Fewer than one-half of patients with ambulatory HF rated HF as the greatest limitation to their QOL, suggesting that this important outcome will be difficult to affect by HF-targeted therapies alone, particularly in those with higher LVEFs and comorbidities. Patients with HF with better LVEF represent a distinct subtype with better overall QOL.
Background:
Assessment of quality of life (QOL) may be helpful in management of heart failure (HF) patients in ambulatory practice and is considered a performance measure. Little is known about the feasibility of routine assessment of QOL in clinical management of HF. The objectives of this study were to a) evaluate ability to serially measure QOL in clinical practice and b) determine patient characteristics that influence change in QOL scores.
Methods:
Patients presenting to the ambulatory HF clinic were routinely administered (prior to physician encounter) a 2-page questionnaire to assess QOL and concerns to be addressed during the visit. Visual analog scales (VAS) were used to assess a) overall QOL, b) dyspnea, and c) fatigue with scores ranging from 0 to 100 (higher scores representing better health status). Patients were asked if their QOL was affected more by their HF or another medical condition. Data was analyzed with ANOVA and Chi-square tests.
Results:
Of 1069 patients who completed baseline questionnaires, 557 (52%) had QOL assessed at subsequent visit (mean time between visits 225±142 days, 58% male, mean age 57
±
15, LVEF 40±16%). Health status was impaired at baseline (VAS QOL 63±29, dyspnea 68±32, and fatigue 65±25). Of patients with paired data, 411 (74%) answered (at baseline) questions on the contribution of HF to their QOL (Table). HF affected QOL most in 48% of these patients, 23% felt HF and other medical conditions affected them equally, and 29% felt other medical conditions were more important. Patients affected more by HF had greater improvements in VAS scores despite trend of more hospitalizations. Patients with other medical problems had better QOL at baseline, but noted declines in VAS scores.
Conclusions:
QOL can be routinely monitored in HF clinics. Strategies to improve QOL should be developed to meet the individual patient's needs as other co-morbidities often affect QOL equally or more. Future studies should evaluate more comprehensive QOL tools.
Patient characteristics that influence change in QOL scores
Introduction:
Clinical assessment of quality of life (QOL) is being increasingly adopted in the ambulatory management of heart failure (HF). Little is known about the impact of other conditions on QOL in clinical practice.
Methods:
Patients routinely presenting to the HF clinic completed a self-administered 1-page questionnaire prior to the visit that assessed QOL, functional status, and degree to which their HF, as well as other conditions, affected their QOL. Visual analog scales (VAS) were used to assess a) overall QOL, b) ease of breathing, and c) energy > fatigue. Scores ranged from 0 to 100 (higher scores representing better health status). Patients were asked if their QOL was affected more, equally, or less by their HF compared to other medical conditions. Data was analyzed with Pearson’s correlation coefficients, ANOVA and Chi-square tests.
Results:
A total of 1069 patients completed baseline QOL (mean age 57±16 years, 56% left ventricular ejection fraction [LVEF] ≥40%, 41% female). Mean QOL score was 63±28. Only 48% of patients felt that HF affected their QOL most while 20% felt HF was equal to other illnesses, 18% cited other medical problems and 14% non-medical problems as most important for their QOL. Patients reporting HF as the primary factor influencing QOL had significantly lower scores on all 3 VAS measures, the highest proportion of patients with low LVEF and the strongest correlation between QOL and VAS Breathing (R=0.68) (Table).
Conclusions:
Patients describing HF as their major limitation had the lowest QOL score and were most affected by dyspnea and fatigue. However, over half of ambulatory HF patients rate other medical and/or non-medical factors as equal or greater limitations to their QOL, suggesting this important clinical outcome will be difficult to impact by therapies targeted at HF alone, particularly in those with LVEF ≥40%.
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