Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure

Abstract

Background Assessing health-related quality of life (HRQoL) in patients with heart failure (HF) are important goals of clinical care and HF research. We sought to investigate ethnic differences in perceived HRQoL and its association with mortality among patients with HF and left ventricular ejection fraction ≤35%, controlling for demographic characteristics and HF severity. Methods and results We compared 5,697 chronic HF patients of Indian (26%), White (23%), Chinese (17%), Japanese/Koreans (12%), Black (12%), and Malay (10%) ethnicities from the HF-ACTION and ASIAN-HF multinational studies using the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0–100; higher scores reflect better health status). KCCQ scores were lowest in Malay (58±22) and Chinese (60±23), intermediate in Black (64±21) and Indian (65±23), and highest in White (67±20) and Japanese or Korean patients (67±22), after adjusting for age, sex, educational status, HF severity and risk factors. Self-efficacy, which measures confidence in the ability to manage symptoms, was lower in all Asian ethnicities (especially Japanese/Koreans [60±26], Malay [66±23] and Chinese [64±28]) compared to Black (80±21) and White (82±19) patients, even after multivariable adjustment (p<0.001). In all ethnicities, KCCQ strongly predicted 1-year mortality (HR 0.45, 95% CI 0.30–0.67 for highest vs lowest quintile of KCCQ; p for interaction by ethnicity 0.101). Conclusions Overall, HRQoL is inversely and independently related to mortality in chronic HF, but is not modified by ethnicity. Nevertheless, ethnic differences exist independent of HF severity and comorbidities. These data may have important implications for future global clinical HF trials that use patient-reported outcomes as endpoints. Clinical Trial Registration NCT00047437 and NCT01633398

Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN‐HF registry

“…Consistent with previous reports, we confirmed that women with HF, regardless of their DM status, had significantly worse QoL scores (physical limitation and self‐efficacy domains), compared to men with HF . This is often attributed to greater depression and lower education levels and a possible delay in health care seeking behaviour in women compared to men with HF . The poorer self‐efficacy in women could impact negatively on the self‐care of both chronic diseases (HF and DM).…”

“…Those with severe valve disease as the primary cause of HF, life‐threatening co‐morbidity with life expectancy of < 1 year, unable or unwilling to give consent, or concurrent participation in a clinical therapeutic trial were excluded. Comprehensive data collection at baseline included demographic characteristics, clinical signs and symptoms, biochemistry, echocardiography and health‐related QoL scores using the Kansas City Cardiomyopathy Questionnaire (KCCQ) . The calculated scores in the KCCQ range from 0 to 100, with higher scores reflecting better health status.…”

“…The calculated scores in the KCCQ range from 0 to 100, with higher scores reflecting better health status. The KCCQ has been validated among multiple HF‐related disease states and several languages for non‐English speaking participants …”

Prevalence, clinical correlates, and outcomes of anaemia in multi‐ethnic Asian patients with heart failure with reduced ejection fraction

“…The Kansas City Cardiomyopathy Questionnaire (KCCQ), a 23‐item self‐administered HF‐specific questionnaire, was used to examine patient‐centred QoL. This instrument has been widely used in recent international HF clinical trials and has been validated in several languages . Non‐English speaking participants used certified versions of the KCCQ translated into their native languages.…”

“…This instrument has been widely used in recent international HF clinical trials and has been validated in several languages. 21,22 Non-English speaking participants used certified versions of the KCCQ translated into their native languages. Computed KCCQ scores 23 range from 0 to 100, with higher scores representing better health-related QoL.…”