Ethnic differences in quality of life and its association with survival in patients with heart failure

Abstract

Background Optimizing quality of life (QoL) is a key priority in the management of heart failure (HF). Hypothesis To investigate ethnic differences in QoL and its association with 1‐year survival among patients with HF. Methods A prospective nationwide cohort (n = 1070, mean age: 62 years, 24.5% women) of Chinese (62.3%), Malay (26.7%) and Indian (10.9%) ethnicities from Singapore, QoL was assessed using the Minnesota Living with HF Questionnaire (MLHFQ) at baseline and 6 months. Patients were followed for all‐cause mortality. Results At baseline, Chinese had a lower (better) mean MLHFQ total score (29.1 ± 21.6) vs Malays (38.5 ± 23.9) and Indians (41.7 ± 24.5); P < .001. NYHA class was the strongest independent predictor of MLHFQ scores (12.7 increment for class III/IV vs I/II; P < .001). After multivariable adjustment (including NT‐proBNP levels, medications), ethnicity remained an independent predictor of QoL (P < .001). Crude 1‐year mortality in the overall cohort was 16.5%. A 10‐point increase of the physical component (of MLHFQ) was associated with a hazard (HR 1.22, 95% 1.03‐1.43) of 1‐year mortality (P = .018) in the overall cohort. An interaction between MLHFQ and ethnicity was found (P = .019), where poor MLHFQ score (per 10‐point increase) predicted higher adjusted mortality only in Chinese (total score: HR 1.18 [95% CI 1.07‐1.30]; physical: HR 1.44 [95% CI 1.17‐1.75]; emotional score: HR 1.45 [95% CI 1.05‐2.00]). Conclusions Ethnicity is an independent determinant of QoL in HF. Despite better baseline QoL in Chinese, QoL was more strongly related to survival in Chinese vs Malays and Indians. These findings have implications for HF trials that use patient‐reported outcomes as endpoints.

The Relationship Between Uncertainty in Illness and Quality of Life in Patients With Heart Failure

“…Linked to a previous study, longer HF duration was associated with QoL 45 . New York Heart Association class has been shown to be correlated with QoL in previous studies, with NYHA class III/IV representing poorer QoL 46,47 . In our study, avoidance was positively correlated with the PCS, whereas acceptance-resignation was negatively correlated with the PCS.…”

“…45 New York Heart Association class has been shown to be correlated with QoL in previous studies, with NYHA class III/IV representing poorer QoL. 46,47 In our study, avoidance was positively correlated with the PCS, whereas acceptance-resignation was negatively correlated with the PCS. This finding was consistent with reports from Chinese patients with cancer.…”

Patient-Reported Status and Heart Failure Outcomes in Asia by Sex, Ethnicity, and Socioeconomic Status

“…In contrast to the other ethnic groups, the Thai/Filipino/other group generally had lower prevalence of symptoms and signs and better HRQoL, which was not associated with all-cause admission or death. In the SHOP (Singapore Heart Failure Outcomes and Phenotypes) study, 29 only Chinese ethnicity had an association with mortality, and there was no association for Malay and Indian ethnic groups, which is in contrast to our findings of a significant association for all 3 groups. The number of Malay and Indian patients in the SHOP study was much lower than in our study, which may explain these differences.…”

“… 16 , 17 , 18 Although evidence over 2 decades has shown a clear association between baseline symptoms, signs, 19 , 20 HRQoL, 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 and outcomes in HF, there is emerging evidence that its relationship with outcomes may also be moderated by country of origin 15 and ethnicity. 29 However, evidence on changing clinical status in different HF subgroups has not been evaluated.…”

Titration of medications and outcomes in multi‐ethnic heart failure cohorts (with reduced ejection fraction) from Singapore and New Zealand

“…Health‐related QoL was assessed at baseline and 6 week and 6 month visits using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). 16 The MLHFQ is a self‐report questionnaire comprising 21 items, which assesses how HF affects the physical and emotional dimensions of well‐being. 17 These dimensions are combined into a total score that reflects a global assessment of well‐being.…”