Health Expectations and Quality of Life After Acute Respiratory Failure: A Multicenter Prospective Cohort Study

Alison E Turnbull; Emma M Lee; Victor D Dinglas; Sarah Beesley; Somnath Bose; Valerie Banner-Goodspeed; Ramona O Hopkins; James C Jackson; Mustafa Mir-Kasimov; Carla M Sevin; Samuel M Brown; Dale M Needham; Addressing Post-Intensive Care Syndrome-01 (APICS-01) Study Team

doi:10.1016/j.chest.2023.01.016

Health Expectations and Quality of Life After Acute Respiratory Failure: A Multicenter Prospective Cohort Study

Chest. 2023 Jul;164(1):114-123. doi: 10.1016/j.chest.2023.01.016. Epub 2023 Jan 19.

Collaborators

Addressing Post-Intensive Care Syndrome-01 (APICS-01) Study Team:
Elise Caraker, Sai Phani Sree Cherukuri, Naga Preethi Kadiri, Tejaswi Kalva, Mounica Koneru, Pooja Kota, Emma Maelian Lee, Mazin Ali Mahmoud, Albahi Malik, Roozbeh Nikooie, Darin Roberts, Sriharsha Singu, Parvaneh Vaziri, Katie Brown, Austin Daw, Mardee Merrill, Rilee Smith, Ellie Hirshberg, Jorie Butler, Benjamin Hoenig, Maria Karamourtopoulos, Margaret Hays, Rebecca Abel, Craig High, Emily Beck, Brent Armbruster, Darrin Applegate, Melissa Fergus, Naresh Kumar, Megan Roth, Susan Mogan, Rebecca Abel, Andre De Souza Licht, Isabel Londono, Julia Larson, Krystal Capers, Andrew Toksoz-Exley, Julia Crane, Lauren Tsai

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD. Electronic address: turnbull@jhmi.edu.
² Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA.
³ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD.
⁴ Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT; Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT; Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT.
⁵ Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT; Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT.
⁶ Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
⁷ Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT; Salt Lake City Veterans Administration, Salt Lake City, UT.
⁸ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD.

PMID: 36682611
PMCID: PMC10331625 (available on 2024-07-01)
DOI: 10.1016/j.chest.2023.01.016

Abstract

Background: Patients often have high expectations for recovery after critical illness, but the impact of these expectations on subsequent quality of life (QoL) after serious illnesses has not been evaluated empirically.

Research question: Among adult survivors of acute respiratory failure (ARF), are met vs unmet expectations for health associated with self-reported QoL 6 months after discharge?

Study design and methods: This was a prospective longitudinal cohort study enrolling consecutive adult patients with ARF managed in ICUs at five academic medical centers. At hospital discharge, we evaluated participants' expected health 6 months in the future via a visual analog scale (VAS; range, 0-100), with higher scores representing better expected health. At 6-month follow-up, perceived health was assessed using the EQ-5D VAS, and QoL was assessed using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) instrument. Participants' health expectations were categorized as having been met when perceived health at 6 months was no more than eight points lower than their expectation at study enrollment. The primary analysis compared WHOQOL-BREF domain scores (range, 0-100) at 6 months after discharge in patients with met vs unmet health expectations using the nonparametric Mann-Whitney U test. Secondary analysis modeled WHOQOL-BREF domain scores using multivariate regression, and sensitivity analyses assessed QoL using EQ-5D-5L index values.

Results: In the primary analysis, QoL was significantly better among participants with met vs unmet health expectations across all domains of the WHOQOL-BREF: physical health (estimated difference in scores: median, 19 [interquartile range (IQR), 12-15]; P < .001), psychological health (median, 12 [IQR, 6-18]; P < .001), social relationships (median, 6 [IQR, 0-13]; P = .02), and environmental health (median, 12 [IQR, 6-13]; P < .001). In multivariate regression, the difference between expected and perceived health remained associated significantly with the physical health domain score.

Interpretation: Fulfillment of health expectations is associated with better QoL after ARF, suggesting a mechanism underpinning successful ICU recovery programs that incorporate normalization and expectation management.

Keywords: critical care outcomes; functional status; quality of life; respiratory distress syndrome; survivorship.

Publication types

Multicenter Study
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Adult
Humans
Longitudinal Studies
Motivation
Prospective Studies
Quality of Life*
Respiratory Insufficiency* / therapy
Surveys and Questionnaires

Grants and funding

K01 HL141637/HL/NHLBI NIH HHS/United States