1
|
Ventoulis I, Kamperidis V, Abraham MR, Abraham T, Boultadakis A, Tsioukras E, Katsiana A, Georgiou K, Parissis J, Polyzogopoulou E. Differences in Health-Related Quality of Life among Patients with Heart Failure. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:109. [PMID: 38256370 PMCID: PMC10818915 DOI: 10.3390/medicina60010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Heart failure (HF) is characterized by a progressive clinical course marked by frequent exacerbations and repeated hospitalizations, leading to considerably high morbidity and mortality rates. Patients with HF present with a constellation of bothersome symptoms, which range from physical to psychological and mental manifestations. With the transition to more advanced HF stages, symptoms become increasingly more debilitating, interfere with activities of daily living and disrupt multiple domains of life, including physical functioning, psychological status, emotional state, cognitive function, intimate relationships, lifestyle status, usual role activities, social contact and support. By inflicting profuse limitations in numerous aspects of life, HF exerts a profoundly negative impact on health-related quality of life (HRQOL). It is therefore not surprising that patients with HF display lower levels of HRQOL compared not only to the general healthy population but also to patients suffering from other chronic diseases. On top of this, poor HRQOL in patients with HF becomes an even greater concern considering that it has been associated with unfavorable long-term outcomes and poor prognosis. Nevertheless, HRQOL may differ significantly among patients with HF. Indeed, it has consistently been reported that women with HF display poorer HRQOL compared to men, while younger patients with HF tend to exhibit lower levels of HRQOL than their older counterparts. Moreover, patients presenting with higher New York Heart Association (NYHA) functional class (III-IV) have significantly more impaired HRQOL than those in a better NYHA class (I-II). Furthermore, most studies report worse levels of HRQOL in patients suffering from HF with preserved ejection fraction (HFpEF) compared to patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF). Last, but not least, differences in HRQOL have been noted depending on geographic location, with lower HRQOL levels having been recorded in Africa and Eastern Europe and higher in Western Europe in a recent large global study. Based on the observed disparities that have been invariably reported in the literature, this review article aims to provide insight into the underlying differences in HRQOL among patients with HF. Through an overview of currently existing evidence, fundamental differences in HRQOL among patients with HF are analyzed based on sex, age, NYHA functional class, ejection fraction and geographic location or ethnicity.
Collapse
Affiliation(s)
- Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St Kiriakidi 1, 54636 Thessaloniki, Greece;
| | - Maria Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Theodore Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Antonios Boultadakis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Efthymios Tsioukras
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Aikaterini Katsiana
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Konstantinos Georgiou
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| |
Collapse
|
2
|
Kuan WC, Chee KH, Kasim S, Lim KK, Dujaili JA, Lee KKC, Teoh SL. Validity and measurement equivalence of EQ-5D-5L questionnaire among heart failure patients in Malaysia: a cohort study. J Med Econ 2024; 27:607-617. [PMID: 38557412 DOI: 10.1080/13696998.2024.2337563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
AIM This study aimed to examine the validity of EQ-5D-5L among HFrEF patients in Malaysia, and to explore the measurement equivalence of three main language versions. METHODS We surveyed HFrEF patients from two hospitals in Malaysia, using Malay, English or Chinese versions of EQ-5D-5L. EQ-5D-5L dimensional scores were converted to utility scores using the Malaysian value set. A confirmatory factor analysis longitudinal model was constructed. The utility and visual analog scale (VAS) scores were evaluated for validity (convergent, known-group, responsiveness), and measurement equivalence of the three language versions. RESULTS 200 HFrEF patients (mean age = 61 years), predominantly male (74%) of Malay ethnicity (55%), completed the admission and discharge EQ-5D-5L questionnaire in Malay (49%), English (26%) or Chinese (25%) languages. 173 patients (86.5%) were followed up at 1-month post-discharge (1MPD). The standardized factor loadings and average variance extracted were ≥ 0.5 while composite reliability was ≥ 0.7, suggesting convergent validity. Patients with older age and higher New York Heart Association (NYHA) class reported significantly lower utility and VAS scores. The change in utility and VAS scores between admission and discharge was large, while the change between discharge and 1MPD was minimal. The minimal clinically important difference for utility and VAS scores was ±0.19 and ±11.01, respectively. Malay and English questionnaire were equivalent while the equivalence of Malay and Chinese questionnaire was inconclusive. LIMITATION This study only sampled HFrEF patients from two teaching hospitals, thus limiting the generalizability of results to the entire heart failure population. CONCLUSION EQ-5D-5L is a valid questionnaire to measure health-related quality of life and estimate utility values among HFrEF patients in Malaysia. The Malay and English versions of EQ-5D-5L appear equivalent for clinical and economic assessments.
Collapse
Affiliation(s)
- Wai Chee Kuan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sazzli Kasim
- Department of Internal Medicine (Cardiology), Faculty of Medicine, Universiti Teknologi MARA (UITM), Jalan Hospital, Selangor, Malaysia
- Cardiac Vascular and Lung Research Institute (CaVaLRI), Universiti Teknologi MARA (UITM), Jalan Hospital, Selangor, Malaysia
| | - Ka Keat Lim
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
- Swansea University Medical School, Swansea University, Wales, United Kingdom
| | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| |
Collapse
|
3
|
Lawson CA, Tay WT, Richards M, Zaccardi F, Tromp J, Teng THK, Hung CL, Chandramouli C, Wander GS, Ouwerkerk W, Teramoto K, Ali M, Kadam U, Hand S, Harrison M, Anand I, Naik A, Squire I, Khunti K, Stromberg A, Lam CS. Patient-Reported Status and Heart Failure Outcomes in Asia by Sex, Ethnicity, and Socioeconomic Status. JACC. ASIA 2023; 3:349-362. [PMID: 37323861 PMCID: PMC10261894 DOI: 10.1016/j.jacasi.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
Background In heart failure (HF), symptoms and health-related quality of life (HRQoL) are known to vary among different HF subgroups, but evidence on the association between changing HRQoL and outcomes has not been evaluated. Objectives The authors sought to investigate the relationship between changing symptoms, signs, and HRQoL and outcomes by sex, ethnicity, and socioeconomic status (SES). Methods Using the ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) Registry, we investigated associations between the 6-month change in a "global" symptoms and signs score (GSSS), Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS), and visual analogue scale (VAS) and 1-year mortality or HF hospitalization. Results In 6,549 patients (mean age: 62 ± 13 years], 29% female, 27% HF with preserved ejection fraction), women and those in low SES groups had higher symptom burden but lower signs and similar KCCQ-OS to their respective counterparts. Malay patients had the highest GSSS (3.9) and lowest KCCQ-OS (58.5), and Thai/Filipino/others (2.6) and Chinese patients (2.7) had the lowest GSSS scores and the highest KCCQ-OS (73.1 and 74.6, respectively). Compared to no change, worsening of GSSS (>1-point increase), KCCQ-OS (≥10-point decrease) and VAS (>1-point decrease) were associated with higher risk of HF admission/death (adjusted HR: 2.95 [95% CI: 2.14-4.06], 1.93 [95% CI: 1.26-2.94], and 2.30 [95% CI: 1.51-3.52], respectively). Conversely, the same degrees of improvement in GSSS, KCCQ-OS, and VAS were associated with reduced rates (HR: 0.35 [95% CI: 0.25-0.49], 0.25 [95% CI: 0.16-0.40], and 0.64 [95% CI: 0.40-1.00], respectively). Results were consistent across all sex, ethnicity, and SES groups (interaction P > 0.05). Conclusions Serial measures of patient-reported symptoms and HRQoL are significant and consistent predictors of outcomes among different groups with HF and provide the potential for a patient-centered and pragmatic approach to risk stratification.
Collapse
Affiliation(s)
- Claire A. Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
| | | | - Mark Richards
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
- National University Heart Centre, Singapore
| | - Francesco Zaccardi
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- School of Allied Health, University of Western Australia, Australia
| | - Chung-Lieh Hung
- Department of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Gurpreet S. Wander
- Department of Cardiology, Hero Dayanand Medical College Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore
- Department of Dermatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | | | - Mohammad Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Umesh Kadam
- Diabetes Research Centre, Leicester, United Kingdom
- Department of Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Simon Hand
- Department of Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Mary Harrison
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Inder Anand
- Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ajay Naik
- Care Institute of Medical Sciences, Ahmedabad, India
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, and Department of Cardiology, Linkoping University, Sweden
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- George Institute for Global Health, Sydney, Australia
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | | |
Collapse
|
4
|
Xu J, Sun Y, Gong D, Fan Y. Association Between Disease-specific Health-related Quality of Life and All-cause Mortality in Patients with Heart Failure: A Meta-analysis. Curr Probl Cardiol 2023; 48:101592. [PMID: 36632931 DOI: 10.1016/j.cpcardiol.2023.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
The association between disease-specific health quality of life (QoL) and adverse outcomes remains controversial in patients with heart failure (HF). This meta-analysis aimed to evaluate the association of QoL measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) or Kansas City Cardiomyopathy Questionnaire (KCCQ) with all-cause mortality in patients with HF. PubMed and Embase databases were comprehensively searched until December 30, 2022 to identify studies investigating the utility of QoL measured by the MLHFQ or KCCQ in predicting all-cause mortality patients with HF. Twenty-five studies reported on 24 articles enrolling 42,414 HF patients were identified. A comparison of the top with the bottom MLHFQ score, the pooled adjusted hazard ratios (HR) of all-cause mortality was 1.56 (95% confidence intervals [CI] 1.26-1.94). When analyzed the MLHFQ as continuous variable, each 10-point MLHFQ score increase conferred a 12% (95% CI 6%-18%) higher risk of all-cause mortality, which was consistently significant for physical component (HR 1.19; 95% CI 1.09-1.30) and mental component (HR 1.21; 95% CI 1.05-1.40). A comparison of the bottom with the top KCCQ score, the pooled adjusted HR was 2.34 (95% CI 2.10-2.60) for all-cause mortality. Furthermore, each 10-point KCCQ score decrease was associated with a 12% (95% CI 7%-16%) higher risk of all-cause mortality. Worse health-related QoL defined by the higher MLHFQ or lower KCCQ score was associated with an increased risk of all-cause mortality in patients with HF. Assessment of disease-specific health QoL at baseline may provide important prognostic information in these patients.
Collapse
Affiliation(s)
- Juan Xu
- Department of Oncology, Ganyu District People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China
| | - Yimeng Sun
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Dandan Gong
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China.
| |
Collapse
|
5
|
Aung T, Qin Y, Tay WT, Binte Salahudin Bamadhaj NS, Chandramouli C, Ouwerkerk W, Tromp J, Anand I, Richards AM, Hung CL, Teramoto K, Katherine Teng TH, Lam CS. Prevalence and Prognostic Significance of Frailty in Asian Patients With Heart Failure. JACC: ASIA 2021; 1:303-313. [PMID: 36341220 PMCID: PMC9627805 DOI: 10.1016/j.jacasi.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Abstract
Background Frailty is common in patients with heart failure (HF) and can adversely impact outcomes. Objectives This study examined the prevalence of frailty among Asian patients with HF, its association with 1-year outcomes, and if race-ethnicity, HF subtypes, and sex modify this relationship. Methods In the multinational ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) registry, a baseline frailty index (FI) was constructed using a cumulative deficits approach with 48 baseline variables, and patients were followed for the 1-year primary outcome of all-cause death or HF hospitalization. Results Among 3,881 participants (age 61 ± 13 years, 27% female), the mean FI was 0.28 ± 0.11, and 69% were frail (FI >0.21). Higher FI was associated with older age, Malay ethnicity, and Southeast Asian residency. While comorbidities were more frequent in frail patients (by definition), body mass index was not different across frailty classes. Compared with FI class 1 (<0.21, nonfrail), FI class 2 (0.21-0.31) and FI class 3 (>0.31) had increased risk of the 1-year composite outcome (hazard ratios of 1.84 [95% confidence interval (CI): 1.42-2.38] and 4.51 [95% CI: 3.59-5.67], respectively), even after multivariable adjustment (adjusted hazard ratios of 1.49 [95% CI: 1.13-1.97] and 2.69 [95% CI: 2.06-3.50], respectively). Race-ethnicity modified the association of frailty with the composite outcome (Pinteraction = 0.0097), wherein the impact of frailty was strongest among Chinese patients. The association between frailty and outcomes did not differ between men and women (Pinteraction = 0.186) or for HF with reduced ejection fraction versus HF with preserved ejection fraction (Pinteraction = 0.094). Conclusions Most Asian patients with HF are frail despite relatively young age. Our results reveal specific ethnic (Malay) and regional (Southeast Asia) predisposition to frailty and highlight its prognostic importance, especially in Chinese individuals. (ASIAN HF Registry, A Prospective Observational Study [ASIANHF]; NCT01633398)
Collapse
Affiliation(s)
- Than Aung
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Yan Qin
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | | | | | | | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore
- Department of Dermatology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
- Duke-National University of Singapore Medical School, Singapore
| | - Inder Anand
- Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - A. Mark Richards
- National University Heart Centre, Singapore
- University of Otago, Dunedin, New Zealand
| | | | | | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
- Dr Tiew-Hwa Katherine Teng, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609.
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
- Duke-National University of Singapore Medical School, Singapore
- Address for correspondence: Dr Carolyn S.P. Lam, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609. @lamcardio
| |
Collapse
|
6
|
The Relationship Between Uncertainty in Illness and Quality of Life in Patients With Heart Failure: Multiple Mediating Effects of Perceived Stress and Coping Strategies. J Cardiovasc Nurs 2021; 37:257-265. [PMID: 33764941 DOI: 10.1097/jcn.0000000000000799] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous investigators have demonstrated that uncertainty in illness is associated with quality of life (QoL) in patients with chronic illness. However, little is known about the mechanism underlying the relationship in patients with heart failure. OBJECTIVE The aim of this study was to examine the multiple mediating effects of perceived stress and coping strategies on the relationship between uncertainty in illness and QoL in patients with heart failure. METHODS We conducted a cross-sectional study in 302 patients with heart failure recruited at a general hospital in China from October 2016 to September 2017. Uncertainty in illness, perceived stress, coping strategies, and QoL were assessed using self-reported questionnaires. The multiple mediation model was tested using the PROCESS macro for SPSS. RESULTS Of the 302 patients, 51.7% had poor physical QoL and 45.7% had poor mental QoL (physical component summary or mental component summary score of <50 points). Uncertainty in illness had a significantly negative indirect effect on mental QoL through perceived stress and acceptance-resignation (indirect effect, -0.02; 95% confidence interval, -0.04 to -0.01). Uncertainty in illness also had a significantly negative indirect effect on mental QoL via perceived stress only (indirect effect, -0.18; 95% confidence interval, -0.26 to -0.09). CONCLUSIONS Poor QoL is prevalent in patients with heart failure. Perceived stress and acceptance-resignation are important mediating factors between uncertainty in illness and mental QoL in patients with heart failure. Interventions aimed at reducing perceived stress and acceptance-resignation coping may be beneficial for improving mental QoL in patients with heart failure.
Collapse
|
7
|
Stein G, Teng THK, Tay WT, Richards AM, Doughty R, Dong Y, Sim D, Yeo PSD, Jaufeerally F, Leong G, Soon D, Ling LH, Lam CSP. Ethnic differences in quality of life and its association with survival in patients with heart failure. Clin Cardiol 2020; 43:976-985. [PMID: 32562317 PMCID: PMC7462190 DOI: 10.1002/clc.23394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
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.
Collapse
Affiliation(s)
- Gillian Stein
- NYU Grossman School of Medicine, New York, New York, USA
| | - Tiew-Hwa K Teng
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,School of Population & Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Wan T Tay
- National Heart Centre Singapore, Singapore, Singapore
| | | | | | - YanHong Dong
- National University Health System, Singapore, Singapore
| | - David Sim
- Singapore General Hospital, Singapore, Singapore
| | - Poh S D Yeo
- Gleneagles Medical Centre, Singapore, Singapore
| | | | | | - Dinna Soon
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Lieng H Ling
- National University Heart Centre, Singapore, Singapore
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|