The following is a summary of “Health Expectations and Quality of Life After Acute Respiratory Failure: A Multicenter Prospective Cohort Study,” published in the July 2023 issue of the Chest by Turnbull et al.
Patients frequently have high expectations for recovery after critical illness. Still, the influence of these expectations on subsequent quality of life (QoL) after acute diseases has yet to be empirically evaluated. Are met versus unmet expectations for health among adult survivors of acute respiratory failure (ARF) associated with self-reported QoL six months after discharge? This was a prospective longitudinal cohort study in which consecutive adult ICU patients with ARF were enrolled. At hospital discharge, the researchers assessed participants’ future health expectations using a visual analog scale (VAS; range: 0-100), with greater scores indicating better health expectations.
At 6-month follow-up, perceived health was evaluated using the EQ-5D VAS, and QoL was assessed using the WHOQOL-BREF instrument. The participants’ health expectations were deemed met if their perception of their health at six months was no more than eight points below their expectation at study enrollment. Using the nonparametric Mann-Whitney U test, the primary analysis compared WHOQOL-BREF domain scores (range, 0-100) six months after discharge between patients with met and unmet health expectations. WHOQOL-BREF domain scores were modeled using multivariate regression, and EQ-5D-5L index values were used to assess the quality of life.
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 substantially associated with the physical health domain score. Fulfilling health expectations is associated with improved QoL after ARF, suggesting a mechanism underlying effective ICU recovery programs that include normalization and expectation management.