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  • Health-related quality of life in congenital heart disease surgery in children and young adults: a systematic review and meta-analysis

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Original article
Health-related quality of life in congenital heart disease surgery in children and young adults: a systematic review and meta-analysis
  1. Laila Akbar Ladak1,
  2. Babar Sultan Hasan2,
  3. Janice Gullick3,
  4. Robyn Gallagher1
  1. 1 Charles Perkins Centre, Sydney Nursing School, The University of Sydney, Sydney, Australia
  2. 2 Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
  3. 3 Sydney Nursing School, The University of Sydney, Sydney, Australia
  1. Correspondence to Laila Akbar Ladak, Charles Perkins Centre, Sydney Nursing School, The University of Sydney, Sydney, NSW 2006, Australia; llad8915{at}uni.sydney.edu.au

Abstract

Background As survival improves in the congenital heart disease (CHD) population, health-related quality of life (HRQOL) outcomes become increasingly important. While surgery improves survival, poor HRQOL occurs postoperatively and cardiac-related HRQOL outcomes are rarely reported.

Objective To conduct a systematic review and meta-analyses of general and cardiac-related HRQOL in CHD surgical children and young adults.

Method Medline, CINAHL and EMBASE were searched. Quantitative designs with a minimum of 80% CHD surgical patients and mean age ≤18 years compared with healthy controls were included in the review. Data were analysed in RevMan V.5.3 using a random effects model.

Outcome measures General and cardiac-related HRQOL.

Results Studies (n=20) were conducted in high-income countries and included 3808 patients plus 2951 parental reports of patients. HRQOL was worse in postoperative patients with CHD versus healthy controls in all domains with the largest difference seen for physical function (standard mean difference (SMD) of −0.56, 95% CI −0.82 to −0.30). Cardiac-related HRQOL was worse in complex compared with simple CHD with the largest SMD (−0.60, 95% CI −0.80 to −0.40) for symptoms. Heterogeneity ranged from 0% to 90%.

Conclusions CHD surgical patients have substantially worse HRQOL compared with age-matched healthy controls. Strategies should focus on improving HRQOL in this subgroup. Results may not be applicable to low/middle-income countries given the dearth of relevant research.

  • cardiac surgery
  • cardiology
  • outcomes research
  • paediatric surgery
  • patient perspective

https://doi.org/10.1136/archdischild-2017-313653

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    Footnotes

    • Contributors LAL designed the review, conducted literature search, undertook data extraction, statistical analysis and data synthesis, and drafted the manuscript. BSH assisted with the design of the review, search strategy and data analysis, and provided critical feedback on the manuscript. JG assisted with the design of the review, confirmed the eligibility of the papers searched and data analysis, and provided critical feedback on the manuscript. RG oversaw the review process, checked the eligibility of papers, assisted with statistical data analysis and synthesis, and provided critical feedback on the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding This study is part of a PhD thesis. LAL received International Post Graduate Research Scholarship (IPRS) and Australian Post Graduate Award (APA) from The University of Sydney, Australia, to pursue doctoral studies.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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