Qualidade de vida relacionada à saúde em pacientes comDoença de Chagas e em portadores de marca-passo

Abstract

Background: Health Related Quality of Life (HRQoL) is today a significant item to be considered in monitoring and treatment of individuals and populations, especially those related to chronic conditions or palliative actions. As a measure, HRQoL has proven useful in several areas of health-related practices and clinical research, besides the organization and resource allocation. Despite the importance of medical social conditions surrounding the patient with Chagasdisease (AHC) and those patients with pacemaker (PM) at the Brazilian health scenarie, yet few knowledge is available, about, the problems related to their HRQoL. Objective: To investigate the pattern of HRQoL in patients with dch and in pacemaker patients, raising the possible associations between clinical, sociodemographic aspects, and test results and the lowest scores of HRQoL. The studies will be presented as original papers. Article 1: The HRQoL was availed in 139 patients with PM, 77 with ChD, 31 non-chagasic (NCh) and 31 without serological confirmation for ChD. It was used the physical and mental summaryof the generic instrument Medical Outcomes Study 36-Item Short-Form (SF36) associated with the Assessment of QUAlity of Life and RELated events (AQUAREL), specific for pacemaker patients. We performed uni and multivariate analyses in multiple linear regression model. Results The worset HRQoL was related in PM patients with: ChD, female condition, single condition and worst funcional class. In the multivariate analysis, the worset functional class was noted as an independent predictor of poor HRQoL in the SF36 physical summary andin all domains of AQUAREL. The single situation and retired situation proved to be predictors of worset HRQoL for the SF36 mental summary and females condition was the worst predictor to the AQUAREL arrhythmia domain. Article 2: We evaluated HRQoL in a 146 patients group , 125 with ChD and 21 NCh by SF36 and specific Minnesota Living With Heart Failure Questionnaire (MLWHFQ). The combination of the worst HRQoL scores with independent variables was tested by univariate and multivariate analysis using the ordinal logistic regressionmodel of proportional odds. Results: ChD pacients had the worse HRQoL scores than NCh pacients in physical capacity and emotional aspect domains of SF36 and MLWHFQ. For those pacients with ChD association was found between HRQL scores and educational level , sex, marital status, medicine use, functional class, cardiovascular and gastrointestinal symptoms. Independent predictors of poor HRQoL of ChD pacient were female sex, few years of education, single association, and worst functional class, cardiovascular symptoms and gastrointestinal symptoms, associated diseases, abnormal Dopplerechocardiogram, and Holter ventricular arrhythmia. Final considerations: In both studies we pointed out the negative influence of ChD for HRQoL of patients. Functional class, for those with MP, and cardiovascular symptoms for those with ChD , appeared as the strongest independent predictors of poor HRQoL. Methodological issues involved as well as challenges in the evaluation and interpretation of results must be considered. Finally, the studies point out the relevance of including systematic point of view of the patient in the rethinking of the Brazilian current biomedical model .