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Quality of life monitoring in ambulatory heart failure patients: temporal changes and prognostic value
Author(s) -
Lupón Josep,
Gastelurrutia Paloma,
Antonio Marta,
González Beatriz,
Cano Lucía,
Cabanes Roser,
Urrutia Agustín,
Díez Crisanto,
Coll Ramón,
Altimir Salvador,
BayesGenis Antoni
Publication year - 2013
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs133
Subject(s) - medicine , hazard ratio , heart failure , ambulatory , quality of life (healthcare) , confidence interval , proportional hazards model , percentile , cohort , cardiology , statistics , nursing , mathematics
Aims Heart failure (HF) is a chronic condition that typically affects a patient's quality of life (QoL). Little is known about long‐term QoL monitoring in HF. This study aimed to evaluate the temporal changes and prognostic value of QoL assessment in a real‐life cohort of HF patients. Methods and results The Minnesota Living with Heart Failure Questionnaire was used to monitor QoL at baseline and at 1, 3, and 5 years for 1151 consecutive patients {71.7% men, median age 69 years [25th–75th percentiles (P 25 –P 75 ) 59–76]} in an HF unit. Follow‐up for prognosis assessment was extended to 6 years. The number of answered questionnaires was 1151 at baseline, 746 at 1 year, 268 at 3 years, and 240 at 5 years. QoL scores showed a steep decrease (indicating QoL improvement) during the first year [29 (P 25 –P 75 16–43) at baseline vs. 15 (P 25 –P 75 8–27) at 1 year, P < 0.001], which was tempered, yet significant up to 5 years [12 (P 25 –P 75 7–23) at 3 years vs. 10 (P 25 –P 75 5–21) at 5 years, P = 0.012]. We recorded 457 deaths during follow‐up. In a comprehensive multivariable Cox regression analysis, baseline QoL remained a significant prognosticator during follow‐up [hazard ratio (HR) Cox for death 1.012, 95% confidence interval 1.006–1.018, P < 0.001]. QoL monitoring showed that a score increase ≥10% between consecutive assessments stratified high‐risk patients within the next 12 months ( P = 0.008). Conclusion Both baseline and follow‐up QoL monitoring were useful for patient risk stratification in a real‐life HF cohort. Worse QoL may warn of a worse prognosis. Widespread QoL monitoring in routine clinical practice is recommended.