Factors Affecting Quality of Life in Adults With Congenital Heart Disease as Candidates for Intervention Targets
論文ID: CJ-23-0655
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論文ID: CJ-23-0655
With decades of advances in the diagnosis, treatment, and management of congenital heart disease (CHD), the majority of CHD patients now survive into adulthood.1,2 On the other hand, CHD remains a chronic disease, sometimes requiring lifelong medication, restrictions on physical activity or pregnancy, and monitoring for late-onset complications. Therefore, adults with CHD often face physical, psychosocial, and behavioral issues that affect their quality of life (QOL).3 In addition to its direct influence on life satisfaction, poorer QOL in adults with CHD has been associated with worse clinical outcomes.4 In a prospective study of heart failure patients with acquired heart disease, improvements in QOL were associated with decreased mortality rates and reduced risk of hospitalization,5 so it is reasonable to set goals for adult CHD care practice that improve QOL. However, improving QOL by modifying patients’ experience of illness is a complex process that requires multidisciplinary care,3 so identifying candidate factors for intervention is important in planning treatment strategies regarding who, when, and how to intervene.
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Several reports have identified factors that influence QOL in adults with CHD6–9 (Table). These studies found that sociodemographic factors, as well as physical conditions, have a significant effect on QOL. Although some of the factors appear to be unchangeable patient profiles, there may be room for improvements by promoting behavioral changes through appropriate patient education, as there is an uneven distribution of patient knowledge about the diseases.10 In the context of multiple, confounding factors, it is important to investigate independent predictors of QOL so that efficient and effective interventions can be made.
Factors Previously Reported to Affect the Quality of Life in Adults With CHD
| Factors associated with physical component scores |
| Biological profiles |
| Age, sex |
| Disease profiles |
| NYHA functional classification, cardiac complications, systemic ventricular EF |
| Social profiles |
| Educational level, employment status, marital status, estimated family income |
| Treatment modalities |
| Pacemaker, cardiac hospitalizations, catheterizations, cardiac medications |
| Factors associated with mental component scores |
| Biological profiles |
| Age, sex |
| Disease profiles |
| NYHA functional classification, CHD complexity, cardiac complications |
| Social profiles |
| Educational level, employment status, marital status |
| Treatment modalities |
| Cardiac medications |
CHD, congenital heart disease; EF, ejection fraction; NYHA, New York Heart Association.
In this issue of the Journal, Tatebe et al11 identify independent factors influencing health-related QOL in adults with CHD in a multicenter, prospective, cross-sectional study conducted in Japan. They also found that physical scores were worse in the target population than in the general control population for most of the age groups, but mental scores were comparable. Because of the cross-sectional nature of the study and the limited means of obtaining information, their study has several limitations. Some of the factors associated with QOL were not confirmed to be causal. The factors examined in the study were limited to those available from questionnaires and medical records, and there may be unknown factors that influence QOL. In addition, the analysis was limited to patients who were able to complete the questionnaire themselves.
Despite these limitations, there are insights into how to improve QOL in adults with CHD. One of the most important findings is exercise habit, such as participation in physical education classes and sports clubs, which was associated with better physical component scores even after adjustment for New York Heart Association (NYHA) functional class, pulmonary hypertension, past medical history, employment status, and educational level. Because some physical scales in the 36-item Short-Form Health Survey (SF36) overlap with other functional indicators such as NYHA functional class, the association between exercise habit and better physical component scores after the adjustment may be due to components of the SF36 physical scales other than functional indicators, such as body pain and duration of daily activities. This suggests that habitual physical activity, avoiding excessive exercise restriction, may be an important candidate intervention. Although the mental scores were comparable between the general population and adults with CHD, the adults with CHD showed a significant decline in mental scores in their 20 s and 30 s. This is the age group in which students are transitioning to adult working life and thus encounter more situations requiring social functioning, which is the focus of the SF36 in calculating mental scores. Therefore, targeted mental health interventions should be aimed at patients in this age group. Previous studies have reported low QOL scores in Japanese patients with CHD,6 and this large multicenter study investigating QOL-related factors in adults with CHD in the context of Japanese culture and social structure is a very valuable first step toward improving the QOL of adults with CHD in Japan.
Authors declare no conflict of interests, grants, or sources of funding.
None.
