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Health-related quality of life in coronary heart disease: a systematic review and meta-analysis mapped against the International Classification of Functioning, Disability and Health

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A Correction to this article was published on 06 June 2018

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Abstract

Background

Health-related quality of life (HRQoL) is an important outcome in coronary heart disease (CHD). However, variability in HRQoL indicators suggests a need to consider domain coverage. This review applies a globally accepted framework, the International Classification of Functioning, Disability and Health (ICF), to map HRQoL measures that are reliable and valid among people with CHD.

Methods

The Embase, Pubmed and PsycInfo databases were searched, with 10 observational studies comparing HRQOL among 4786 adults with CHD to 50949 controls identified. Study reporting quality was examined (QualSyst). Hedges’ g statistic (with 95% CIs and p values) was used to measure the effect size for the difference between group means (≤ 0.2 small, ≤ 0.5 medium, ≤ 0.80 large difference), and between-study heterogeneity (tau, I2 test) examined using a random effects model.

Results

Adults with CHD reported lowered HRQoL (gw = − 0.418, p < 0.001). Adjusted mean differences in HRQoL ratings, controlling for socio-demographics, were smaller but remained significant. Large group differences were associated with individual measures of activity and participation (WHOQOL g = − 1.199, p < 0.001) and self-perceived health (SF 36 g = − 0.616, p < 0.001).

Conclusions

The ICF provides a framework for evaluating and understanding the impact of CHD on HRQoL. The results demonstrate that HRQoL goes beyond physical symptoms, with activity limitations, social support and participation, and personal perceptions identified as key ICF domains in CHD assessment. Further investigations are needed to unravel the dynamic and inter-relationships between these domains, including longitudinal trends in HRQoL indicators.

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Copyright (2002). Adapted with permission from WHO

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Change history

  • 06 June 2018

    In the original publication of the article, the surname of one of the co-authors was misspelled as ‘Mpfou’. This has been updated in this correction.

References

*References with an asterisk demote studies included in current review

  1. Moran, A. E., Forouzanfar, M. H., Roth, G. A., Mensah, G. A., Ezzati, M., Murray, C. J. L., et al. (2014). Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: The Global Burden of Disease 2010 study. Circulation, 129(14), 1483–1492.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pandya, A., Gaziano, T. A., Weinstein, M. C., & Cutler, D. (2013). More Americans living longer with cardiovascular disease will increase costs while lowering quality of life. Health Affairs (Project Hope), 32(10), 1706–1714.

    Article  PubMed Central  Google Scholar 

  3. Karimi, M., & Brazier, J. (2016). Health, health-related quality of life, and quality of life: What is the difference? Pharmacoeconomics, 34(7), 645–649.

    Article  PubMed  Google Scholar 

  4. *Seo, J., Lee, Y., Kang, S., Chun, H., Pyun, W. M., Park, S. H., et al. (2015). Poor health-related quality of life and proactive primary control strategy may act as risk factors for acute coronary syndrome. Korean Circulation Journal, 45(2), 117–124.

    Article  PubMed  PubMed Central  Google Scholar 

  5. *Srivastava, S., Shekhar, S., Bhatia, M. S., Manjeet, S., & Dwivedi, S. (2017). Quality of life in patients with coronary artery disease and panic disorder: A comparative study. Oman Medical Journal, 32(1), 20–26.

    Article  PubMed  PubMed Central  Google Scholar 

  6. *Alonso, J., Ferrer, M., Gandek, B., Ware, J., Aaronson, N., Mosconi, P., et al. (2004). Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project. Quality of Life Research, 13, 283–298.

    Article  PubMed  Google Scholar 

  7. *Lalonde, L., Clarke, A. E., Joseph, L., Mackenzie, T., & Grover, S. A. (2001). Health-related quality of life with coronary heart disease prevention and treatment. Journal of Clinical Epidemiology, 54(10), 1011–1018.

    Article  CAS  PubMed  Google Scholar 

  8. Payakachat, N., Ali, M. M., & Tilford, J. M. (2015). Can the EQ-5D detect meaningful change? A systematic review. PharmacoEconomics, 33(11), 1137–1154.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Busija, L., Pausenberger, E., Haines, T. P., Haymes, S., Buchbinder, R., & Osborne, R. H. (2011). Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQOL). Arthritis Care & Research, 63(S11), S383-S412.

    Article  Google Scholar 

  10. Hand, C. (2016). Measuring health-related quality of life in adults with chronic conditions in primary care settings: Critical review of concepts and 3 tools. Canadian Family Physician, 62(7), e375-e383.

    PubMed Central  Google Scholar 

  11. Stevanović, J., Pechlivanoglou, P., Kampinga, M. A., Krabbe, P. F. M., & Postma, M. J. (2016). Multivariate meta-analysis of preference-based quality of life values in coronary heart disease. PLoS ONE, 11(3), e0152030.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. World Health Organization. (2001). International classification of functioning, disability and health. Geneva: World Health Organization.

    Google Scholar 

  13. Madden, R., Glozier, N., Fortune, N., Dyson, M., Gilroy, J., Bundy, A., Llewellyn, G., Salvador-Carulla, L., Lukersmith, S., Mpofu, E., & Madden, R. (2015). In search of an integrative measure of functioning. International Journal Environmental Research and Public Health, 12, 5815–5832.

    Article  PubMed  Google Scholar 

  14. Peterson, D. B., Mpofu, E., & Oakland, T. (2010). Concepts and models in disability, functioning and health. In E. Mpofu & T. Oakland (Eds.), Rehabilitation and health assessment: Applying ICF guidelines (pp. 3–26). New York: Springer.

    Google Scholar 

  15. Cieza, A., Stucki, A., Geyh, S., Berteanu, M., Quittan, M., Simon, A., et al. (2004). ICF Core Sets for chronic ischaemic heart disease. Journal of Rehabilitation Medicine, 36, 94–99.

    Article  Google Scholar 

  16. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269.

    Article  PubMed  Google Scholar 

  17. Foxwell, R., Morley, C., & Frizelle, D. (2013). Illness perceptions, mood and quality of life: A systematic review of coronary heart disease patients. Journal of Psychosomatic Research, 75(3), 211–222.

    Article  PubMed  Google Scholar 

  18. Dickens, C., Cherrington, A., & McGowan, L. (2012). Depression and health-related quality of life in people with coronary heart disease: A systematic review. European Journal of Cardiovascular Nursing, 11(3), 265–275.

    Article  PubMed  Google Scholar 

  19. Calton, R., Satija, T., Dhanoa, J., Jaison, T. M., & David, T. (1998). Correlation of Braunwald’s clinical classification of unstable angina pectoris with angiographic extent of disease, lesion morphology and intra-luminal thrombus. Indian Heart Journal, 50(3), 300–306.

    CAS  PubMed  Google Scholar 

  20. Thompson, D. R., & Yu, C. M. (2003) Quality of life in patients with coronary heart disease-I: Assessment tools. Health and Quality of Life Outcomes, 1(1), 42.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jüni, P., Holenstein, F., Sterne, J., Bartlett, C., & Egger, M. (2002). Direction and impact of language bias in meta-analyses of controlled trials: Empirical study. International Journal of Epidemiology, 31(1), 115–123.

    Article  PubMed  Google Scholar 

  22. Garratt, A. M., & Stavem, K. (2017). Measurement properties and normative data for the Norwegian SF-36: Results from a general population survey. Health and Quality of Life Outcomes, 15, 51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kendall, P. C., Marrs-Garcia, A., Nath, S. R., & Sheldrick, R. C. (1999). Normative comparisons for the evaluation of clinical significance. Journal of Consulting and Clinical Psychology, 67(3), 285–299.

    Article  CAS  PubMed  Google Scholar 

  24. *Claesson, M., Burell, G., Birgander, L. S., Lindahl, B., & Asplund, K. (2003). Psychosocial distress and impaired quality of life—Targets neglected in the secondary prevention in women with ischaemic heart disease. European Journal of Cardiovascular Prevention and Rehabilitation, 10, 258–266.

    Article  PubMed  Google Scholar 

  25. *Garster, N. C., Palta, M., Sweitzer, N. K., Kaplan, R. M., & Fryback, D. G. (2009). Measuring health-related quality of life in population-based studies of coronary heart disease: Comparing six generic indexes and a disease-specific proxy score. Quality of Life Research, 8, 1239–1247.

    Article  Google Scholar 

  26. *Lee, H. T., Shin, J., Lim, Y. H., Kim, K. S., Kim, S. G., Kim, J. H., et al. (2015). Health-related quality of life in coronary heart disease in Korea: The Korea National Health and Nutrition Examination Survey 2007 to 2011. Angiology, 66(4), 326–332.

    Article  PubMed  Google Scholar 

  27. *Tavella, R., Cutri, N., Adams, R., & Beltrame, J. (2010). Health status of stable patients with obstructive or non-obstructive coronary artery disease compared with healthy controls. Heart, Lung and Circulation, 6, 728.

    Google Scholar 

  28. *Unsar, S., Sut, N., & Durna, Z. (2007). Health-related quality of life in patients with coronary artery disease. Journal of Cardiovascular Nursing, 22(6), 501–507.

    Article  PubMed  Google Scholar 

  29. *Zaninotto, P., Sacker, A., Breeze, E., McMunn, A., & Steptoe, A. (2016). Gender-specific changes in well-being in older people with coronary heart disease: Evidence from the English Longitudinal Study of Ageing. Aging & Mental Health, 20(4), 432–440.

    Article  Google Scholar 

  30. Higgins, J. P. T., & Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. http://handbook.cochrane.org. Accessed 22 Jan 2018.

  31. Cieza, A., & Stucki, G. (2005). Content comparison of health-related quality of life (HRQOL) instruments based on the international classification of functioning, disability and health (ICF). Quality of Life Research, 14(5), 1225–1237.

    Article  PubMed  Google Scholar 

  32. Grotkamp, S. L., Cibis, W. M., Nüchtern, E. A. M., von Mittelstaedt, G., & Seger, W. K. F. (2012). Personal factors in the International classification of functioning, disability and health: Prospective evidence. The Australian Journal of Rehabilitation Counselling, 18(1), 1–24.

    Article  Google Scholar 

  33. Cieza, A., Geyh, S., Chatterji, S., Kostanjsek, N., Ustu¨n, B., & Stucki, G. (2005). ICF linking rules: An update based on lessons learned. Journal of Rehabilitation Medicine, 37, 212–218.

    Article  PubMed  Google Scholar 

  34. Kmet, L. M., Lee, R. C., & Cook, L. S. (2004) Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research Edmonton. Report No.: 1-896956-77-7.

  35. Ellis, P. D. (2010). The essential guide to effect sizes. New York: Cambridge University Press.

    Book  Google Scholar 

  36. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155.

    Article  CAS  PubMed  Google Scholar 

  37. Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. Londres: Wiley.

    Book  Google Scholar 

  38. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.

    Google Scholar 

  39. Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ: British Medical Journal, 327(7414), 557–560.

    Article  PubMed  Google Scholar 

  40. Huedo-Medina, T. B., Sánchez-Meca, J., Marín-Martínez, F., & Botella, J. (2006). Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychological Methods, 11(2), 193.

    Article  PubMed  Google Scholar 

  41. Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods, 1(2), 97–111.

    Article  PubMed  Google Scholar 

  42. Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., et al. (2017). Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 135(10), e146-e603.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Khayyam-Nekouei, Z., Neshatdoost, H., Yousefy, A., Sadeghi, M., & Manshaee, G. (2013). Psychological factors and coronary heart disease. ARYA Atherosclerosis, 9(1), 102–111.

    PubMed  PubMed Central  Google Scholar 

  44. Tusek-Bunc, K., & Petek, D. (2016). Comorbidities and characteristics of coronary heart disease patients: Their impact on health-related quality of life. Health and Quality of Life Outcomes, 14, 1.

    Article  Google Scholar 

  45. Leigh, J. A., Alvarez, M., & Rodriguez, C. J. (2016). Ethnic minorities and coronary heart disease: An update and future directions. Current Atherosclerosis Reports, 18(2), 9.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Tully, P. J. (2013). Quality-of-Life measures for cardiac surgery practice and research: A review and primer. The Journal of Extra-Corporeal Technology, 45(1), 8–15.

    PubMed  PubMed Central  Google Scholar 

  47. Le Grande, M. R., Elliott, P. C., Murphy, B. M., Worcester, M. U. C., Higgins, R. O., Ernest, C. S., et al. (2006). Health related quality of life trajectories and predictors following coronary artery bypass surgery. Health and Quality of Life Outcomes, 4, 49.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gierlaszyńska, K., Pudlo, R., Jaworska, I., Byrczek-Godula, K., & Gąsior, M. (2016). Tools for assessing quality of life in cardiology and cardiac surgery. Kardiochirurgia i Torakochirurgia Polska = Polish Journal of Cardio-Thoracic Surgery, 13(1), 78–82.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Thompson, D. R., Ski, C. F., Garside, J., & Astin, F. (2016). A review of health-related quality of life patient-reported outcome measures in cardiovascular nursing. European Journal of Cardiovascular Nursing, 15(2), 114–125.

    Article  PubMed  Google Scholar 

  50. Schrøder, M., Boisen, K. A., Reimers, J., Teilmann, G., & Brok, J. (2016). Quality of life in adolescents and young adults with CHD is not reduced: A systematic review and meta-analysis. Cardiology in the Young, 26, 415–425.

    Article  PubMed  Google Scholar 

  51. Asadi-Lari, M., Packham, C., & Gray, D. (2003). Unmet health needs in patients with coronary heart disease: Implications and potential for improvement in caring services. Health and Quality of Life Outcomes, 1, 26–26.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Hwang, K., & Mpofu, E. (2010). Health care quality assessments. In E. Mpofu & T. Oakland (Eds.), Rehabilitation and health assessment: Applying ICF guidelines (141–161). New York: Springer.

    Google Scholar 

  53. World Health Organisation (2003). The ICF checklist. Geneva: WHO. http://www.who.int/classifications/icf/training/icfchecklist.pdf. Accessed 24 Apr 2018.

  54. Weigl, M., Cieza, A., Andersen, C., Kollerits, B., Amann, E., & Stucki, G. (2004). Identification of relevant ICF categories in patients with chronic health conditions: A Delphi exercise. Journal of Rehabilitation Medicine, 44, 12–21.

    Article  Google Scholar 

  55. World Health Organisation. (2013). How to use the ICF: A practical manual for using the International Classification of Functioning, Disability and Health (ICF). Exposure draft for comment. October 2013. Geneva: WHO.

    Google Scholar 

  56. Sterne, J. A., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rücker, G., Harbord, R. M., Schmid, C. H., Tetzlaff, J., Deeks, J. J., Peters, J., Macaskill, P., Schwarzer, G., Duval, D., Altman, D. G., Moher, D., & Higgins, J. P. T. (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ British Medical Journal, 343, d4002.

    Article  PubMed  Google Scholar 

  57. Begg, C. B., & Mazumdar, M. (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50, 1088–1101.

    Article  CAS  PubMed  Google Scholar 

  58. Sedgwick, P. (2013) Meta-analyses: Heterogeneity and subgroup analysis. BMJ: British Medical Journal, 346, f4040.

    Article  Google Scholar 

  59. von Hippel, P. T. (2015). The heterogeneity statistic I2 can be biased in small meta-analyses. BMC Medical Research Methodology, 15, 1–8.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Maureen Bell, Research Librarian at the University of Adelaide, for assistance with the electronic database searches.

Funding

The research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia

    Jana Le, Diana S. Dorstyn & Elise Prior

  2. Department of Rehabilitation and Health Services, University of North Texas, Denton, USA

    Elias Mpfou

  3. Department of Educational Psychology and Inclusive Education, University of Johannesburg, Johannesburg, South Africa

    Elias Mpfou

  4. Faculty of Health Sciences, University of Sydney, Sydney, Australia

    Elias Mpfou

  5. School of Medicine, Freemasons Foundation Centre For Men’s Health, University of Adelaide, Adelaide, Australia

    Phillip J. Tully

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  1. Jana Le
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  2. Diana S. Dorstyn
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  3. Elias Mpfou
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  5. Phillip J. Tully
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Correspondence to Diana S. Dorstyn.

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Le, J., Dorstyn, D.S., Mpfou, E. et al. Health-related quality of life in coronary heart disease: a systematic review and meta-analysis mapped against the International Classification of Functioning, Disability and Health. Qual Life Res 27, 2491–2503 (2018). https://doi.org/10.1007/s11136-018-1885-5

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