ). METHODS: Two hundred and six consecutive adult patients with the diagnosis of a chronic liver disease from 2 general hospitals in Athens were enrolled in the study from May to September 2008. In order to assess their quality of life (QOL) the CLDQ was applied. The instrument was translated from English, back translated and reviewed in focus groups within the framework of a large multicenter study. The measurements that were performed included: 2 independent sample t tests, one-way analysis of variance, reliability coefficients, explanatory factor analysis using a varimax rotation and the principal components method. RESULTS: One hundred and twenty five (61%) patients were men, half were aged 40-59 years and > 33% were > 60 years old. Among the patients, 48 (23%) were hospitalized and 97 (47%) were cirrhotic according to the Child-Pugh score. The internal consistency of the Greek CLDQ version using Cronbach's alpha coefficient was found to be 0.93. Exploratory factor analysis identified 7 domains accounting for 65% of the variance of CLDQ items and only partially overlapping with those found in the original version. The area under the receiver operating characteristics curve was calculated at 0.813 and the logistic estimate for the threshold score of 167.50 provided a sensitivity of 74.3% and a specificity of 71.6% for the model. CONCLUSION: Our data confirmed the validity of the Greek version of the CLDQ in identifying the QOL among patients with chronic liver disease.