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

Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.
European Journal of Heart Failure (Impact Factor: 6.53). 08/2012; 15(1). DOI: 10.1093/eurjhf/hfs133
Source: PubMed


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 resultsThe 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-P 75 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-P 75 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.

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