Quality of life predicts outcome in a heart failure disease management program

Abstract 

Background

Chronic heart failure (HF) is associated with a poor Health Related Quality of Life (HRQoL). HRQoL has been shown to be a predictor of HF outcomes however, variability in the study designs make it difficult to apply these findings to a clinical setting. The aim of this study was to establish if HRQoL is a predictor of long-term mortality and morbidity in HF patients followed-up in a disease management program (DMP) and if a HRQoL instrument could be applied to aid in identifying high-risk patients within a clinical context.

Methods

This is a retrospective analysis of HF patients attending a DMP with 18±9 months follow-up. Clinical and biochemical parameters were recorded on discharge from index HF admission and HRQoL measures were recorded at 2 weeks post index admission.

Results

225 patients were enrolled into the study (mean age=69±12 years, male=61%, and 78%=systolic HF). In multivariable analysis, all dimensions of HRQoL (measured by the Minnesota Living with HF Questionnaire) were independent predictors of both mortality and readmissions particularly in patients <80 years. A significant interaction between HRQoL and age (Total_(HRQoL)⁎age: p<0.001) indicated that the association of HRQoL with outcomes diminished as age increased.

Conclusions

These data demonstrate that HRQoL is a predictor of outcome in HF patients managed in a DMP. Younger patients (<65 years) with a Total HRQoL score of ≥50 are at high risk of an adverse outcome. In older patients ≥80 years HRQoL is not useful in predicting outcome.

Keywords: Minnesota living with heart failure questionnaire, Heart failure, Disease management program, Health Related Quality of Life, Predictor