Health-related Quality of Life and Survival in Pulmonary Arterial Hypertension

Abstract

Rationale: Pulmonary arterial hypertension is a progressive disease with high morbidity and mortality despite advances in medical therapy. The relationship between patient-related outcomes, such as health-related quality of life (HRQOL), and survival is not well described.

Objective: To assess the relationship between HRQOL and outcomes in patients with pulmonary arterial hypertension.

Methods: Consecutive patients with right heart catheterization-proven pulmonary arterial hypertension who completed the Medical Outcomes Survey Short Form-36 survey (SF-36) were included. Demographic, clinical, physiological, and hemodynamic data were collected at baseline. Survival was assessed from the time of diagnosis of pulmonary arterial hypertension. Cox proportional hazard models were constructed to assess the relationship between HRQOL and transplant-free survival.

Measurements and main results: Eighty-seven patients with pulmonary arterial hypertension were enrolled and followed prospectively for a median of 3.8 years. At baseline, HRQOL was significantly worse than U.S. normal values for six of eight domains of the SF-36. Several domains demonstrated moderate correlation (r value ≥ 0.40) with 6-minute-walk distance and World Health Organization functional class; there were no significant associations with hemodynamics. In univariable Cox proportional hazard models, six of eight domains and both summary scores were significantly associated with survival. In multivariable models, adjusted for age, disease type, and cardiac function, these relationships largely persisted.

Conclusions: In this cohort of patients with pulmonary arterial hypertension, HRQOL, as assessed by the SF-36, was strongly associated with transplant-free survival. These relationships persisted when controlling for potential confounders such as disease type and disease severity. These findings suggest that HRQOL may be an important predictor of outcomes in pulmonary arterial hypertension and therefore a target for future therapeutic interventions.

Keywords: outcomes; pulmonary hypertension; quality of life.

Figure 1.

Spider plot of individual domain and summary scores in pulmonary arterial hypertension (PAH) versus U.S. population normative values. All values presented as means. *P < 0.05 for comparison with U.S. population norms. BP = body pain; GH = general health; MCS = mental component summary; MH = mental health; PCS = physical component summary; PF = physical functioning; RE = role emotional; RP = role physical; SF = social functioning; VT = vitality.

Figure 2.

Survival stratified by Medical Outcomes Survey Short Form-36 survey (SF-36) physical component summary (PCS) score. High PCS = PCS greater than median score of cohort (median = 30.1 units); Low PCS = PCS less than median score of cohort.