Symptoms and quality of life: a serious and significant relationship

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I – EARLIEST SYMPTOMS OF CVI:
A VERY DISABLING QUALITY OF LIFE

Chronic venous insufficiency (CVI) is a serious clinical condition affecting a large number of people, and is important both from an epidemiological point of view, and on account of its socioeconomic repercussions.1 In the Western world, the consequences of the high prevalence of CVI are well known, as are the costs of diagnostic procedures and treatment programs as well as the significant amount of working hours lost and the repercussions on quality of life.2-4
A specific questionnaire for CVI (CIVIQ) has been in use since 1992, with surprising results for a disease that has hitherto been so severely underestimated.5 CVI has a profoundly negative effect on patients, daily life and the results illustrate the impact of CVI on morbidity. In addition, in the French survey by Levy in 2002, 53% of CVI patients considered that venous symptoms severely impaired their quality of life.6
CVI leads to serious phlebological repercussions and also physical and social consequences in the daily life of CVI patients. Pain and leg heaviness are causes of sensation of fatigue.5

The patients feel very uncomfortable, which can make everyday life more or less difficult: for instance, patients are troubled, and almost limited, while standing for a long time, climbing stairs, crouching, or kneeling. They are also handicapped in their daily life activities, such as working in the kitchen, carrying a child, ironing, cleaning floors or furniture, or doing jobs around the house. They also complain of problems with sporting activities and physically strenuous efforts.

II – QUALITY OF LIFE SIGNIFICANTLY
DEPENDS ON SYMPTOMS7

(see abstract above)
As demonstrated by this new study which was presented in Orlando at the last American Venous Forum Congress, quality of life is significantly linked to the presence of symptoms (Table I). Surprisingly, the presence of reflux at assignment to a high clinical CEAP class had a slight influence on the quality of life of CVD patients, as for demography (sex, age, ethnic origin). This strongly suggests that a treatment reducing symptoms might improve the quality of life of symptomatic patients, even in the absence of severe signs or reflux.

Table I
* CIVIQ score

III – DAFLON 500mg IMPROVES THE QUALITY
OF LIFE OF CVI PATIENTS

The new results presented at Orlando come from a new statistical analysis of the RELIEF study.8 The primary aim of the RELIEF study was to internationally validate the CIVIQ questionnaire wich appears to be a reliable, sensitive, and clinically valid tool.
The RELIEF study also confirmed the efficacy of Daflon 500 mg in improving quality of life of CVI patients. A significant improvement in quality of life scores was obtained according to dimension and global index in both groups of patients (with and without venous reflux). Psychological, social, physical, and pain dimensions significantly improved with Daflon 500 mg treatment. A sustained improvement was observed from the beginning of the treatment to the end of the study (Figure 1).

Figure 1
Figure 1. Jantet G, and the RELIEF Study Group. Chronic venous insufficiency: worldwide results of the
RELIEF study. Angiology. 2002;53:245-256.

As regards the global index of CIVIQ, the main improvement was noted after the first 2 months of treatment, and further improvements were observed during each visit until the end of the study (Figure 1). The evolution of the global index of the CIVIQ significantly differed between the two groups (P=0.0001), the group without reflux being less impaired (of 5 points in GIS) than the group presenting reflux.

CONCLUSION

Quality of life of CVI patients has been evidenced to be very impaired due to symptoms such as pain, leg heaviness, itching, and sensation of swelling. The main drive for a patient with CVD to consult a doctor might be the presence of symptoms, even in the absence of reflux or severe signs. Evidence from the RELIEF study indicates that CVI, even “modest” cannot be limited to cosmetic problems. Symptoms that are very often associated with CVI, right from the beginning of the disease, immediately translates into limitations in daily activities.
The quality of life results of the worldwide RELIEF study showed a significant improvement in the patients’ QoL with a Daflon 500 mg treatment. This improvement in QoL scores is the logical result of the improvement in all clinical manifestations of CVI by Daflon 500 mg.

REFERENCES

1. Agus GB, Allegra C, Arpaia G, et al. Guidelines for the diagnosis and treatment of chronic venous insufficiency. Italian College of Phlebology. IntAngiol.2001;20 (suppl 2):1-73.
2. Consensus Statement: The investigation of chronic venous insufficiency. Circulation. 2000;102:E126-E163.
3. International Task Force. The management of chronic venous disorders of the leg: an evidence-based report. Phlebology. 1999;(suppl 1):14.
4. Franks PJ. Quality of life for leg ulcer patients. In: Ruckley CV, Fowkes FGR, Bradbury A, eds. Venous Disease. London, UK: Springer; 1999:51-70.
5. Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res. 1996;5:539-554.
6. Levy E, Levy P, Los F, Chevallier H. Patient profile of the French active population treated by phlebotropic drugs dispensed on prescription. Phlebology. 2002;17:121-125.
7. Gloviczki P, Yao JST. Handbook of Venous Disorders. Guidelines of the American Venous Forum. 2nd ed. London, UK: Arnold; 2001:309-321.
8. Jantet G, and the RELIEF study group. Chronic venous insufficiency: worldwide results of the RELIEF study. Angiology. 2002;53:245-256.