Clinical application progress of patient-reported outcomes in postoperative cardiac surgery patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIAO Zhongyu ¹ , LI Yicheng ¹ , SUN Runchen ¹ , LIN Shen ^1,2 ,  ZHENG Zhe ^1,2

1. National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

ZHENG Zhe, Email: zhengzhe@fuwai.com

Keywords：

Cardiac surgery; patient-reported outcome measures; postoperative recovery; review

DOI：

10.7507/1007-4848.202410052

Video：

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Abstract Full text Figures/Tables Video References Cited by

Cardiac surgery is associated with high risks, significant trauma, and long recovery periods. With advances in cardiac surgery techniques, the mortality rate and incidence of complications have been steadily decreasing. Patient-reported outcomes (PROs) have gradually become an important area of research in postoperative recovery of cardiac surgery. The use of patient-reported outcome measures (PROMs) in this field helps to reflect patients' physiological, psychological, and social functioning during recovery, and provides scientific evidence for clinical interventions, which may further improve prognosis and enhance patient recovery experience. This paper reviews the dimensions of PROMs in the field of cardiac surgery recovery, the current status of existing PROMs scales, and the progress of their application, while also identifying the limitations of the existing tools. Finally, it explores future research directions for PROMs in cardiac surgery patients.

1.	马文君, 马涵萍, 王运红, 等. 《2021年中国心血管病医疗质量报告》概要. 中国循环杂志, 2021, 36(11): 1041-1064.
2.	Goldfarb M, Drudi L, Almohammadi M, et al. Outcome reporting in cardiac surgery trials: Systematic review and critical appraisal. J Am Heart Assoc, 2015, 4(8): e002204.
3.	Birkmeyer JD, Dimick JB, Birkmeyer NJ. Measuring the quality of surgical care: Structure, process, or outcomes? J Am Coll Surg, 2004, 198(4): 626-632.
4.	Subramanian M, Kozower BD, Brown LM, et al. Patient-reported outcomes in cardiothoracic surgery. Ann Thorac Surg, 2019, 107(1): 294-301.
5.	Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. J Clin Oncol, 2016, 34(6): 557-565.
6.	US Department of Health and Human Services Food and Drug Administration. Guidance for industry. Patient-reported outcome measures: Use in medicinal product development to support labeling claims, 2009.
7.	Mori M, Angraal S, Chaudhry SI, et al. Characterizing patient-centered postoperative recovery after adult cardiac surgery: A systematic review. J Am Heart Assoc, 2019, 8(21): e013546.
8.	Anker SD, Agewall S, Borggrefe M, et al. The importance of patient-reported outcomes: A call for their comprehensive integration in cardiovascular clinical trials. Eur Heart J, 2014, 35(30): 2001-2009.
9.	Ghoneim MM, O'Hara MW. Depression and postoperative complications: An overview. BMC Surg, 2016, 16: 5.
10.	O'Neill D, Forman DE. The importance of physical function as a clinical outcome: Assessment and enhancement. Clin Cardiol, 2020, 43(2): 108-117.
11.	Rahimi K, Malhotra A, Banning AP, et al. Outcome selection and role of patient reported outcomes in contemporary cardiovascular trials: Systematic review. BMJ, 2010, 341: c5707.
12.	Rumsfeld JS, Alexander KP, Goff DC, et al. Cardiovascular health: The importance of measuring patient-reported health status: A scientific statement from the American Heart Association. Circulation, 2013, 127(22): 2233-2249.
13.	Nguyen DD, Decker C, Pacheco CM, et al. Developing an individualized patient decision aid for chronic coronary disease based on the ISCHEMIA trial: A mixed-methods study. Circ Cardiovasc Qual Outcomes, 2024, 17(10): e010923.
14.	Myles PS, Hunt JO, Nightingale CE, et al. Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg, 1999, 88(1): 83-90.
15.	Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: The QoR-15. Anesthesiology, 2013, 118(6): 1332-1340.
16.	Royse CF, Newman S, Chung F, et al. Development and feasibility of a scale to assess postoperative recovery: The post-operative quality recovery scale. Anesthesiology, 2010, 113(4): 892-905.
17.	Schroter S, Lamping DL. Coronary revascularisation outcome questionnaire (CROQ): Development and validation of a new, patient based measure of outcome in coronary bypass surgery and angioplasty. Heart, 2004, 90(12): 1460-1466.
18.	Nieveen JL, Zimmerman LM, Barnason SA, et al. Development and content validity testing of the Cardiac Symptom Survey in patients after coronary artery bypass grafting. Heart Lung, 2008, 37(1): 17-27.
19.	Posen I, Grosman-Rimon L, Caspi-Avissar N, et al. Depression predicts delayed return to daily activities in patients post-cardiac surgery: A prospective observational study. J Cardiothorac Surg, 2024, 19(1): 504.
20.	Lin TR, Cheng CH, Wei J, et al. Factors influencing sleep quality in open-heart patients in the postoperative intensive care unit. Healthcare (Basel), 2022, 10(11): 2311.
21.	Hu XM, Wei WT, Huang DY, et al. Sleep patterns and potential risk factors for disturbed sleep quality in patients after surgery for infective endocarditis. J Cardiothorac Surg, 2022, 17(1): 121.
22.	Sanders J, Bowden T, Woolfe-Loftus N, et al. Predictors of health-related quality of life after cardiac surgery: A systematic review. Health Qual Life Outcomes, 2022, 20(1): 79.
23.	Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol, 2010, 63(11): 1179-1194.
24.	Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Ⅰ. Conceptual framework and item selection. Med Care, 1992, 30(6): 473-483.
25.	Ware J, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care, 1996, 34(3): 220-233.
26.	Rabin R, de Charro F. EQ-5D: A measure of health status from the EuroQol Group. Ann Med, 2001, 33(5): 337-343.
27.	Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota living with heart failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J, 1992, 124(4): 1017-1025.
28.	Green CP, Porter CB, Bresnahan DR, et al. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: A new health status measure for heart failure. J Am Coll Cardiol, 2000, 35(5): 1245-1255.
29.	Oldridge N, Saner H, McGee HM, et al. The Euro Cardio-QoL Project. An international study to develop a core heart disease health-related quality of life questionnaire, the HeartQoL. Eur J Cardiovasc Prev Rehabil, 2005, 12(2): 87-94.
30.	Hlatky MA, Boineau RE, Higginbotham MB, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol, 1989, 64(10): 651-654.
31.	Spertus JA, Winder JA, Dewhurst TA, et al. Development and evaluation of the Seattle Angina Questionnaire: A new functional status measure for coronary artery disease. J Am Coll Cardiol, 1995, 25(2): 333-341.
32.	LaPier TK. Psychometric evaluation of the heart surgery symptom inventory in patients recovering from coronary artery bypass surgery. J Cardiopulm Rehabil, 2006, 26(2): 101-106.
33.	Wong J, Tong D, De Silva Y, et al. Development of the functional recovery index for ambulatory surgery and anesthesia. Anesthesiology, 2009, 110(3): 596-602.
34.	Myles PS, Weitkamp B, Jones K, et al. Validity and reliability of a postoperative quality of recovery score: The QoR-40. Br J Anaesth, 2000, 84(1): 11-15.
35.	Calvert M, Kyte D, Mercieca-Bebber R, et al. Guidelines for inclusion of patient-reported outcomes in clinical trial protocols: The SPIRIT-PRO extension. JAMA, 2018, 319(5): 483-494.
36.	Lamy A, Devereaux PJ, Prabhakaran D, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med, 2016, 375(24): 2359-2368.
37.	Hansen TB, Zwisler AD, Berg SK, et al. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care. Eur J Prev Cardiol, 2017, 24(7): 698-707.
38.	Holmes C, Briffa N. Patient-reported outcome measures (PROMS) in patients undergoing heart valve surgery: Why should we measure them and which instruments should we use? Open Heart, 2016, 3(1): e000315.
39.	Schroter S, Lamping DL. Responsiveness of the coronary revascularisation outcome questionnaire compared with the SF-36 and Seattle angina questionnaire. Qual Life Res, 2006, 15(6): 1069-1078.
40.	Klotz SGR, Ketels G, Behrendt CA, et al. Interdisciplinary and cross-sectoral perioperative care model in cardiac surgery: Implementation in the setting of minimally invasive heart valve surgery (INCREASE)-study protocol for a randomized controlled trial. Trials, 2022, 23(1): 528.
41.	Jeanneteau A, Demarquette A, Blanchard-Daguet A, et al. Effect of superficial and deep parasternal blocks on recovery after cardiac surgery: Study protocol for a randomized controlled trial. Trials, 2023, 24(1): 444.
42.	Choi JY, Lee HS, Kim JY, et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial. J Clin Anesth, 2022, 82: 110955.
43.	Pereira H, Graça MI, Fonseca D, et al. Impact of ketamine on quality of recovery after laparoscopic surgery: A single-centre single-blinded trial using the QoR-15 questionnaire. Anesthesiol Res Pract, 2023, 2023: 8890025.
44.	Lee WK, Kim MS, Kang SW, et al. Type of anaesthesia and patient quality of recovery: A randomized trial comparing propofol-remifentanil total i. v. anaesthesia with desflurane anaesthesia. Br J Anaesth, 2015, 114(4): 663-668.
45.	Claessens J, Goris P, Yilmaz A, et al. Patient-centred outcomes after totally endoscopic cardiac surgery: One-year follow-up. J Clin Med, 2023, 12(13): 4406.
46.	Rogers CA, Pike K, Campbell H, et al. Coronary artery bypass grafting in high-RISk patients randomised to off- or on-Pump surgery: A randomised controlled trial (the CRISP trial). Health Technol Assess, 2014, 18(44): v-xx,1v-157v.
47.	Milne B, Lucas de Carvalho J, Ayis S, et al. Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: A pilot study. Br J Anaesth, 2022, 128(6): 949-958.
48.	Ben-Ali W, Lamarche Y, Carrier M, et al. Use of Mobile-based application for collection of patient-reported outcomes in cardiac surgery. Innovations (Phila), 2021, 16(6): 536-544.
49.	Mori M, Brooks C, Spatz E, et al. Protocol for project recovery after cardiac surgery: A single-center cohort study leveraging digital platform to characterise longitudinal patient-reported postoperative recovery patterns. BMJ Open, 2020, 10(9): e036959.
50.	Vámosi M, Lauberg A, Borregaard B, et al. Patient-reported outcomes predict high readmission rates among patients with cardiac diagnoses. Findings from the DenHeart study. Int J Cardiol, 2020, 300: 268-275.
51.	Berg SK, Thorup CB, Borregaard B, et al. Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey. Eur J Prev Cardiol, 2019, 26(6): 624-637.
52.	Borregaard B, Pedersen SS, Berg SK, et al. What to expect after open heart valve surgery? Changes in health-related quality of life. Qual Life Res, 2020, 29(5): 1247-1258.
53.	Nielsen SN, Rasmussen TB, Lassen JF, et al. The association between self-reported health status and adverse events: A comparison among coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). Qual Life Res, 2020, 29(11): 3017-3029.
54.	Devji T, Carrasco-Labra A, Qasim A, et al. Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: Instrument development and reliability study. BMJ, 2020, 369: m1714.
55.	Masterson Creber R, Spadaccio C, Dimagli A, et al. Patient-reported outcomes in Cardiovascular trials. Can J Cardiol, 2021, 37(9): 1340-1352.
56.	Wang Y, Devji T, Carrasco-Labra A, et al. A step-by-step approach for selecting an optimal minimal important difference. BMJ, 2023, 381: e073822.
57.	Zhang Y, Xi X, Huang Y. The anchor design of anchor-based method to determine the minimal clinically important difference: A systematic review. Health Qual Life Outcomes, 2023, 21(1): 74.
58.	Fagundes CP, Shi Q, Vaporciyan AA, et al. Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory. J Thorac Cardiovasc Surg, 2015, 150(3): 613-619.
59.	Dai W, Feng W, Zhang Y, et al. Patient-reported outcome-based symptom management versus usual care after lung cancer surgery: A multicenter randomized controlled trial. J Clin Oncol, 2022, 40(9): 988-996.

1. 马文君, 马涵萍, 王运红, 等. 《2021年中国心血管病医疗质量报告》概要. 中国循环杂志, 2021, 36(11): 1041-1064.
2. Goldfarb M, Drudi L, Almohammadi M, et al. Outcome reporting in cardiac surgery trials: Systematic review and critical appraisal. J Am Heart Assoc, 2015, 4(8): e002204.
3. Birkmeyer JD, Dimick JB, Birkmeyer NJ. Measuring the quality of surgical care: Structure, process, or outcomes? J Am Coll Surg, 2004, 198(4): 626-632.
4. Subramanian M, Kozower BD, Brown LM, et al. Patient-reported outcomes in cardiothoracic surgery. Ann Thorac Surg, 2019, 107(1): 294-301.
5. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. J Clin Oncol, 2016, 34(6): 557-565.
6. US Department of Health and Human Services Food and Drug Administration. Guidance for industry. Patient-reported outcome measures: Use in medicinal product development to support labeling claims, 2009.
7. Mori M, Angraal S, Chaudhry SI, et al. Characterizing patient-centered postoperative recovery after adult cardiac surgery: A systematic review. J Am Heart Assoc, 2019, 8(21): e013546.
8. Anker SD, Agewall S, Borggrefe M, et al. The importance of patient-reported outcomes: A call for their comprehensive integration in cardiovascular clinical trials. Eur Heart J, 2014, 35(30): 2001-2009.
9. Ghoneim MM, O'Hara MW. Depression and postoperative complications: An overview. BMC Surg, 2016, 16: 5.
10. O'Neill D, Forman DE. The importance of physical function as a clinical outcome: Assessment and enhancement. Clin Cardiol, 2020, 43(2): 108-117.
11. Rahimi K, Malhotra A, Banning AP, et al. Outcome selection and role of patient reported outcomes in contemporary cardiovascular trials: Systematic review. BMJ, 2010, 341: c5707.
12. Rumsfeld JS, Alexander KP, Goff DC, et al. Cardiovascular health: The importance of measuring patient-reported health status: A scientific statement from the American Heart Association. Circulation, 2013, 127(22): 2233-2249.
13. Nguyen DD, Decker C, Pacheco CM, et al. Developing an individualized patient decision aid for chronic coronary disease based on the ISCHEMIA trial: A mixed-methods study. Circ Cardiovasc Qual Outcomes, 2024, 17(10): e010923.
14. Myles PS, Hunt JO, Nightingale CE, et al. Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg, 1999, 88(1): 83-90.
15. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: The QoR-15. Anesthesiology, 2013, 118(6): 1332-1340.
16. Royse CF, Newman S, Chung F, et al. Development and feasibility of a scale to assess postoperative recovery: The post-operative quality recovery scale. Anesthesiology, 2010, 113(4): 892-905.
17. Schroter S, Lamping DL. Coronary revascularisation outcome questionnaire (CROQ): Development and validation of a new, patient based measure of outcome in coronary bypass surgery and angioplasty. Heart, 2004, 90(12): 1460-1466.
18. Nieveen JL, Zimmerman LM, Barnason SA, et al. Development and content validity testing of the Cardiac Symptom Survey in patients after coronary artery bypass grafting. Heart Lung, 2008, 37(1): 17-27.
19. Posen I, Grosman-Rimon L, Caspi-Avissar N, et al. Depression predicts delayed return to daily activities in patients post-cardiac surgery: A prospective observational study. J Cardiothorac Surg, 2024, 19(1): 504.
20. Lin TR, Cheng CH, Wei J, et al. Factors influencing sleep quality in open-heart patients in the postoperative intensive care unit. Healthcare (Basel), 2022, 10(11): 2311.
21. Hu XM, Wei WT, Huang DY, et al. Sleep patterns and potential risk factors for disturbed sleep quality in patients after surgery for infective endocarditis. J Cardiothorac Surg, 2022, 17(1): 121.
22. Sanders J, Bowden T, Woolfe-Loftus N, et al. Predictors of health-related quality of life after cardiac surgery: A systematic review. Health Qual Life Outcomes, 2022, 20(1): 79.
23. Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol, 2010, 63(11): 1179-1194.
24. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Ⅰ. Conceptual framework and item selection. Med Care, 1992, 30(6): 473-483.
25. Ware J, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care, 1996, 34(3): 220-233.
26. Rabin R, de Charro F. EQ-5D: A measure of health status from the EuroQol Group. Ann Med, 2001, 33(5): 337-343.
27. Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota living with heart failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J, 1992, 124(4): 1017-1025.
28. Green CP, Porter CB, Bresnahan DR, et al. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: A new health status measure for heart failure. J Am Coll Cardiol, 2000, 35(5): 1245-1255.
29. Oldridge N, Saner H, McGee HM, et al. The Euro Cardio-QoL Project. An international study to develop a core heart disease health-related quality of life questionnaire, the HeartQoL. Eur J Cardiovasc Prev Rehabil, 2005, 12(2): 87-94.
30. Hlatky MA, Boineau RE, Higginbotham MB, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol, 1989, 64(10): 651-654.
31. Spertus JA, Winder JA, Dewhurst TA, et al. Development and evaluation of the Seattle Angina Questionnaire: A new functional status measure for coronary artery disease. J Am Coll Cardiol, 1995, 25(2): 333-341.
32. LaPier TK. Psychometric evaluation of the heart surgery symptom inventory in patients recovering from coronary artery bypass surgery. J Cardiopulm Rehabil, 2006, 26(2): 101-106.
33. Wong J, Tong D, De Silva Y, et al. Development of the functional recovery index for ambulatory surgery and anesthesia. Anesthesiology, 2009, 110(3): 596-602.
34. Myles PS, Weitkamp B, Jones K, et al. Validity and reliability of a postoperative quality of recovery score: The QoR-40. Br J Anaesth, 2000, 84(1): 11-15.
35. Calvert M, Kyte D, Mercieca-Bebber R, et al. Guidelines for inclusion of patient-reported outcomes in clinical trial protocols: The SPIRIT-PRO extension. JAMA, 2018, 319(5): 483-494.
36. Lamy A, Devereaux PJ, Prabhakaran D, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med, 2016, 375(24): 2359-2368.
37. Hansen TB, Zwisler AD, Berg SK, et al. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care. Eur J Prev Cardiol, 2017, 24(7): 698-707.
38. Holmes C, Briffa N. Patient-reported outcome measures (PROMS) in patients undergoing heart valve surgery: Why should we measure them and which instruments should we use? Open Heart, 2016, 3(1): e000315.
39. Schroter S, Lamping DL. Responsiveness of the coronary revascularisation outcome questionnaire compared with the SF-36 and Seattle angina questionnaire. Qual Life Res, 2006, 15(6): 1069-1078.
40. Klotz SGR, Ketels G, Behrendt CA, et al. Interdisciplinary and cross-sectoral perioperative care model in cardiac surgery: Implementation in the setting of minimally invasive heart valve surgery (INCREASE)-study protocol for a randomized controlled trial. Trials, 2022, 23(1): 528.
41. Jeanneteau A, Demarquette A, Blanchard-Daguet A, et al. Effect of superficial and deep parasternal blocks on recovery after cardiac surgery: Study protocol for a randomized controlled trial. Trials, 2023, 24(1): 444.
42. Choi JY, Lee HS, Kim JY, et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial. J Clin Anesth, 2022, 82: 110955.
43. Pereira H, Graça MI, Fonseca D, et al. Impact of ketamine on quality of recovery after laparoscopic surgery: A single-centre single-blinded trial using the QoR-15 questionnaire. Anesthesiol Res Pract, 2023, 2023: 8890025.
44. Lee WK, Kim MS, Kang SW, et al. Type of anaesthesia and patient quality of recovery: A randomized trial comparing propofol-remifentanil total i. v. anaesthesia with desflurane anaesthesia. Br J Anaesth, 2015, 114(4): 663-668.
45. Claessens J, Goris P, Yilmaz A, et al. Patient-centred outcomes after totally endoscopic cardiac surgery: One-year follow-up. J Clin Med, 2023, 12(13): 4406.
46. Rogers CA, Pike K, Campbell H, et al. Coronary artery bypass grafting in high-RISk patients randomised to off- or on-Pump surgery: A randomised controlled trial (the CRISP trial). Health Technol Assess, 2014, 18(44): v-xx,1v-157v.
47. Milne B, Lucas de Carvalho J, Ayis S, et al. Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: A pilot study. Br J Anaesth, 2022, 128(6): 949-958.
48. Ben-Ali W, Lamarche Y, Carrier M, et al. Use of Mobile-based application for collection of patient-reported outcomes in cardiac surgery. Innovations (Phila), 2021, 16(6): 536-544.
49. Mori M, Brooks C, Spatz E, et al. Protocol for project recovery after cardiac surgery: A single-center cohort study leveraging digital platform to characterise longitudinal patient-reported postoperative recovery patterns. BMJ Open, 2020, 10(9): e036959.
50. Vámosi M, Lauberg A, Borregaard B, et al. Patient-reported outcomes predict high readmission rates among patients with cardiac diagnoses. Findings from the DenHeart study. Int J Cardiol, 2020, 300: 268-275.
51. Berg SK, Thorup CB, Borregaard B, et al. Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey. Eur J Prev Cardiol, 2019, 26(6): 624-637.
52. Borregaard B, Pedersen SS, Berg SK, et al. What to expect after open heart valve surgery? Changes in health-related quality of life. Qual Life Res, 2020, 29(5): 1247-1258.
53. Nielsen SN, Rasmussen TB, Lassen JF, et al. The association between self-reported health status and adverse events: A comparison among coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). Qual Life Res, 2020, 29(11): 3017-3029.
54. Devji T, Carrasco-Labra A, Qasim A, et al. Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: Instrument development and reliability study. BMJ, 2020, 369: m1714.
55. Masterson Creber R, Spadaccio C, Dimagli A, et al. Patient-reported outcomes in Cardiovascular trials. Can J Cardiol, 2021, 37(9): 1340-1352.
56. Wang Y, Devji T, Carrasco-Labra A, et al. A step-by-step approach for selecting an optimal minimal important difference. BMJ, 2023, 381: e073822.
57. Zhang Y, Xi X, Huang Y. The anchor design of anchor-based method to determine the minimal clinically important difference: A systematic review. Health Qual Life Outcomes, 2023, 21(1): 74.
58. Fagundes CP, Shi Q, Vaporciyan AA, et al. Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory. J Thorac Cardiovasc Surg, 2015, 150(3): 613-619.
59. Dai W, Feng W, Zhang Y, et al. Patient-reported outcome-based symptom management versus usual care after lung cancer surgery: A multicenter randomized controlled trial. J Clin Oncol, 2022, 40(9): 988-996.

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