Older patients with hemophilia reported lower quality of life (QoL) scores and more comorbidities compared with younger patients, despite an overrepresentation of mild disease, according to the results of an analysis of the HUGS VII study published in the Journal of Blood Medicine.
“The increasing survival rates among persons with hemophilia (PWH) reveal a growing array of physical, social, and mental health vulnerabilities requiring the attention of clinicians, caregivers, advocates, and health-care policymakers,” the authors wrote.
The HUGS VII study builds on the original observational HUGS study, in which disease burden and costs of care were evaluated among PWH aged 40 years and older using data from Hemophilia Treatment Centers. Self-reported questionnaires collected data at baseline and 6-months later on comorbidities and complications, joint health and pain, QoL, work productivity and activity impairment, anxiety and depression, and healthcare utilization.
This analysis included 69 males with mild to severe hemophilia, of whom, 65.2% were aged 50 or older and 75.4% had hemophilia A. Mild to moderate hemophilia was present in a greater proportion of patients aged 50 years or older at 68.9% compared with 41.7% among patients aged 40 to 49 years.
“Older PWH in this sample are over-represented by individuals with mild/moderate disease, potentially due to premature death among those with severe disease,” the authors wrote.
Among patients with mild to moderate hemophilia, the rate of joint pain was similar at baseline among older and younger patients at 83.9% and 70.0%, respectively (P =.43). However, older patients reported higher rates of joint pain at follow-up with a rate of 91.3% compared with 57.1% of younger patients (P =.06), although this difference was not significant.
Older and younger patients also reported similar rates of limited range of motion at a baseline (73.3% vs 60.0%; P =.43), but this became significantly higher for older patients at follow-up at 73.9% compared with 28.6% among younger patients (P =.04). The number of joint and non-joint bleeds were similar between older and younger patients. Older PWHs also reported lower QoL scores compared with younger PWH (P =.02).
Despite the differences in clinical scores and QoL, younger patients demonstrated greater utilization of healthcare services. Patients aged 40 to 49 years had higher rates of emergency department visits at 21.7% compared with 4.5% among older persons (P =.03). Younger persons also used physical therapy more frequently than older patients, with a rate of 43.5% compared with 15.9% among older persons (P =.01).
Depression rates were high at 85.7% among the entire cohort, with no differences between age groups. There were 64.3% of patients in the cohort who reported diagnostic anxiety, which was also similar between the age groups.
The authors concluded that, “These results, coupled with the important finding of a high rate of depression and anxiety in both age groups, highlight the need for special attention be paid to PWH.”
Disclosures: This study was funded by Pfizer through an investigator-initiated research agreement with the University of Southern California. Please see the original reference for a full list of disclosures.
Curtis R, Manco-Johnson M, Konkle BA, et al. Comorbidities, health-related quality of life, health-care utilization in older persons with hemophilia—Hematology Utilization Group Study Part VII (HUGS VII). J Blood Med. 2022;13:229-241. doi: 10.2147/JBM.S354526