Variable Contribution of Heart Failure to Quality of Life in Ambulatory Heart Failure With Reduced, Better, or Preserved Ejection Fraction

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• 作者：Emer Joyce ; MD ; PhD ; Christine Chung ; MD ; Sabrina Badloe ; MD ; Kayode Odutayo ; MD ; Akshay Desai ; MD ; Michael M. Givertz ; MD ; Anju Nohria ; MD ; Neal K. Lakdawala ; MD ; Garrick C. Stewart ; MD ; Michelle Young ; NP ; Joanne Weintraub ; NP ; Lynne W. Stevenson ; MD ; Eldrin F. Lewis ; MD ; MPH ; ^{eflewis@partners.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：better left ; heart failure ; left ventricular ejection fraction ; quality of life
• 刊名：JACC: Heart Failure
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：4
• 期：3
• 页码：184-193
• 全文大小：528 K

文摘

The relative contribution of heart failure (HF) compared with other medical and nonmedical factors on diminished quality of life (QOL) across subtypes with reduced, better, and preserved left ventricular ejection fraction (LVEF) in a large ambulatory HF population was evaluated.

Background

Dominant factors influencing limited QOL in patients with HF have not been investigated.

Methods

Before routine HF clinic visits, 726 patients with ambulatory HF (mean age 56 ± 15 years, 37% women) completed a 1-page questionnaire that assessed QOL and relative contributions of HF compared with other medical and nonmedical factors to their QOL limitations. Visual analogue scales were used to assess overall QOL, breathing, and energy level. Results were compared across reduced (57%), preserved (16%) and better (improvement in LVEF ≥50%) (19%) subtypes.

Results

Just under one-half of patients (48%) rated QOL as limited dominantly by HF, 19% rated HF and medical problems as equally limiting, 18% cited medical problems as dominant, and 15% cited nonmedical factors. Patients with HF with better LVEF had the highest overall QOL score and less dyspnea burden than those with HF with preserved EF. Independent correlates of HF-dominated diminished QOL were prior cardiac surgery, worse New York Heart Association functional class, renin-angiotensin-aldosterone antagonism, use of diuretic agents, lower body mass index, lower LVEF, and lack of arthritis or history of cancer.

Conclusions

Fewer than one-half of patients with ambulatory HF rated HF as the greatest limitation to their QOL, suggesting that this important outcome will be difficult to affect by HF-targeted therapies alone, particularly in those with higher LVEFs and comorbidities. Patients with HF with better LVEF represent a distinct subtype with better overall QOL.