Biopsychosocial Determinants of Quality of Life in Adolescents and Adults with Congenital Heart Disease

  • Mrs Yu-Chuan Hua, Cardiac Children’s Foundation, Taiwan, Taiwan
  • Dr Chun-An Chen, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
  • Dr Shih-Cheng Liao, Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
  • Prof Jou-Kou Wang, National Taiwan University Hospital, Taiwan
  • Dr Chung-I Chang, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
  • Dr Ing-Sh Chiu, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
  • Dr Yih-Sharng Chen, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
  • Dr Mei-Hwan Wu, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Taiwan

    • Objectives: To assess the quality of life (QoL) in an Asian cohort of adolescents and adults with congenital heart disease (CHD) and to identify its biopsychosocial determinants.

    Methods: 278 patients (> 12 years) with CHD (Figure) were investigated at a mean age of 25.8 years. QoL was measured using the Quality of Life questionnaire of the World Health Organization (WHOQOL-BREF). Personality traits, psychological characters and family support were assessed by the Maudsley Personality Inventory (MPI), the Brief Symptom Rating Scale (BSRS) and the Family APGAR, respectively. CHD severity was evaluated according to initial diagnosis, illness course, and CHD functional index.

    Results: CHD patients had worse QoL compared to healthy population. On multivariate analysis (Table), depressive mood significantly predicted QoL in each domain (physical, psychological, social, and environmental), and 20% patients had significantly lower depression scores. Better family support and higher extroversion scores were most closely associated with better QoL. CHD functional index determined only the physical domain of QoL (β = -0.399, P < 0.001), and the correlation was marginal (r = -0.162, P = 0.007). The initial diagnosis and illness course of CHD had no significant influence on QoL.

    Conclusions: In this Asian cohort, lower QoL was found in adolescents and adults with CHD and all the dimensions were predominantly determined by patient’s depressive symptoms, level of extroversion, and family function. The fact that functional status of CHD patients affected only physical domain of QoL highlighted the limitation of traditional therapies targeting somatic functioning in improving overall QoL.

    Multiple linear regression models of sub-dimensions of WHOQOL scale by stepwised forward method with clinical and psychosocial variables as regressors
    QoL: physical QoL: psychological QoL: social QoL: environmental
    Variables Coefficients P value Coefficients P value Coefficients P value Coefficients P value
    Depression -0.027 ± 0.009 0.002 -0.059 ± 0.010 < 0.001 -0.035 ± 0.009 < 0.001 -0.029 ± 0.010 0.006
    Extroversion 0.098 ± 0.026 < 0.001 0.123 ± 0.026 < 0.001 0.148 ± 0.031 < 0.001 0.096 ± 0.031 0.002
    Family APGAR 0.074 ± 0.032 0.022 0.151 ± 0.031 < 0.001 0.115 ± 0.038 0.003 0.216 ± 0.037 < 0.001
    CHD functional index -0.399 ± 0.103 < 0.001 -- NS -- NS -- NS
    Age -0.027 ± 0.009 0.005 -- NS -- NS -0.037 ± 0.010 < 0.001