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      Heart failure and health related quality of life

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          Abstract

          Quality of life is a major goal in the context of preventive and therapeutic cardiology. It is important, both as an outcome measure in clinical trials of congestive heart failure (CHF) and as a consideration in individual physicians' therapeutic decisions. In this article, quality of life concepts are reviewed, methods of measurement are explored and clinically significant changes on prognosis are discussed. There is a need for more research which is based on carefully selected measures of quality of life chosen as being of particular importance to patients and to the hypotheses being tested.

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          Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables.

          A Haunstetter, Atahualpa Kraemer, C Zugck … (2002)
          To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables. University hospital. A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test. Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life. In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.
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            The influence of age, gender, and race on the prevalence of depression in heart failure patients.

            S. Thomas, Bruce M Potenza, Erika Friedmann … (2004)
            The goal of this study was to determine the prevalence of depression in an out-patient heart failure (HF) population; its relationship to quality of life (QOL); and the impact of gender, race, and age. Most studies of depression in HF have evaluated hospitalized patients (a small percentage of the population) and have ignored the influence of various patient characteristics. Although reported depression rates among hospitalized patients range from 13% to 77.5%, out-patient studies have been small, have reported rates of 13% to 42%, and have not adequately accounted for the impact of age, race, or gender. A total of 155 patients with stable New York Heart Association functional class II, III, and IV HF and an ejection fraction or =10. A total of 48% of the patients scored as depressed. Depressed patients tended to be younger than non-depressed patients. Women were more likely (64%) to be depressed than men (44%). Among men, blacks (34%) tended to have less depression than whites (54%). Depressed patients scored significantly worse than non-depressed patients on all components of both the questionnaires measuring QOL. However, they did not differ in ejection fraction or treatment, except that depressed patients were significantly less likely to be receiving beta-blockers. Depression is common in patients with HF, with age, gender, and race influencing its prevalence in ways similar to those observed in the general population. These data suggest that pharmacologic or non-pharmacologic treatment of depression might improve the QOL of HF patients.
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              Monitoring the quality of life in patients with coronary artery disease.

              S Fihn, S. Winder, J Spertus … (1994)
              Monitoring the outcomes of treatment and quantifying patients' functional status have assumed a prominent role in both clinical trials and quality assurance programs. Because patients with coronary artery disease (CAD) may have comorbid illnesses, and because generic health status questionnaires may not focus on symptoms and impairments unique to coronary disease, a generic measure of health status may not be sufficient to detect important changes in patients' CAD. The responsiveness to clinical change of the Seattle Angina Questionnaire (SAQ), a disease-specific measure for CAD, was compared with that of the Short Form-36, a generic measure of health status. Both questionnaires were serially administered, 3 months apart, to 45 patients undergoing coronary angioplasty and to 130 patients with stable CAD. Most scales of both questionnaires improved significantly after coronary angioplasty. The responsiveness statistics of the SAQ exceeded those of the Short Form-36. Among 130 patients with initially stable angina, 33 deteriorated, 79 remained stable, and 18 improved over 3 months of observation. Mean SAQ scores changed significantly and appropriately in each of these groups. In contrast, none of the Short Form-36 scales detected these more subtle changes. Although useful in assessing overall function, a generic health status measure, such as the Short Form-36, may not be responsive enough to detect important clinical changes in patients' CAD. A disease-specific instrument, such as the SAQ, can be an important and relevant outcome measure in clinical trials or quality assurance programs.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Pract Epidemiol Ment Health
                Title: Clinical Practice and Epidemiology in Mental Health : CP & EMH
                Publisher: BioMed Central
                ISSN (Electronic): 1745-0179
                Publication date Collection: 2005
                Publication date (Electronic): 4 October 2005
                Volume: 1
                Page: 19
                Affiliations
                [1 ]Department of Psychiatry, Hospital de S. João, Porto Medical School, Porto, Portugal
                [2 ]Department of Psychiatry, Hospital de Magalhães Lemos, Porto, Portugal
                [3 ]Department of Psychiatry, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
                [4 ]Department of Internal Medicine, Hospital de S. João, Porto, Portugal
                [5 ]Unit of Cardiovascular Research and Development. Hospital de S. João, Porto Medical School, Porto, Portugal
                Article
                Publisher ID: 1745-0179-1-19
                DOI: 10.1186/1745-0179-1-19
                PMC ID: 1274338
                PubMed ID: 16202163
                SO-VID: 386b1dc0-0451-4a86-a0ea-286db7b97aad
                Copyright © Copyright ©2005 Coelho et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 September 2005
                Date accepted : 4 October 2005
                Categories
                Subject: Review

                ScienceOpen disciplines: Neurology
                Keywords: congestive heart failure,quality of life,prognosis
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: congestive heart failure, quality of life, prognosis

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