Health-Related Quality of Life and Mortality in Heart Failure: The Global Congestive Heart Failure Study of 23 000 Patients From 40 Countries

Abstract

Background: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. Methods: We used the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 to record HRQL in 23,291 HF patients from 40 countries in 8 different world regions in the Global Congestive Heart Failure study (G-CHF). We compared standardized KCCQ-12-summary scores (SS; adjusted for age, sex and markers of HF severity) between regions (0-100, higher=better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12-SS and the composite of all-cause death, of HF hospitalization and each component over a median follow-up of 1.6 years. Results: The mean age was 65 years, 61% were men, 40% had NYHA class III-IV symptoms, and 46% had left ventricular ejection fraction (EF) ≥40%. Average HRQL differed between regions (lowest in Africa [39.5 SE±0.3], highest in Western Europe [62.5±0.4]). There were 4,460 (19%) deaths, 3,885 (17%) HF hospitalizations and 6,949 (30%) had either event. Lower KCCQ-12-SS was associated with higher risk of all outcomes, the adjusted hazard ratio (HR) for each 10-unit KCCQ-12-SS decrement was 1.18 (95% CI 1.17-1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America and Africa (weakest association in South Asia, HR 1.08 [95% CI 1.03-1.14], strongest in Eastern Europe HR 1.31 [95% CI [1.21-1.42], interaction p<0.0001). Lower HRQL predicted death in both those with NYHA class I-II and III-IV symptoms (HR 1.17 [95% CI 1.14-1.19] and HR 1.14 [95% CI [1.12-1.17], interaction p=0.13) and was a stronger predictor for the composite outcome in NYHA class I-II vs. III-IV (HR 1.15 [95% CI 1.13-1.17] vs. 1.09 [95% CI [1.07-1.11], interaction p<0.0001). HR for death was greater in EF ≥40 vs. <40% (HR 1.23 [95% CI 1.20-1.26] and HR 1.15 [95% 1.13-1.17], interaction p<0.0001). Conclusions: HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF and among those with preserved and reduced EF. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03078166

Empagliflozin, Health Status, and Quality of Life in Patients With Heart Failure and Preserved Ejection Fraction: The EMPEROR-Preserved Trial

“…The KCCQ has been shown to be valid, reliable, and sensitive to clinical changes, and lower KCCQ scores are associated with higher risk of hospitalizations and mortality. [8][9][10] The KCCQ was completed by patients at baseline and at 12, 32, and 52 weeks after randomization to placebo or empagliflozin.…”

Posttraumatic stress disorder predicts poor health-related quality of life in cardiac patients in Palestine

“…Decreases in HRQL among cardiac patients with PTSD compared to those without PTSD were of similar magnitude as observed in the current study. The 20% decrease in HRQL observed in this study is expected to increase re-hospitalizations and mortality, as low HRQL has been found to be an independent and strong predictor of life expectancy and hospitalizations in patients with different heart diseases [27].…”

“…A total PCL-S score is determined by summing up the scores of all items (range 17-85). In the present study, the total score was divided into two categories of PTSD symptom severity: "no-to-little symptoms" (PCL-S scores [17][18][19][20][21][22][23][24][25][26][27][28][29] and "moderate-tohigh symptoms" (PCL-S scores �30; cutoff for clinically relevant PTSD) [19]. In the current sample, the PCL-S demonstrated an internal consistency (Cronbach α) of 0�86 for all 17 items.…”

Geschlechtsunterschiede bei Herzinsuffizienz – Behandlung und Prognose

“…Die Werte sind umso niedriger, je schwerer die Erkrankung ist. In einer weltweiten Studie an mehr als 23000 HI-Patienten aus 40 Ländern fanden sich deutliche regionale Unterschiede: Am niedrigsten waren die KCCQ-Scores in Afrika, wo sozial akzeptiertes Verhalten besonders von Frauen von religiösen Normen und physischen Restriktionen bestimmt wird, am höchsten in Westeuropa [16]. Niedrige KCCQ-Werte waren in dieser wie in vielen früheren Studien mit höheren Mortalitäts-und Hospitalisierungsraten assoziiert [16].…”