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
Published: March 28, 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess 1985;49:71-5.
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.
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.
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.
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.
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.
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
How to Cite
Caruana, M., Moons, P., Kovacs, A. H., Luyckx, K., Thomet, C., Budts, W., … Apers, S. (2024). Quality of life in Maltese adults with congenital heart disease: a second look: An APPROACH-IS substudy. Global Cardiology, 2(1). https://doi.org/10.4081/cardio.2024.26
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