AimsTo examine whether self-rated disease-specific and generic quality of life predicts long-term mortality, independent of brain natriuretic peptide (BNP) levels, and to explore factors related to low quality of life in a well-defined heart failure (HF) population. Methods and resultsA cohort of 661 patients (62% male; age 71 years; left ventricular ejection fraction 34%) was followed prospectively for 3 years. Quality of life questionnaires (Ladder of Life, RAND36, and Minnesota Living with Heart Failure Questionnaire) and BNP levels were assessed at discharge after a hospital admission for HF. Three-year mortality was 42%. After adjustment for demographic variables, clinical variables, and BNP levels, poor quality of life scores predicted higher mortality; per 10 units on the physical functioning [hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.02-1.14] and general health (HR 1.08, 95% CI 1.01-1.16) dimensions of the RAND36. Patients with low scores on these dimensions were more likely to be in New York Heart Association class III-IV, diagnosed with co-morbidities, have suffered longer from HF, have lower estimated glomerular filtration rates, and have fewer beta-blocker prescriptions. ConclusionQuality of life was independently related to survival in a cohort of hospitalized patients with HF. Trial

The objective of this study was to gain a better understanding of the seclusion room experiences of chronic psychiatric patients, the way in which they cope with their seclusion room experience, and the effect of seclusion on subsequent relations with care providers. A qualitative research design was used, in line with the procedure of Grounded Theory. Semi-structured interviews were held with seven chronic psychiatric outpatients whose seclusion took place at a certain remove in time. The transcriptions were analyzed with the aid of Winmax. The following results were found. Most seclusion experiences by far are negative. However, patients whose experience took place a considerable time ago also mention positive experiences. It is hard to come to terms with the seclusion experience; this is a matter of learning to live with it (adaptation) rather than assimilating it (adjustment, or active coping and controlling). Factors conducive to the coping process are: understanding the reason why it took place, time, distraction, possibilities to discuss it with others, and quick recovery of control. Factors prohibitive to the coping process are: the danger of recurrence, iniquitous treatment by care providers during seclusion, confrontation with others being secluded, and lack of opportunity to talk about it. Seclusion does not affect subsequent relation with care providers, with two exceptions. When patients feel they have been treated iniquitously during seclusion, or when seclusion continues to be a daily threat, this has a negative effect on relations with care providers. The central themes of this study are autonomy, trust, and loneliness.

AimsKnowledge of patient preferences is vital for delivering optimal healthcare. This study uses utility measurement to assess the preferences of heart failure (HF) patients regarding quality of life or longevity. The utility approach represents the perspective of a patient; facilitates the combination of mortality, morbidity, and treatment regimen into a single score; and makes it possible to compare the effects of different interventions in healthcare. Methods and resultsPatient preferences of 100 patients with HF were assessed in interviews using the time trade-off (TTO) approach. Healthrelated quality of life (HR-QoL) was assessed with the EQ-5D and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients' own estimation of life expectancy was assessed with a visual analogue scale (VAS). Of the 100 patients (mean age 70 + 9 years; 71% male), 61% attach more weight to quality of life over longevity; while 9% and 14% were willing to trade 6 and 12 months, respectively, for perfect health and attach more weight to quality of life. Patients willing to trade time had a significantly higher level of NT-proBNP and reported significantly more dyspnoea during exertion. Predictors of willingness to trade time were higher NT-proBNP and lower EQ VAS. ConclusionThe majority of HF patients attach more weight to quality of life over longevity. There was no difference between both groups with respect to life expectancy described by the patients. These insights enable open and personalized discussions of patients' preferences in treatment and care decisions, and could guide the future development of more patient-centred care.--