Quality of life monitoring in ambulatory heart failure patients: temporal changes and prognostic value

• Published in: European journal of heart failure Vol. 15; no. 1; pp. 103 - 109
• Main Authors: Lupón, Josep, Gastelurrutia, Paloma, de Antonio, Marta, González, Beatriz, Cano, Lucía, Cabanes, Roser, Urrutia, Agustín, Díez, Crisanto, Coll, Ramón, Altimir, Salvador, Bayes-Genis, Antoni
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-01-2013
• Subjects: Aged; Female; Follow-Up Studies; Heart failure; Heart Failure - psychology; Humans; Male; Minnesota Living with Heart Failure Questionnaire; Prognosis; Quality of Life; Retrospective Studies; Risk Assessment - methods; Surveys and Questionnaires
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1093/eurjhf/hfs133

Aims
Heart failure (HF) is a chronic condition that typically affects a patient's quality of life (QoL). Little is known about long‐term QoL monitoring in HF. This study aimed to evaluate the temporal changes and prognostic value of QoL assessment in a real‐life cohort of HF patients.
Methods and results
The Minnesota Living with Heart Failure Questionnaire was used to monitor QoL at baseline and at 1, 3, and 5 years for 1151 consecutive patients {71.7% men, median age 69 years [25th–75th percentiles (P25–P75) 59–76]} in an HF unit. Follow‐up for prognosis assessment was extended to 6 years. The number of answered questionnaires was 1151 at baseline, 746 at 1 year, 268 at 3 years, and 240 at 5 years. QoL scores showed a steep decrease (indicating QoL improvement) during the first year [29 (P25–P75 16–43) at baseline vs. 15 (P25–P75 8–27) at 1 year, P < 0.001], which was tempered, yet significant up to 5 years [12 (P25–P75 7–23) at 3 years vs. 10 (P25–P75 5–21) at 5 years, P = 0.012]. We recorded 457 deaths during follow‐up. In a comprehensive multivariable Cox regression analysis, baseline QoL remained a significant prognosticator during follow‐up [hazard ratio (HR)Cox for death 1.012, 95% confidence interval 1.006–1.018, P < 0.001]. QoL monitoring showed that a score increase ≥10% between consecutive assessments stratified high‐risk patients within the next 12 months (P = 0.008).
Conclusion
Both baseline and follow‐up QoL monitoring were useful for patient risk stratification in a real‐life HF cohort. Worse QoL may warn of a worse prognosis. Widespread QoL monitoring in routine clinical practice is recommended.