This page contains a Flash digital edition of a book.
Quality of life

depression and health-related QoL in patients with PAH, and confirmed that diminished QOL in PAH patients correlates with their dyspnoea and underlying depression.

The question of whether medical therapy improves QoL in PAH patients has also been addressed. In a retrospective analysis of 69 patients treated for six months with bosentan,21 the therapy was associated with improvements in QoL (measured by the SF-36 questionnaire) and 6MWD. At all measured time-points, there was a close correlation between 6MWD and most QoL domains. In a 12-week, double- blind, placebo-controlled study with sildenafil and during the open-label extension of the study,22


treated patients, compared with placebo- treated patients, exhibited significant improvement in exercise capacity and increases in all SF-36 domains at week 12 and these benefits were maintained for 24 weeks.

A further study was conducted that aimed at determining whether functional and health-related QoL changes following treatment of PAH patients represent important benefits.5

analyse this, minimally important differences in exercise capacity, measured by the 6MWD and in health-

related QoL, assessed by the SF-36 questionnaire, were defined. The minimally important difference in the 6MWD was in range with other similar studies (41 metres). Furthermore, this study provided the first estimated

prognostic marker. Remarkably, QoL was a stronger predictor for clinical outcome than established parameters, including WHO functional class, 6MWD or right atrial pressure. Another study investigating the relevance of QoL

“Assessment of patients’ QoL has been an important issue for recently approved drugs and therapy strategies for PAH presented in the guidelines”

minimally important differences for major SF-36 domains. In addition, to associate clinically relevant parameters with QoL parameters, and in so doing connect them to the daily life of patients, there is evidence that QoL may be considered as a relevant clinical endpoint in itself. Maybe the best argument for this was delivered by a Swiss study that investigated the clinical relevance of the MLwHF questionnaire by prospectively studying 48 patients with either PAH or chronic thromboembolic PH.23

In order to

to the multivariate analysis in the study, QoL was the sole factor that predicted subsequent clinical outcomes, which suggests that QoL is a relevant

parameters followed-up patients with PAH or chronic thromboembolic PH for an eight-year period and demonstrated that QoL, as assessed by the CAMPHOR questionnaire, had been able to predict clinical deterioration.24

Current practical approach The actual ESC/ERS guidelines for the diagnosis and treatment of PH were published in 2015.13

The assessment of According

patients’ QoL has been an important issue for recently approved drugs and therapy strategies for PAH presented in the guidelines. In addition to specific PAH therapy agents used for the management of concomitant conditions and controlled exercise training25

may be beneficial for


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48