Health-Related Quality of Life in Thoracic Aortic Disease: Part I. Cases Managed Non-operatively

Background: The health-related quality of life (HRQOL) in subjects with chronic thoracic aortic disease (TAD) not scheduled for intervention has not been previously reported. Such information may aid counseling, management, and clinical decision-making. We report HRQOL in TAD, its main subtypes (aneurysm versus dissection and proximal versus distal), compare it to a reference group from the general population, and explore independent predictors.

Methods: The short-form 36-item (SF-36) questionnaire was used, as part of a self-reporting health survey, to measure HRQOL in eight domains and a physical component summary (PCS) and a mental component summary (MCS) score. Median differences (Δ) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures. Multivariable techniques were used to evaluate independent predictors.

Results: In 178 TAD subjects, the HRQOL was reduced (versus the reference group) in the PCS, Δ -6.4 [95% confidence limits -8.8, -4.0] and in three out of eight SF-36 domains: physical functioning (PF), Δ -10 [-15, -4.5]; physical role (RP), Δ -25 [-34, -16]; general health (GH), Δ -5.0 [-9.7, -0.27]. There were no statistically significant differences in HRQOL scores in type (aneurysm versus dissection) or location (proximal versus distal) of TAD. Multivariable analyses identified symptoms of exertional dyspnea, exertional calf pain, joint pain, and angina pectoris as predictors of lower SF-36 component summary scores.

Conclusions: The HRQOL in subjects with chronic TAD is reduced compared to a matched reference group. Differences, however, are comparably small and limited to physical domains. There were no differences according to type or location of TAD. Present symptoms and conditions were influential on the physical and mental component summary scores. HRQOL could be a useful part of thoracic aortic disease surveillance and could help guide interventional decision-making.