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Am Heart J. 2017 Sep;191:75-81. doi: 10.1016/j.ahj.2017.06.016. Epub 2017 Jul 1.

Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure.

Author information

1
Duke University Medical Center, Duke Clinical Research Institute, Durham, NC. Electronic address: nancy.luo@duke.edu.
2
National Heart Centre Singapore, Singapore.
3
Division of Cardiology, University of Minnesota, Minneapolis, MN.
4
Duke University Medical Center, Duke Clinical Research Institute, Durham, NC.
5
Queen Elizabeth II Hospital, Malaysia.
6
National University Heart Centre Singapore, Singapore.
7
Duke University Medical Center, Duke Clinical Research Institute, Durham, NC; Inova Heart and Vascular Institute, Falls Church, VA.
8
Montefiore-Einstein Medical Center, New York, NY.
9
National University Heart Centre Singapore, Singapore; University of Otago, Christchurch, New Zealand.
10
National Cardiovascular Centre, Tokyo, Japan.
11
Thomas Jefferson University, Philadelphia, PA.
12
National Heart Centre Singapore, Singapore; Duke-National University of Singapore, Singapore. Electronic address: Carolyn.lam@duke-nus.edu.org.

Abstract

BACKGROUND:

Assessing health-related quality of life (HRQoL) in patients with heart failure (HF) is an important goal of clinical care and HF research. We sought to investigate ethnic differences in perceived HRQoL and its association with mortality among patients with HF and left ventricular ejection fraction ≤35%, controlling for demographic characteristics and HF severity.

METHODS AND RESULTS:

We compared 5697 chronic HF patients of Indian (26%), white (23%), Chinese (17%), Japanese/Koreans (12%), black (12%), and Malay (10%) ethnicities from the HF-ACTION and ASIAN-HF multinational studies using the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0-100; higher scores reflect better health status). KCCQ scores were lowest in Malay (58±22) and Chinese (60±23), intermediate in black (64±21) and Indian (65±23), and highest in white (67±20) and Japanese or Korean patients (67±22) after adjusting for age, sex, educational status, HF severity, and risk factors. Self-efficacy, which measures confidence in the ability to manage symptoms, was lower in all Asian ethnicities (especially Japanese/Koreans [60±26], Malay [66±23], and Chinese [64±28]) compared to black (80±21) and white (82±19) patients, even after multivariable adjustment (P<.001). In all ethnicities, KCCQ strongly predicted 1-year mortality (HR 0.45, 95% CI 0.30-0.67 for highest vs lowest quintile of KCCQ; P for interaction by ethnicity .101).

CONCLUSIONS:

Overall, HRQoL is inversely and independently related to mortality in chronic HF but is not modified by ethnicity. Nevertheless, ethnic differences exist independent of HF severity and comorbidities. These data may have important implications for future global clinical HF trials that use patient-reported outcomes as endpoints.

PMID:
28888273
PMCID:
PMC5663287
DOI:
10.1016/j.ahj.2017.06.016
[Indexed for MEDLINE]
Free PMC Article

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