Perceptions of Quality of Life and Priorities of Owners of Cats with
C.A. Reynolds, M.A. Oyama, J.E. Rush, E.A. Rozanski, G.E. Singletary, D.C. Brown, S.M. Cunningham,
P.R. Fox, B. Bond, D.B. Adin, R.M. Williams, K.A. MacDonald, R. Malakoff, M.M. Sleeper,
K.E. Schober, J.P. Petrie, and D.F. Hogan
Background: Owners’ perceptions and priorities regarding quality of life (QoL) are important considerations given the un-
known efficacy of many commonly administered medications, stress of hospital visits, difficulties providing home care, and
personal choices including euthanasia.
Objective: To describe the relative importance of quality versus quantity of life to owners of cats with heart disease.
Animals: Two hundred and thirty-nine cats with heart disease.
Methods: Prospective questionnaire-based clinical study. Cat owners completed a questionnaire to identify important pa-
rameters when assessing their cat’s QoL, the relative importance of quality versus quantity of life, and willingness to trade
survival time for QoL. Variables associated with these parameters were evaluated with multivariate analyses.
Results: Appetite, owner interaction, sleep patterns, and litterbox habits were deemed important to QoL. Concern over pet
suffering was significantly greater than concern over life expectancy. Ninety-three percent of owners were willing to trade sur-
vival time for good QoL; 57% of these were willing to trade up to 6 months. On multivariate analysis, the only factor
significantly (P 5 .002) associated with willingness to trade 6 months was study site. Owner concern regarding stress of admin-
istering medications at home increased with number and frequency of medications.
Conclusions and Clinical Relevance: These results indicated that QoL is more important to owners of cats with heart disease
than longevity. The various priorities and concerns of cat owners should be taken into account in order to provide optimal care.
Key words: Heart failure.
ity of life (QoL) while simultaneously extending quantity
of life. With rare exceptions, curative treatment of heart
disease in cats is not achievable, and therapy is directed
toward palliation of clinical signs and maximizing sur-
vival time in a progressive disease. Treatment of
cardiomyopathy in cats can be particularly challenging
because of the lack of evidence-based therapy. Thus,
treatment of affected cats typically consists of medica-
tions that improve QoL, such as diuretics to relieve
shared goal of both veterinarians and owners of
cats with heart disease is the provision of high qual-
congestion, as well as agents such as angiotensin con-
verting enzyme(ACE)inhibitors, beta-blockers, calcium-
channel blockers, and antithrombotics that are thought
to increase longevity. In veterinary medicine, quality and
quantity of life are intertwined in that euthanasia is com-
monly elected when treatment fails to maintain adequate
patient QoL. Moreover, if a prescribed medication incurs
a negative effect such as adverse effects, increased need
for monitoring or hospital visits, or difficulty in admin-
istering medication, treatment in itself could decrease
perceived quality or quantity of life. In formulating and
monitoring treatment regimens, veterinarians are likely
guided by the owner’s perception of their cat’s QoL;
however, the specific priorities, perceptions, and param-
eters that cat owners use to assess their cat’s QoL have
not been well described. Knowledge of specific parame-
ters could improve communication regarding treatment
regimes as well as decision-making regarding euthanasia.
In a previous study of dogs with heart disease, we found
that owners generally value quality over quantity of life,
and the majority of owners would be willing to trade
some amount of survival time for good QoL.1By better
understanding owner priorities regarding their pet’s
quality versus quantity of life, the clinician and cat owner
can better align themselves toward individualized
and more effective therapy for the animal. In this study,
we sought to identify parameters that owners consider
important when assessing their cat’s QoL, to determine
From the Department of Clinical Studies-Philadelphia, School of
Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
(Reynolds, Oyama, Singletary, Brown, Sleeper); Department of
Clinical Sciences, Cummings School of Veterinary Medicine, Tufts
University, North Grafton, MA (Rush, Rozanski, Cunningham); The
Animal Medical Center, New York, NY (Fox, Bond); Veterinary
Specialists of Rochester, Rochester, New York, NY (Adin); Veteri-
nary Emergency Clinic, Toronto, ON, Canada (Williams); Animal
Care Center, Rohnert Park, CA (MacDonald); Angell Animal Med-
ical Center, Boston, MA (Malakoff); Department of Veterinary
Clinical Sciences, College of Veterinary Medicine, The Ohio State
University, Columbus, OH (Schober); Hudson Valley Veterinary
Cardiology, Sloatsburg, NY (Petrie); and the Veterinary Clinical
Sciences, Purdue University, West Lafayette, IN (Hogan). This
study was centered at the Matthew J. Ryan Veterinary Hospital, Uni-
versity of Pennsylvania, Philadelphia, PA. Presented in part at the
27th Annual American College of Veterinary Internal Medicine
(ACVIM) forum, Montreal, Canada, 2009.
Corresponding author: Dr Mark A. Oyama, DVM, DACVIM-
Cardiology, Department of Clinical Studies-Philadelphia, School of
Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
19104; e-mail: email@example.com.
Submitted May 5, 2010; Revised June 4, 2010; Accepted July
Copyrightr2010 by the American College of Veterinary Internal
angiotensin converting enzyme
International Small Animal Cardiac Health Council
quality of life
J Vet Intern Med 2010;24:1421–1426
help achieve optimal veterinary care. Further study
should address creation of standardized tools to measure
QoL and incorporation of QoL endpoints into studies
seeking to ascertain the clinical value of veterinary inter-
ventions in cats with heart disease.
aStata version 8, StataCorp, College Station, TX
bFox PR. Prospective double-blinded multicenter evaluation of
chronic therapies for feline diastolic heart failure: Interim analy-
sis. J Vet Cardiol 2003;17:398 (abstract)
The authors thank Gordon Peddle, Carolyn Michel,
and Lynne O’Sullivan for their assistance.
1. Oyama MA, Rush JE, O’Sullivan ML, et al. Perceptions and
priorities of owners of dogs with heart disease regarding quality
versus quantity of life for their pets. JAVMA 2008;223:104–108.
2. Rust?en T, Stubhaug A, Eidsmo I, et al. Pain and quality of
life in hospitalized patients with heart failure. J Pain Symptom
3. Tzannes S, Hammond MF, Murphy S, et al. Owners percep-
tion of their cats quality of life during COP chemotherapy for
lymphoma. J Feline Med Surg 2008;10:73–81.
4. Pittari J, Rodan I, Beekman G, et al. American Association
of Feline Practitioners. Senior care guidelines. J Fel Med Surg
5. Rollin BE. Ethical issues in geriatric feline medicine. J Fel
Med Surg 2007;9:326–334.
6. Heyworth IT, Hazell ML, Linehan MF, Frank TL. How do
commonchronic conditions affect health-related quality of life? Br J
Gen Pract 2009;59:e353–e359.
7. Nyman JA, Barleen NA, Dowd BE, et al. Quality-of-life
weights for the US population: Self-reported health status and pri-
ority health conditions, by demographic characteristics. Med Care
8. Ekman M, Berg J, Wimo A, et al. Health utilities in mild
cognitive impairment and dementia: A population study in Sweden.
Int J Geriatr Psychiatry 2007;22:649–655.
9. Burstro ¨ m K, Johannesson M, Diderichsen F. A comparison
of individual and social time trade-off values for health states in the
general population. Health Policy 2006;76:359–370.
10. U.S. Census data. Available at: http://www.census.gov/. Ac-
cessed February 21, 2010.
11. Havranek EP, McGovern KM, Weinberger J, et al. Patient
preferences for heart failure treatment: Utilities are valid measures
of health-related quality of life in heart failure. J Cardiac Fail
12. MacIver J, Rao V, Delgado DH, et al. Choices: A study of
preferences for end-of-life treatments in patients with advanced
heart failure. J Heart Lung Transplant 2008;27:1002–1007.
13. Stevenson LW, Hellkamp AS, Leier CV, et al. Changing
preferences for survival after hospitalization with advance heart
failure. JACC 2006;52:1702–1708.
1426 Reynolds et al