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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


sildenafil-


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 www.hospitalpharmacyeurope.com


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