Does heart failure-specific health status identify patients with bothersome symptoms, depression, anxiety, and/or poorer spiritual well-being?

Abstract

Aims Patients with heart failure often have under-recognized symptoms, depression, anxiety, and poorer spiritual well-being (‘QoL domains’). Ideally all patients should have heart failure-specific health status and quality of life (QoL) domains routinely evaluated; however, lack of time and resources are limiting in most clinical settings. Therefore, we aimed to evaluate whether heart failure-specific health status was associated with QoL domains and to identify a score warranting further evaluation of QoL domain deficits. Methods and results Participants (N = 314) enrolled in the Collaborative Care to Alleviate Symptoms and Adjust to Illness trial completed measures of heart failure-specific health status [Kansas City Cardiomyopathy Questionnaire, KCCQ (score 0–100, 0 = worst health status)], additional symptoms (Memorial Symptom Assessment Scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and spiritual well-being (Facit-Sp) at baseline. Mean ± standard deviation (SD) KCCQ score was 46.9 ± 19.3, mean age was 65.5 ± 11.4, and 79% were male. Prevalence of QoL domain deficits ranged from 11% (nausea) to 47% (depression). Sensitivity/specificity of KCCQ for each QoL domain ranged from 20–40%/80–96% for KCCQ ≤ 25, 61–84%/48–62% for KCCQ ≤ 50, 84–97%/26–40% for KCCQ ≤ 60, and 96–100%/8–13% for KCCQ ≤ 75. Patients with KCCQ ≤ 60 had mean ± SD 4.5 ± 2.5 QoL domain deficits (maximum 12), vs. 1.6 ± 1.6 for KCCQ > 60 (P < 0.001). Similar results were seen for KCCQ ≤25 (6.6 ± 2.4 vs. 3.3 ± 2.4), KCCQ ≤ 50 (4.8 ± 2.6 vs. 2.5 ± 2) and KCCQ ≤ 75 (4.0 ± 2.6 vs. 1.0 ± 1.2) (all P < 00001). Conclusion KCCQ ≤ 60 had good sensitivity for each QoL domain deficit and for patients with at least one QoL domain deficit. Screening for QoL domain deficits should target patients with lower KCCQ scores based on a clinic’s KCCQ score distribution and clinical resources for addressing QoL domain deficits.

Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure

“…Our findings confirm previous studies using the KCCQ 15,16 and the IPOS, 29 which identified a large number of unmet PC concerns in HF patients. In our study we used hospitalisation of HF patients as a transition-of-care situation to assess PC concerns routinely.…”

“…IPOS) should be prioritized. 15,16,29 In the German validation study, the KCCQ was also well accepted (by 86% of the HF patients). 36 The high acceptance of the IPOS in our study may have been due to its briefness (17 vs. 23 items), its minimisation of text, and because it is a generic and not a disease-specific PROM.…”

“…Screening for PC needs in predefined situations as well as clear criteria for assessment and co-management by PC specialists may be helpful in this respect. 8,12,15,16…”

“…Screening for PC needs in predefined situations as well as clear criteria for assessment and co-management by PC specialists may be helpful in this respect. 8,12,15,16 The European Society of Cardiology recommends a holistic, multidisciplinary needs assessment for patients with progressive and/or advanced HF, shifting treatment goals towards palliation and focusing on optimal symptom control and QoL. The first admission to the hospital for decompensated HF often heralds this phase.…”

Spiritual needs, prayer and cardiac function changes in healthy young women – the interconnection of spirituality with human physiology

“…Spirituality is about the search for ultimate or transcendent meaning from different sources: religious practice, interpersonal relationship, connectedness with nature, music and the arts [5]. There is now substantial literature which demonstrates the positive effect of religious and spiritual beliefs on quality of life [6][7][8] and its indicators such as sleep quality and health status [9,10], heart activity and heart failure-specific health status [11,12]. Recent Lithuanian study determined the association of individually perceived importance of religiosity and spirituality with spiritual wellbeing and unmet spiritual needs [13].…”