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Canadian Journal of Cardiology

The Role of Quality of Life Indices in Patient-Centred Management of Arrhythmia

Published:March 19, 2020DOI:https://doi.org/10.1016/j.cjca.2020.03.014

      Abstract

      Clinicians obviously need to understand the impact of illness and its management on their patients’ quality of life (QOL). Objective, “hard” outcomes have taken primacy in the assessment of treatment outcomes in cardiovascular care, at least in part because they are relatively easy to measure precisely and accurately. QOL, on the other hand, is a subjective and more nebulous concept. However, decades of clinical observation and research have clearly shown that what matters most to patients is their subjective QOL, and objective measures of disease burden are less salient to their concerns. It is possible to measure QOL objectively and quantitatively using validated methods and to incorporate these into both everyday clinical care and research to measure the effect of various treatments and strategies. Physician beliefs about patients' subjective states are often imprecise and imperfectly accurate. Patient-reported QOL measures can help to predict the potential benefits of treatment; using validated measures, an estimate of the relevance of a particular amount of change in QOL can be obtained; the efficacy of different treatments from the patient’s perspective can be compared. In patient-centred care, the patient is the central focus of attention; this focus should be on patients and their subjective perceptions, more importantly than on the disease or associated laboratory measures of severity.

      Résumé

      Il va de soi que les cliniciens doivent comprendre les répercussions de la maladie sur la qualité de vie de leurs patients et savoir comment les prendre en charge. L'évaluation de l'efficacité des soins cardiovasculaires tient principalement compte des résultats objectifs et « tangibles », au moins en partie parce qu’ils sont relativement faciles à mesurer avec précision et exactitude. En revanche, la qualité de vie demeure un concept subjectif et plus nébuleux. Des décennies d’observation et de recherche clinique montrent toutefois nettement que ce qui compte le plus pour les patients est leur qualité de vie subjective; les mesures objectives du fardeau de la maladie sont moins importantes à leurs yeux. Il est possible de mesurer la qualité de vie de manière objective et quantitative grâce à des méthodes validées, qui peuvent être intégrées tant aux soins cliniques courants qu’aux activités de recherche, afin de mesurer l’effet des divers traitements et stratégies. Les croyances des médecins au sujet de l’état subjectif de leurs patients sont souvent imprécises et incomplètes. Les mesures de la qualité de vie rapportées par les patients peuvent aider à prédire les bienfaits éventuels d’un traitement; grâce à des outils de mesure validés, il est possible d’estimer l’importance d’une variation particulière de l’évaluation de la qualité de vie et de comparer l’efficacité de différents traitements du point de vue du patient. Pour prodiguer des soins réellement axés sur le patient, il faut tenir compte concrètement de ce dernier et de ses perceptions subjectives, bien plus que de la maladie ou des résultats des épreuves de laboratoire indiquant la gravité de l’atteinte.
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