Variable Contribution of Heart Failure to Quality of Life in Ambulatory Heart Failure With Reduced, Better, or Preserved Ejection Fraction

Joyce, Emer; Chung, Christine S.; Badloe, Sabrina; Odutayo, Kayode A; Desai, Akshay S.; Givertz, Michael M.; Nohria, Anju; Lakdawala, Neal K.; Stewart, Garrick C.; Young, Michelle; Weintraub, Joseph R.; Stevenson, Lynne Warner; Lewis, Eldrin F.

doi:10.1016/j.jchf.2015.12.011

Cited by 49 publications

(36 citation statements)

References 29 publications

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“…Several available publications have defined the subset of patients with HFpEF who previously had HFrEF as heart failure with recovered ejection fraction 2,3,17 or heart failure with better ejection fraction 4,23 and have been using different EF cut-off points for defining this HF category (≥40%, 2 ≥45%, 17 and ≥50%…”

Section: Discussionmentioning

confidence: 99%

“…These patients were clinically distinct from those with HFpEF and more similar to the HFrEF population from which they initially arose. Further studies found that HFiEF is associated with a better biomarker profile, quality of life, and event-free survival than continued HFrEF and HFpEF 3,4 but still experience a significant number of HF hospitalizations, suggesting persistent HF risk. 3 In this post hoc analysis of the Valsartan Heart Failure Trial (Val-HeFT) 5 database, we characterized the subjects who had improved their EF during the first 12 months of follow-up, evaluated the independent correlates of EF improvement, and determined whether their all-cause mortality was substantially different from the subjects whose EF remained reduced.…”

Section: See Editorial By Basuray and Fang See Clinical Perspectivementioning

confidence: 96%

“…A complete blood cell count and measurements of serum albumin, uric acid, creatinine, and blood urea nitrogen were performed at a central laboratory with a commercially automated system at randomization and after 4,6,12,18, and 24 months. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation.…”

Section: Biochemical Measurementsmentioning

confidence: 99%

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Heart Failure With Improved Ejection Fraction: Clinical Characteristics, Correlates of Recovery, and Survival

Florea

Rector

Anand

et al. 2016

Circ: Heart Failure

104

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Background— Heart failure with recovered or improved ejection fraction (HFiEF) has been proposed as a new category of HF. Whether HFiEF is clinically distinct from HF with persistently reduced ejection fraction remains to be validated. Methods and Results— Of the 5010 subjects enrolled in the Valsartan Heart Failure Trial (Val-HeFT), 3519 had a baseline left ventricular EF of <35% and a follow-up echocardiographic assessment of EF at 12 months. Of these, 321 (9.1%) patients who had a 12-month EF of >40% constituted the subgroup with HFiEF. EF improved from 28.7±5.6% to 46.5±5.6% in the subgroup with HFiEF and remained reduced (25.2±6.2% and 27.5±7.1%) in the subgroup with HF with reduced ejection fraction. The group with HFiEF had a less severe hemodynamic, biomarker, and neurohormonal profile, and it was treated with a more intense HF medication regimen. Subjects who had higher blood pressure and those treated with a β-blocker or randomized to valsartan had greater odds of being in the HFiEF group, whereas those with an ischemic pathogenesis, a more dilated left ventricle, and a detectable hs-troponin had lower odds of an improvement in EF. Recovery of the EF to >40% was associated with a better survival compared with persistently reduced EF. Conclusions— Our data support HFiEF as a stratum of HF with reduced ejection fraction with a more favorable outcome, which occurs in a minority of patients with HF with reduced ejection fraction who have a lower prevalence of ischemic heart disease, a less severe hemodynamic, biomarker, and neurohormonal profile, and who are treated with a more intense HF medication regimen. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00336336.

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Section: Discussionmentioning

confidence: 99%

Section: See Editorial By Basuray and Fang See Clinical Perspectivementioning

confidence: 96%

Section: Biochemical Measurementsmentioning

confidence: 99%

See 1 more Smart Citation

Heart Failure With Improved Ejection Fraction: Clinical Characteristics, Correlates of Recovery, and Survival

Florea

Rector

Anand

et al. 2016

Circ: Heart Failure

104

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“…The literature shows a lack of correlation between QOL and LVEF 12, 35, 36, 37, 38. However, Joyce et al 39 compared patients with reduced, preserved, and better LVEF (improvement in LVEF, ≥50%) and found that fewer than one-half of patients with ambulatory HF rated HF as the greatest limitation to their QOL. This suggested that it may be difficult to improve QOL using HF-targeted therapies alone, particularly in patients with higher LVEF and comorbidities 39 …”

Section: Discussionmentioning

confidence: 99%

Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction

Gastelurrutia

Lupón

Moliner

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area.Patients and MethodsConsecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed.ResultsComorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, P<.001, and 36.5±20.7, P=.003, respectively). No statistically significant differences in fragility between HFmrEF (48.6%) and HFrEF (41.9%) (P=.09) nor HFpEF (54.3%) (P=.29) were found. In univariate analysis, the association of comorbidities, QOL, and fragility with the 3 end points was higher for HFmrEF than for HFrEF and HFpEF. In multivariate analysis, comorbidities were independently associated with the 3 end points (P≤.001), and fragility was independently associated with all-cause death and the composite end point (P<.001) in HFmrEF.ConclusionComorbidities and fragility are independent predictors of outcomes in ambulatory patients with HFmrHF and should be considered in the routine clinical assessment of HFmrEF.

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“…Depending on the details of the populations studied, QOL impairment has been shown to be similar or slightly different between HFrEF and HFpEF groups. 19,27 This may reflect the characteristic pathophysiology of each of these LVEF HF subtypes, [28][29][30][31][32][33][34][35] and the fact that HFpEF in general encompasses older patients in whom age and accumulating comorbidities play an increasing role in limitation. 36 In our study, the difference between limitations reported by patients with HFrEF and HFpEF disappeared when the regression model was adjusted by age, body mass index, and comorbidities.…”

Section: Perceived Limitations and Lvef Subtypementioning

confidence: 99%

Patients report more severe daily limitations than recognized by their physicians

Castro

Joyce

Lakdawala

et al. 2019

Clinical Cardiology

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BackgroundPatient limitations guide selection of heart failure therapies, for which indications often specify New York Heart Association Class.ObjectivesTo determine the extent of patient‐reported limitations during daily activities and compare to New York Heart Association class assigned by providers during the same visit, and to left ventricular ejection fraction (LVEF) group.Methods and ResultsWhile waiting for their appointment, 948 patients on return visits to an ambulatory HF clinic completed a written questionnaire assessing specific activity limitations, which were compared to physician‐assigned NYHA class during the same visit. Patient‐reported limitation to perform daily activity ranged from 25% for bathing to 61% for yardwork or housework and 71% for jogging or hurrying. Most patients who did not report limitations to perform daily life activities were correctly classified as NYHA I by the physicians (76%), but 12% of the 376 patients classified as NYHA I reported limitations to showering or bathing and 73% reported limitations while doing yardwork or house work. Limitation to walking was reported by 172 patients (50%) classified as class II. Limitations to walking one block were most common in patients with LVEF ≥40% compared to patients with LVEF <40%, and least commonly, in HF with better EF (improved from 31 ± 13 to 52 ± 7).ConclusionsActivity limitations are commonly reported by ambulatory HF patients, but underestimated by physicians. It is not clear how this should guide therapy validated for NYHA class but focused activity questions may merit wider use to track limitations and improvement in ambulatory HF.

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Variable Contribution of Heart Failure to Quality of Life in Ambulatory Heart Failure With Reduced, Better, or Preserved Ejection Fraction

Cited by 49 publications

References 29 publications

Heart Failure With Improved Ejection Fraction: Clinical Characteristics, Correlates of Recovery, and Survival

Heart Failure With Improved Ejection Fraction: Clinical Characteristics, Correlates of Recovery, and Survival

Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction

Patients report more severe daily limitations than recognized by their physicians

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