Original Articles
28 March 2024
Vol. 2 No. 1 (2024)
https://doi.org/10.4081/cardio.2024.26

Quality of life in Maltese adults with congenital heart disease: a second look

An APPROACH-IS substudy

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Congenital heart defects, quality of life, patient reported outcome
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Authors

Maryanne Caruana
caruana.maryanne@gmail.com
Department of Cardiology, Mater Dei Hospital, Msida, Malta.
Philip Moons
Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; The Sahlgrenska Academy at University of Gothenburg, Institute of Medicine, Gothenburg, Sweden.
Adrienne H. Kovacs
Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States.
Koen Luyckx
School of Psychology and Child and Adolescent Development, KU Leuven - University of Leuven, Belgium.
Corina Thomet
Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Centre for Congenital Heart Disease, University Hospital of Bern, University of Bern, Switzerland.
Werner Budts
Department of Cardiovascular Sciences, Division of Congenital and Structural Cardiology, Leuven University Hospitals, KU Leuven - University of Leuven, Belgium.
Maayke Sluman
Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
Katrine Eriksen
Oslo University Hospital, Norway.
Mikael Dellborg
The Sahlgrenska Academy at University of Gothenburg, Institute of Medicine, Gothenburg; Adult Congenital Heart Unit, Sahlgrenska University Hospital – Östra, Institute for Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden.
Malin Berghammer
Department of Health Science, University West, Trollhättan, Sweden; Centre for Person-Centred Care, University of Gothenburg, Sweden.
Bengt Johansson
Department of Clinical Medicine and Public Health, Umeå University, Sweden.
Alexandra Soufi
Hospital Louis Pradel, Lyon, France.
Edward Callus
Clinical Psychology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Victor Grech
Department of Paediatrics, University of Malta Medical School, Msida, Malta.
Silke Apers
Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium.

Background: A first quality of life (QOL) study among Maltese adults with congenital heart disease (ACHD) in 2016 found no significant differences when compared to the general population. The aims of the present study were i) to compare QOL between Maltese and other European ACHD patients and ii) investigate medical predictors (i.e. number of surgical/non-surgical interventions, heart failure, arrhythmias, pacemaker/implantable cardioverter-defibrillator, cardiac hospitalization during preceding year, follow-up frequency, other medical conditions, mood/anxiety/psychiatric disorders) of QOL in Maltese patients.
Methods: Data collected during Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease – International Study was used. QOL was measured using linear analogue scale (LAS) and Satisfaction with Life Scale (SWLS). QOL in 109 Maltese and 1510 European participants was compared. Multivariable logistic regression was used to test the predictive value of medical factors on QOL in Maltese patients.
Results: There were no significant differences in QOL between the two cohorts [mean LAS Malta 80.51 (95% CI: 77.96, 83.07) vs. European 79.43 (95% CI: 78.65, 80.21) (p=0.776); mean SWLS Malta 26.00 (95% CI: 24.94, 27.06) vs. European 26.26 (95% CI: 25.95, 26.57) (p=0.288)] and no significant differences when cohorts were divided by gender and age. Only a mood/anxiety/other psychiatric disorder significantly predicted poorer QOL on both scales in Maltese patients [LAS (ß=-0.389, p<0.001), SWLS (ß=-0.352, p=0.001)].
Conclusions: Maltese ACHD patients have a good QOL comparable to that of European counterparts. Mood, anxiety and other psychiatric disorders can negatively impact Maltese patients’ QOL. Better access to clinical psychology services should be ensured.

 

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Marelli AJ, Mackie AS, Ionescu-Ittu R, Rahme E, Pilote L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 2007;115:163-72. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.627224
Moons P, Bovijn L, Budts W, Belmans A, Gewillig M. Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium. Circulation 2010;122:2264-72. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.946343
Bratt EL, Moons P. Forty years of quality-of-life research in congenital heart disease: Temporal trends in conceptual and methodological rigor. Int J Cardiol 2015;195:1-6. DOI: https://doi.org/10.1016/j.ijcard.2015.05.070
Schroder M, Boisen KA, Reimers J, Teilmann G, Brok J. Quality of life in adolescents and young adults with CHD is not reduced: a systematic review and meta-analysis. Cardiol Young 2016;26:415-25. DOI: https://doi.org/10.1017/S104795111500181X
Caruana M, Grech V. Adult CHD patients under clinical follow-up have a similar quality of life to the general population in Malta. Cardiol Young 2017;27:1051-9. DOI: https://doi.org/10.1017/S1047951116001980
Apers S, Kovacs AH, Luyckx K, et al. Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS): rationale, design, and methods. Int J Cardiol 2015;179:334-42. DOI: https://doi.org/10.1016/j.ijcard.2014.11.084
Apers S, Kovacs AH, Luyckx K, et al. Quality of life of adults with congenital heart disease in 15 countries: evaluating country-specific characteristics. J Am Coll Cardiol 2016;67:2237-45. DOI: https://doi.org/10.1016/j.jacc.2016.03.477
Moons P, Budts W, De Geest S. Critique on the conceptualisation of quality of life: a review and evaluation of different conceptual approaches. Int J Nurs Stud 2006;43:891-901. DOI: https://doi.org/10.1016/j.ijnurstu.2006.03.015
Moons P, Van Deyk K, Marquet K, et al. Individual quality of life in adults with congenital heart disease: a paradigm shift. Eur Heart J 2005;26:298-307. DOI: https://doi.org/10.1093/eurheartj/ehi054
Moons P, Van Deyk K, De Bleser L, et al. Quality of life and health status in adults with congenital heart disease: a direct comparison with healthy counterparts. Eur J Cardiovasc Prev Rehabil 2006;13:407-13. DOI: https://doi.org/10.1097/00149831-200606000-00017
Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess 1985;49:71-5. DOI: https://doi.org/10.1207/s15327752jpa4901_13
Warnes CA, Liberthson R, Danielson GK, et al. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001;37:1170-5. DOI: https://doi.org/10.1016/S0735-1097(01)01272-4
Apers S, Luyckx K, Moons P. Quality of life in adult congenital heart disease: what do we already know and what do we still need to know? Curr Cardiol Rep 2013;15:407. DOI: https://doi.org/10.1007/s11886-013-0407-x
Jackson JL, Hassen L, Gerardo GM, Vannatta K, Daniels CJ. Quality of life in adult congenital heart disease: what do we already know and what do we still need to know? Int J Cardiol 2016;202:804-9. DOI: https://doi.org/10.1016/j.ijcard.2015.09.116
Kovacs AH, Saidi AS, Kuhl EA, et al. Depression and anxiety in adult congenital heart disease: predictors and prevalence. Int J Cardiol 2009;137:158-64. DOI: https://doi.org/10.1016/j.ijcard.2008.06.042
Kovacs AH, Sears SF, Saidi AS. Biopsychosocial experiences of adults with congenital heart disease: review of the literature. Am Heart J 2005;150:193-201. DOI: https://doi.org/10.1016/j.ahj.2004.08.025
Callus E, Quadri E, Ricci C, et al. Update on psychological functioning in adults with congenital heart dis1. Marelli AJ, Mackie AS, Ionescu-Ittu R, Rahme E, Pilote L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 2007;115:163-72. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.627224
Moons P, Bovijn L, Budts W, Belmans A, Gewillig M. Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium. Circulation 2010;122:2264-72. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.946343
Bratt EL, Moons P. Forty years of quality-of-life research in congenital heart disease: Temporal trends in conceptual and methodological rigor. Int J Cardiol 2015;195:1-6. DOI: https://doi.org/10.1016/j.ijcard.2015.05.070
Schroder M, Boisen KA, Reimers J, Teilmann G, Brok J. Quality of life in adolescents and young adults with CHD is not reduced: a systematic review and meta-analysis. Cardiol Young 2016;26:415-25. DOI: https://doi.org/10.1017/S104795111500181X
Caruana M, Grech V. Adult CHD patients under clinical follow-up have a similar quality of life to the general population in Malta. Cardiol Young 2017;27:1051-9. DOI: https://doi.org/10.1017/S1047951116001980
Apers S, Kovacs AH, Luyckx K, et al. Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS): rationale, design, and methods. Int J Cardiol 2015;179:334-42. DOI: https://doi.org/10.1016/j.ijcard.2014.11.084
Apers S, Kovacs AH, Luyckx K, et al. Quality of life of adults with congenital heart disease in 15 countries: evaluating country-specific characteristics. J Am Coll Cardiol 2016;67:2237-45. DOI: https://doi.org/10.1016/j.jacc.2016.03.477
Moons P, Budts W, De Geest S. Critique on the conceptualisation of quality of life: a review and evaluation of different conceptual approaches. Int J Nurs Stud 2006;43:891-901. DOI: https://doi.org/10.1016/j.ijnurstu.2006.03.015
Moons P, Van Deyk K, Marquet K, et al. Individual quality of life in adults with congenital heart disease: a paradigm shift. Eur Heart J 2005;26:298-307. DOI: https://doi.org/10.1093/eurheartj/ehi054
Moons P, Van Deyk K, De Bleser L, et al. Quality of life and health status in adults with congenital heart disease: a direct comparison with healthy counterparts. Eur J Cardiovasc Prev Rehabil 2006;13:407-13. DOI: https://doi.org/10.1097/00149831-200606000-00017
Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess 1985;49:71-5. DOI: https://doi.org/10.1207/s15327752jpa4901_13
Warnes CA, Liberthson R, Danielson GK, et al. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001;37:1170-5. DOI: https://doi.org/10.1016/S0735-1097(01)01272-4
Apers S, Luyckx K, Moons P. Quality of life in adult congenital heart disease: what do we already know and what do we still need to know? Curr Cardiol Rep 2013;15:407. DOI: https://doi.org/10.1007/s11886-013-0407-x
Jackson JL, Hassen L, Gerardo GM, Vannatta K, Daniels CJ. Quality of life in adult congenital heart disease: what do we already know and what do we still need to know? Int J Cardiol 2016;202:804-9. DOI: https://doi.org/10.1016/j.ijcard.2015.09.116
Kovacs AH, Saidi AS, Kuhl EA, et al. Depression and anxiety in adult congenital heart disease: predictors and prevalence. Int J Cardiol 2009;137:158-64. DOI: https://doi.org/10.1016/j.ijcard.2008.06.042
Kovacs AH, Sears SF, Saidi AS. Biopsychosocial experiences of adults with congenital heart disease: review of the literature. Am Heart J 2005;150:193-201. DOI: https://doi.org/10.1016/j.ahj.2004.08.025
Callus E, Quadri E, Ricci C, et al. Update on psychological functioning in adults with congenital heart disease: a systematic review. Expert Rev Cardiovasc Ther 2013;11:785-91. DOI: https://doi.org/10.1586/erc.13.9

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Quality of life in Maltese adults with congenital heart disease: a second look: An APPROACH-IS substudy. (2024). Global Cardiology, 2(1). https://doi.org/10.4081/cardio.2024.26
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