Change of Health-Related Quality of Life Over Time and Its Association With Patient Outcomes in Patients With Heart Failure

J Am Heart Assoc. 2020 Sep;9(17):e017278. doi: 10.1161/JAHA.120.017278. Epub 2020 Aug 19.

Abstract

Background Improving health-related quality of life is an important goal in the management of patients with heart failure (HF). Defining health-related quality of life changes over time in patients with HF with preserved (HFpEF) or reduced ejection fraction and showing their association with other important clinical events could support the use of health-related quality of life as a measure of quantifying HF care. Methods and Results In the Alberta HEART (Heart Failure Aetiology and Analysis Team) cohort (n=621), patients were categorized into 4 subgroups: healthy controls (n=98), at risk (n=163), HFpEF (n=191), and HF with reduced ejection fraction (n=169). The change of the Kansas City Cardiomyopathy Questionnaire (KCCQ), EuroQOL 5 dimensions, and Functional Assessment of Cancer Therapy-Anemia over 12 months, and its association with a composite of death or rehospitalization within 3 years were assessed. At baseline, the KCCQ overall summary score was 73 (interquartile range, 53-86) in HFpEF and 78 (interquartile range, 56-90) in HF with reduced ejection fraction (P=0.22). Overall, 30.5% of patients with HF experienced ≥5-point improvements and 32.4% had ≥5-point worsening in KCCQ overall summary score at 12 months, which did not differ between HFpEF and HF with reduced ejection fraction (P=0.23). Clinical events were higher in patients with HF who had a decline in KCCQ over 12 months as compared with those with stable KCCQ scores (70.2% versus 52.0%, P=0.012). The results were similar for the Functional Assessment of Cancer Therapy-Anemia and EuroQOL 5 dimensions. Conclusions In patients with HF, the KCCQ quantified clinically meaningful changes over time, which were associated with important clinical outcomes in patients with HFpEF. Given the observed variability and prognostication in different patient trajectories, health-related quality of life measures could be valuable for quantifying the quality of care in healthcare systems.

Keywords: Kansas City Cardiomyopathy Questionnaire; health‐related quality of life; heart failure; heart failure with preserved ejection fraction.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alberta / epidemiology
  • Case-Control Studies
  • Comorbidity
  • Female
  • Health Status
  • Heart Failure / classification
  • Heart Failure / physiopathology*
  • Heart Failure / psychology*
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Quality of Life / psychology*
  • Stroke Volume / physiology
  • Surveys and Questionnaires / statistics & numerical data*
  • Time Factors