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. 2019 Jun 14;17(1):103.
doi: 10.1186/s12955-019-1178-x.

Medium-term health-related quality of life in patients with pulmonary arterial hypertension treated with goal-oriented sequential combination therapy based on exercise capacity

Akihiro Hirashiki  1   2 , Shiro Adachi  3 , Naoki Okumura  3 , Yoshihisa Nakano  4 , Shigetake Shimokata  4 , Atsuya Shimizu  5 , Hidenori Arai  5 , Kenji Toba  5 , Toyoaki Murohara  4 , Takahisa Kondo  3
Affiliations

Medium-term health-related quality of life in patients with pulmonary arterial hypertension treated with goal-oriented sequential combination therapy based on exercise capacity

Akihiro Hirashiki et al. Health Qual Life Outcomes. .

Abstract

Background: Pulmonary arterial hypertension (PAH) remains a life-threatening condition, despite modern therapies. We prospectively investigated the therapeutic health-related quality of life (HRQOL) effects of goal-oriented sequential combination therapy based on exercise capacity in patients newly diagnosed with PAH.

Methods: To examine the changes in HRQOL in PAH patients, we treated 30 patients newly diagnosed with PAH with goal-oriented sequential combination therapy based on exercise capacity. We monitored exercise capacity by cardiopulmonary exercise testing and observed the benefit of using a peak VO2 cut-off of 15 mL/kg/min to guide combination therapy. First-line treatment was an endothelin receptor antagonist (ERA); second-line treatment was the addition of a phosphodiesterase-5 inhibitor (PDE-5I). At baseline and at 3, 6, and 12 months, HRQOL was evaluated by using the eight-item Medical Outcomes Survey Short Form Health Survey.

Results: At 12 months, 100% of PAH patients were receiving an ERA, and 82% an ERA + PDE-5I. The mean physical component summary (PCS) score was 33.5 at baseline, 41.2 at 3 months, 40.8 at 6 months, and 42.0 at 12 months, and the mean mental component summary (MCS) scores were 45.6, 47.0, 50.0, and 50.1, respectively. PCS score was significantly greater at 3 months than at baseline (P = 0.035). MCS score was comparable at 3 months and at baseline, but was significantly greater at 6 and 12 months than at baseline (P = 0.033, P = 0.028, respectively). Thus, PCS score improved soon after initiation of therapy, and MCS score improved later.

Conclusions: Together, these results suggest that goal-oriented sequential combination therapy based on exercise capacity improves HRQOL in patients with PAH.

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Conflict of interest statement

Akihiro Hirashiki used to belong to a department endowed by Actelion Pharmaceuticals Japan, Ltd. Both Takahisa Kondo, Naoki Okumura and Shiro Adachi belong to a department endowed by Actelion Pharmaceuticals Japan, Ltd.

Figures

Fig. 1
Fig. 1
Study protocol. Goal-based therapeutic algorithm used in the present study for patients with newly diagnosed pulmonary arterial hypertension (PAH). ERA, endothelin receptor antagonist; PDE-5, phosphodiesterase-5; WHO FC, World Health Organization functional class
Fig. 2
Fig. 2
Parameter changes during the study period. BNP, brain natriuretic peptide; 6MWD, 6-min walking distance; TRPG, tricuspid regurgitation pressure gradient
Fig. 3
Fig. 3
Changes in health-related quality of life score during the study period, as assessed by using the 8-item Medical Outcomes Study Short Form Health Survey. PF, physical functioning; RP, role functioning – physical; BP, bodily pain; GH, general health perception; VT, vitality; SF, social functioning; RE, role functioning – emotional; MH, mental health
Fig. 4
Fig. 4
Changes in mean physical component summary (PCS) score and mental component summary (MCS) score during the study period
See this image and copyright information in PMC

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