Quality of Life: Can It and Should It Be Assessed in Patients with Heart Failure?

Abstract

The goal of therapy in patients with severe symptomatic heart failure is improvement in symptoms, stabilization or improvement in functional abilities, and improved comfort for the remaining duration of life. Prolongation of survival without these benefits appears less desirable. There is poor correlation among hemodynamic features (including ejection fraction), exercise capacity, and quality of life attributes. Patients value as an outcome of therapy quality of life attributes: comfort, sense of well-being, and physical and other functional capabilities. By contrast, patients with asymptomatic ventricular dysfunction cannot anticipate any short-term benefit of therapy, whose goal is solely improvement in long-term survival. Interference by therapy with any aspect of life quality is likely to adversely affect compliance and thereby limit long-term outcome advantages.

Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables

“…35 In general, the variance in the short form scales that can be explained by factors such as NYHA functional class, peak oxygen uptake, six minute walk test, left ventricular ejection fraction, age, and the duration of disease was small. Only the variance of physical functioning was determined to a considerable degree (51%) by NYHA functional class and the six minute (predictor) 0.40 (1) 0.16 (1) 0.10 (1) 0.28 (1) 0.27 (1) 0.10 (1) 0.10 (1) 0.15 (1) Step2 (predictor) 0.11 (2) Total (predictor) 0.51 (1,2) 0.16 (1) 0.10 (1) 0.28 (1) 0.27 (1) 0.10 (1) 0.10 (1) 0.15 (1) Data are presented as Spearman rank correlation coefficients. Significance of correlations after Bonferroni adjustment of p values (α/48): *p<0.01; ** p<0.001; R = variance of dependent variable explained by multiple regression analysis.…”

“…Quality of life is a relatively new scientific measure to evaluate effectiveness of treatment strategies and the course of a disease. [1][2][3] In congestive heart failure, several disease specific instruments-such as the Minnesota living with heart failure questionnaire 4 -have proved useful in clinical studies. [5][6][7][8][9][10][11] Disadvantages of these specific measures are that they are difficult to compare across diseases and with controls in the general population.…”

Gender differences in health perceptions and meaning in persons living with heart failure

“…Normalization is an important defense for these patients [5][6] ; therefore, effective treatment strategies are likely to be those that improve health perceptions, 7 support psychosocial adjustment to illness, 8 and maintain and stabilize the patient's limited functional abilities. 9 Pender 10 underscores the importance of establishing measures of health based on the participant's point of view that are consistent with contemporary models of health and seek to include the participant's input in assessing health. Because health status, life satisfaction, and happiness are subjective assessments of what the patient perceives as important, health perceptions involve patients' assessments of the impact of the illness and its treatment on their ability to function in everyday life.…”

“…They reflect the person's value systems, beliefs, and perspectives. 9 Incongruence between perceived and actual health is important in that it is the rating of perceived health status that has been shown to correlate strongly with the risk of morbidity and mortality among patients with HF 7,9 and other patient populations. [11][12][13] Several researchers have previously studied health perceptions 6,14 and psychosocial adjustment to illness in patients with HF.…”

Safety and efficacy of G-CSF in patients with ischemic heart failure: The CORNER (Cell Option for Recovery in the Non-Eligible patients for Revascularization) study

“…Of note, despite its well-known impact on outcome, ejection fraction is poorly correlated to symptoms, like dyspnoea and angina, and consequently to quality of life [25].…”