Time in therapeutic range, quality of life and treatment satisfaction of patients on long‑term warfarin for non‑valvular atrial fibrillation: a cross‑sectional study

Background: The use of warfarin in patients with non-valvular atrial fibrillation (NVAF) can be challenging. In this study, we evaluate the time in therapeutic range (TTR), health-related quality of life (HRQoL) and treatment satisfaction of patients on long-term warfarin for NVAF. The HRQoL and treatment satisfaction were compared based on the TTR. Methods: A cross-sectional study was conducted among patients on warfarin for NVAF who attended the anticoagulant clinic of a tertiary cardiology referral center in Sarawak from 1st June 2018 to 31st May 2019. Patients’ TTR was calculated by using Rosendaal technique, while their HRQoL and treatment satisfaction were assessed by using Short Form 12 Health Survey version 2 (SF12v2) and Duke Anticoagulant Satisfaction Scale (DASS), respectively. Results: A total of 300 patients were included, with mean TTR score of 47.0 ± 17.3%. The physical component summary (PCS) and mental component summary (MCS) score of SF-12v2 were 47.0 ± 9.0 and 53.5 ± 9.6, respectively. The total score for DASS was 55.2 ± 21.3, while the score for limitations (L), hassles and burdens (H&B) and positive psychological impacts (PPI) were 18.0 ± 10.0, 15.6 ± 9.1 and 21.6 ± 5.9, respectively. Seventy-three (24.3%) patients had good TTR (≥ 60%), with mean of 70.2 ± 8.7%; while 227 (75.5%) patients with poor TTR had significantly lower mean of 39.5 ± 11.9% (p = 0.006). There was no significant difference in the score of PCS (p = 0.150), MCS (p = 0.919) and each domain of SF-12v2 (p = 0.184–0.684) between good and poor TTR, except for social functioning (p = 0.019). The total DASS score was also not significantly different between group (p = 0.779). Similar non-significant difference was also reported in all the DASS sub dimensions (p = 0.502–0.699). Conclusions: Majority of the patients on long-term warfarin for NVAF in the current study have poor TTR. Their HRQoL and treatment satisfaction are independent of their TTR. Achieving a good TTR do not compromise the HRQoL and treatment satisfaction. Therefore, appropriate measures should be taken to optimise INR control, failing which direct oral anticoagulant therapy should be considered

292P Erectile dysfunction among male lymphoma survivors in a developing country

Background: Although erectile dysfunction (ED) is one of the known long-term complications among male cancer survivors, it is not commonly reported particularly in South East Asian region. This study aims to determine the prevalence of ED in lymphoma survivors in Malaysia and to determine its association with anxiety and depression, and its effects on patients’ quality of life (QOL). Methods: This was a cross-sectional study conducted in an outpatient haematology clinic at a tertiary hospital inMalaysia. Patients were allmale lymphoma survivors who were age 18 years old and above. The International Index of Erectile Function (IIEF-5) Questionnairewere used to screen for ED.Hospital Anxiety and Depression Score (HADS) questionnaire were used to assess for anxiety and depression.Quality of life were assessed using EORTC QLQ-C30. Bio-demographic datawas analysed using descriptive analysis. The association of EDwith the bio-demographics was assessed using Chi square test. The correlation between ED and anxiety/depression scores andQOL scores were measured using Pearson correlation. P value of<0.05 is statistically significant. Results: A total of 106 male patients were recruited (response rate of 79.6%). The mean age of the participants was 55.7 years old (range from 18-85 years). More than half (61%) of the patients were above 50 years old and 50.7% had other comorbidities. Thirty-five percent of patients were not sexually active at the time of interview and the most common reason provided were ‘feeling too tired’ (48.1%). Among those who were sexually active patients, 81.7% reported presence of ED. However, 4.2% had severe ED. The prevalence of ED among younger age group (< 40 years old) was 61.5%. Age was the only factor found to be associated with ED and the severity of EDincreased with age (p value ¼ 0.002). There was no association between ED with symptoms of anxiety or depression. Quality of life was also not found to be significantly associated with ED. Conclusions: ED is more prevalent in the older population and this is consistent with many studies. However, the relatively high prevalence of ED in younger patients is of concerns. This should remind the treating clinicians to be more mindful of the sexual dysfunction of these groups of patients and perhaps intervention may offer some help

Erectile dysfunction in male lymphoma survivors in a Southeast Asian country

Introduction: Although erectile dysfunction (ED) is one of known long-term complications among male lymphoma survivors, it is not commonly reported, particularly in Southeast Asia. This study aimed to determine the prevalence of ED in lymphoma survivors in Malaysia and its association with anxiety and depression, and effects on quality of life. Methods: This was a cross-sectional study conducted at a tertiary hospital in Malaysia. Patients were all male lymphoma survivors. The self-administered International Index of Erectile Function questionnaire was used to screen for ED. The Hospital Anxiety and Depression Score questionnaire was used to assess for anxiety and depression, and quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire. Results: Overall, 106 patients were recruited. Mean age was 55.7 years, with 61.3% of patients aged above 50 years. Only 67.0% of patients were sexually active and 81.7% of these reported the presence of ED, with only 4.2% having severe ED. Prevalence of ED among younger patients (age ≤ 50 years old) was 64.5%.The most common reason given by patients who were not sexually active was fatigue. Age was the only factor found to be associated with ED (p < 0.005) and severity of ED increased with age. There was no association between ED and psychological stress or quality of life. Conclusion: Prevalence of ED and absence of sexual activity in lymphoma survivors was high. This should serve as a reminder to the treating clinician to offer early treatment and counselling

Quality of Life and Treatment Satisfaction Among Patients on Long Term Oral Anticoagulant in A Developing Country

Background: Randomised phase III studies had proven the efficacy and safety profile of direct oral anticoagulant (DOAC) over warfarin in stroke and systemic embolism prevention for patients with atrial fibrillation (AF) and venous thromboembolism (VTE). Nevertheless, patients’ quality of life (QOL) and treatment satisfaction was not explored in these studies. Objective: The primary objective of this study was to compare the QOL and treatment satisfaction of patients on long term warfarin versus DOACs in a tertiary hospital in Malaysia. Methods: This is a cross-sectional study of patients with nonvalvular AF (NVAF) or VTE on long term warfarin versus DOACs attending the cardiology clinic and anticoagulation clinic of University Malaya Medical Centre from 1 st July 2016 to 30 st June 2018. Patients’ QOL was assessed by using Short Form 12v2 Health Survey (SF12v2); while treatment satisfaction was assessed by using Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2). Results: Of 208 patients, 52.4% received warfarin and remaining 47.6% received DOACs. The warfarin group was significantly younger and had longer treatment duration (p b 0.001); while DOAC group had significant more underlying NVAF (p b 0.001) and polypharmacy (p= 0.003). There was no significant difference in the score of physical component summary (PCS) (p= 0.083), mental component summary (MCS) (p = 0.665) and each domain of SF-12v12 (p = 0.058 – 0.953) between anticoagulant groups. There were no differences between the 2 groups of anticoagulants even after adjustment of age. The satisfactionscore was significant higher in DOACs group compared to warfarin group (p = 0.003); but there was no difference in the convenience score (p= 0.234). Hospitalisation rate was significantly higher (p = 0.002) in warfarin group. Only 45.0% of patients achieved good time in therapeutic range (TTR). Conclusions: Despite no significant difference in QOL, patients with AF or VTE who were treated with DOACs demonstrated better efficacy, safety, and satisfaction profile, as well as a relatively stable within-group QOL

Copd assessment test (cat) score of patients with chronic obstructive pulmonary disease based on clinical phenotypes

Background and Aims: Spanish chronic obstructive pulmonary disease (COPD) guideline classifies COPD into 4 clinical phenotypes: nonexacerbator (A), asthma-COPD overlap (B), exacerbator with emphysema (C) and exacerbator with bronchitis (D). Methods: A cross-sectional observational study of quality of life (QOL) of COPD patients utilizing COPD Assessment Test (CAT), conducted in University of Malaya Medical Center from 1 June 2017 – 31 May 2018. Results: Of 220 patients traeted for COPD, 189 patients with post bronchodilator Force Expiratory Volume in 1 second (FEV1)/Force Vital Capacity (FVC) of <0.70 were recruited. Patients’ demographic, clinical characteristics and CAT score are as shown in Table 1. Patients with COPD phenotype C and D had poorer modified medical research center (MMRC) functional status and global initiative of COPD (GOLD) class based on their FEV1. Patients with phenotype D had significantly higher total CAT score than patients with other clinical phenotypes. Other than sleep quality, patients with phenotype D had significantly higher score in every other components, notably cough severity, phlegm volume, chest tightness, breathlessness upon walking uphill, activity limitation at home, ability toleave home and energy. There was no different in terms of total and components CAT score of patients with phenotype A, B and C. Conclusion: Patients with phenotype D had significant higher CAT score, thus poorer quality of life and higher tendency of execebration. This group of patients need better medical treatment and closer monitoring

363P A randomized controlled trial of mindfulness breathing exercise in patients with advanced lung cancer

Background: Study of mindfulness breathing exercise in dyspnea reduction of patients with advanced lung cancer is lacking. Methods: This is a parallel-group, nonblinded randomized controlled trial of mindfulness breathing exercise versus placebo (best medical care alone) in patients with advanced lung cancer admitted to the respiratory unit and palliative unit of University Malaya Medical Center from 1st August 2017 to 31st March 2018. Results: A total of 34 patients were equally assigned to mindfulness breathing exercise group and control group (Table). For patients receiving mindfulness breathing exercise, 10 (58.8%) of them had reduction in modified Borg dyspnea scale (MBDS) score at 5-minutes (OR, 9.33; 95% CI, 1.80–48.38; p¼0.005) and 20-minutes (OR, 2.86; 95% CI, 0.67–12.11; p¼0.149), compared to only 3 (17.6%) and 7 (41.1%) of them in control arm at 5-minutes and 20-minutes, respectively. 5 patients (29.4%) on mindfulness breathing exercise achieved improvement in their SpO2 compare to only 2 patients (11.8%) of control arm had that at 5-minutes (OR, 3.75; 95% CI, 0.61–23.35; p¼0.209). 4 patients (23.5%) on mindfulness breathing exercise had SpO2 improvement at 20-minutes, while none in control arm had SpO2 improvement at same time. Similar number of patients had reduced respiratory rate after mindfulness breathing exercise or at control for 5-minutes [9 (52.9%) versus 10 (58.8%), (OR, 1.05; 95% CI, 0.26–4.32; p¼0.946)]. At 20-minutes, similar number of patients on mindfulness breathing exercise still had sustained reduction in respiratory rate while only 7 patients (41.1%) in control arm had similar respiratory benefit (OR, 2.14; 95% CI, 0.52–8.81; p¼0.288). Conclusions: Mindfulness breathing exercise is effective in reducing dyspnea among patients with advanced lung cancer

Clinical phenotypes of COPD and health-related quality of life: a cross-sectional study

The Spanish COPD guideline (GesEPOC) classifies COPD into four clinical phenotypes based on the exacerbation frequency and dominant clinical manifestations. In this study, we compared the disease-specific health-related quality of life (HRQoL) of patients with different clinical phenotypes

COPD exacerbations and patient-reported outcomes according to post-bronchodilator FEV1 – a post-hoc analysis of pooled data

Background Management strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV1), exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV1, exacerbations, and PROs of patients with stable COPD. Methods This was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV1 (PB-FEV1), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George’s Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used. Results Three hundred seventy-four patients were included in the analysis. The PB-FEV1 predicted was < 30% in 85 (22.7%), 30–49% in 142 (38.0%), 50–79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV1 < 30% predicted had significantly more COPD exacerbations than those with PB-FEV1 30–49% predicted (p < 0.001), 50–79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV1 (p = 0.121–0.271). The PB-FEV1 predicted had significant weak negative correlations with exacerbations (r = − 0.182, p < 0.001), mMRC (r = − 0.121, p = 0.020), and SGRQ-c scores (r = − 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407–0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001). Conclusions In COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was wea

Comparing quality of life and treatment satisfaction between patients on warfarin and direct oral anticoagulants : a cross-sectional study

Introduction and aim: Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC). Methods: This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2). Results: A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, P=0.083; mental QOL, P=0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 (P=0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, P=0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, P=0.069). Conclusion: Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes

Quality Of Life Of Patients With Chronic Obstructive Pulmonary Disease Based On Clinical Phenotypes

Background and Aims: Spanish chronic obstructive pulmonary disease (COPD) guideline classifies COPD into 4 clinical phenotypes: nonexacerbator (A), asthma-COPD overlap (B), exacerbator with emphysema(C) and exacerbator with bronchitis (D). Methods: A cross-sectional study of quality of life (QOL) based on COPD phenotypes utilizing St George’s Respiratory Questionnaire (SGRQ-c) conducted in University Malaya Medical Center from 1 June 2017 – 31 May 2018. Results: Of 220 patients, 189 patients with post bronchodilator force expiratory volume in 1 second (FEV1)/force vital capacity (FVC) of <0.70 were recruited. Their demographic, clinical characteristics and SGRQ-c score are as shown in Table 1. Patients with phenotype C and D had poorer modified medical research center (MMRC) performance status and global initiative for COPD (GOLD) class based on FEV1. Nevertheless, only patients with phenotype D had significant higher total SGRQ-c score than others. They also scored significant higher in sub-components of COPD symptoms, activities and impacts. Patients with phenotypes B had numerically higher SGRQ-c total and symptoms score than those with phenotype A and C. The total and sub-components SGRQ-c score of patients with phenotype A and C were almost similar. Conclusion: Patients with phenotype D had poorest QOL, followed by phenotype B. These groups of patients need additional medical attention, in terms of pharmacology treatment, physiotherapy and rehabilitation