ABSTRACT
The MacNew questionnaire is a disease-specific quality of life measure that has been used in patients with myocardial infarction and heart failure. We aimed to investigate the impact of transcatheter aortic valve implantation (TAVI) on health-related quality of life (HRQoL) using MacNew Questionnaire and identify predictors associated with a change in its score. This was a prospective multi-center study performed across 5 National Health Service hospitals in the United Kingdom performing TAVI between 2016 and 2018. HRQoL was assessed using MacNew Questionnaire, Euro Quality of Life-5D-5L, and Short Form 36 questionnaires collected at baseline, 3-, 6- and 12 months after the procedure. Out of 225 recruited patients, 19 did not have TAVI and 4 withdrew their consent, and hence 202 patients were included. HRQoL was assessed in 181, 161, and 147 patients at 3, 6, and 12 months, respectively. Using MacNew, there was a significant improvement in all domains of HRQoL as early as 3 months after TAVI which was sustained up to 12 months with improved discrimination of change in HRQoL compared with other scales. Poor mobility at baseline and history of myocardial infarction were independent predictors of reduced improvement in HRQoL at 3 months. HRQoL increased in all subgroups of patients including frail ones. In conclusion, the MacNew assessment tool performed well in a representative TAVI cohort and could be used as an alternative disease-specific method for assessing HRQoL change after TAVI.
Subject(s)
Aortic Valve Stenosis/surgery , Quality of Life , Transcatheter Aortic Valve Replacement , Aged , Aged, 80 and over , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/physiopathology , Comorbidity , Female , Frailty/epidemiology , Humans , Male , Mobility Limitation , Myocardial Infarction/epidemiology , Patient Reported Outcome Measures , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , United KingdomABSTRACT
PURPOSE: Fibromyalgia (FM) is a chronic syndrome characterized by pain and fatigue. The aim of this study was to explore how individuals with FM make sense of the illness experience and integrate it into their personal biographies. METHOD: Ten women from a pain management service in the north west of England were interviewed for the study. A chronological summary of each life story was produced and narrative features such as plot, tone, imagery and metaphors were identified and compared. RESULTS: Findings are presented in the form of a meta-narrative incorporating all 10 narratives over five phases: (1) making sense of FM: when I was younger, I didn't have any problems at all; (2) onset and diagnosis: you just feel like you're constantly complaining; (3) invasion of FM: you're just trapped; trapped in this body; (4) coping with FM: you try to do things in a pattern it will obey and (5) ongoing struggle: I refuse to give in to it. CONCLUSIONS: The narrative is characterized by a lack of movement and resolution, with participants engaged in an enduring struggle against the challenges of FM. Psychological approaches that facilitate this ongoing adjustment process may prove beneficial in FM treatment and rehabilitation.
