CAMPHOR score: patient-reported outcomes are improved by pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension.
Journal
The European respiratory journal
ISSN: 1399-3003
Titre abrégé: Eur Respir J
Pays: England
ID NLM: 8803460
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
26
10
2019
accepted:
07
05
2020
pubmed:
10
6
2020
medline:
22
6
2021
entrez:
10
6
2020
Statut:
epublish
Résumé
Pulmonary endarterectomy (PEA) is the recommended treatment for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) score is an internationally validated patient-reported outcome (PRO) measure for CTEPH. It assesses three domains: activity, quality of life (QoL) and symptoms. We assessed PROs in patients with CTEPH undergoing PEA. This retrospective observational study of consecutive CTEPH patients undergoing PEA at the UK national PEA centre between 2006 and 2017 assessed change in CAMPHOR score from baseline (pre-PEA) until up to 5 years post-PEA. CAMPHOR scores were compared between 1) those with and without clinically significant residual pulmonary hypertension and 2) those undergoing PEA and propensity-matched CTEPH patients who were not operated on. The minimally clinically important difference (MCID) was calculated using an anchor-based method. Out of 1324 CTEPH patients who underwent PEA, 1053 (80%) had a CAMPHOR score recorded pre-PEA, 934 (71%) had a score recorded within a year of PEA and 784 (60%) had both. There were significant improvements between pre- and post-PEA in all three CAMPHOR domains (median±interquartile range activity -5±7, QoL -4±8, symptoms -7±8; all p<0.0001). Improvements in CAMPHOR score were greater and more sustained in those without clinically significant residual pulmonary hypertension. CTEPH patients undergoing PEA had better CAMPHOR scores than those not operated on. The MCID in CAMPHOR score was -3±5 for activity, -4±7 for QoL and -6±7 for symptoms. PROs are markedly improved by PEA in patients with CTEPH, more so in those without clinically significant residual pulmonary hypertension.
Sections du résumé
BACKGROUND
Pulmonary endarterectomy (PEA) is the recommended treatment for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) score is an internationally validated patient-reported outcome (PRO) measure for CTEPH. It assesses three domains: activity, quality of life (QoL) and symptoms. We assessed PROs in patients with CTEPH undergoing PEA.
METHODS
This retrospective observational study of consecutive CTEPH patients undergoing PEA at the UK national PEA centre between 2006 and 2017 assessed change in CAMPHOR score from baseline (pre-PEA) until up to 5 years post-PEA. CAMPHOR scores were compared between 1) those with and without clinically significant residual pulmonary hypertension and 2) those undergoing PEA and propensity-matched CTEPH patients who were not operated on. The minimally clinically important difference (MCID) was calculated using an anchor-based method.
RESULTS
Out of 1324 CTEPH patients who underwent PEA, 1053 (80%) had a CAMPHOR score recorded pre-PEA, 934 (71%) had a score recorded within a year of PEA and 784 (60%) had both. There were significant improvements between pre- and post-PEA in all three CAMPHOR domains (median±interquartile range activity -5±7, QoL -4±8, symptoms -7±8; all p<0.0001). Improvements in CAMPHOR score were greater and more sustained in those without clinically significant residual pulmonary hypertension. CTEPH patients undergoing PEA had better CAMPHOR scores than those not operated on. The MCID in CAMPHOR score was -3±5 for activity, -4±7 for QoL and -6±7 for symptoms.
CONCLUSIONS
PROs are markedly improved by PEA in patients with CTEPH, more so in those without clinically significant residual pulmonary hypertension.
Identifiants
pubmed: 32513780
pii: 13993003.02096-2019
doi: 10.1183/13993003.02096-2019
pii:
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright ©ERS 2020.
Déclaration de conflit d'intérêts
Conflict of interest: M. Newnham has nothing to disclose. Conflict of interest: K. Bunclark has nothing to disclose. Conflict of interest: N. Abraham has nothing to disclose. Conflict of interest: S. Ali has nothing to disclose. Conflict of interest: L. Amaral-Almeida has nothing to disclose. Conflict of interest: J.E. Cannon reports grants from Actelion, during the conduct of the study; meeting travel support from Actelion and GSK, outside the submitted work. Conflict of interest: N. Doughty has nothing to disclose. Conflict of interest: C. Ng has nothing to disclose. Conflict of interest: A. Ponnaberanam has nothing to disclose. Conflict of interest: K. Sheares reports educational support from Actelion, Bayer and GSK, personal fees for consultancy from Actelion, outside the submitted work. Conflict of interest: N. Speed has nothing to disclose. Conflict of interest: D. Taboada reports other (speaker honoraria and education/travel grants) from Actelion, Bayer, GlaxoSmithKline, Lilly, MDS and Pfizer, outside the submitted work. Conflict of interest: M. Toshner reports personal fees from Actelion/J&J and GSK, grants and personal fees from Bayer, grants from Merck, outside the submitted work. Conflict of interest: S. Tsui has nothing to disclose. Conflict of interest: D.P. Jenkins reports grants and personal fees for lectures from Bayer, personal fees for lectures and adjudication committee work from Actelion, outside the submitted work. Conflict of interest: J. Pepke-Zaba has participated in advisory board activities for Actelion, GSK and MSD, given paid lectures for Actelion and MSD, and via institution has received research, education grants from Actelion and MSD.