• Health-related Quality of Life and Mortality in Incident Heart Failure from the Cardiovascular Health Study (CHS)

      Woltz, Patricia Clark; Friedmann, Erika (2014)
      Heart failure (HF) is a debilitating clinical syndrome and the end stage of many heart diseases. Despite recent advances in treatment, it is a growing problem with a steadily increasing number of deaths annually. Costs of care have been rising and are projected to continue to do so over the next 20 years. Studies report that health related quality of life (HRQL) in HF adds prognostic information beyond that of traditional demographic and clinical risk factors, however findings vary. This research was conducted on data from The Cardiovascular Health Study (CHS), a large, population based cohort study of community dwelling older adults recruited in 2 annual waves (1989-1990; 1992-1993) and followed through 2009. The data were aligned into a data set that began at participant intake and continued with a maximum 20 year follow up (median 13.56) to examine changes in HRQL in participants newly diagnosed with HF. Changes in self-reported health, life satisfaction, depressive symptoms, physical functioning, and perceived social support were evaluated from the annual study visit immediately before to immediately after new HF diagnosis (N=987). In linear mixed models analysis, depressive symptoms (t(3150) = 3.13, p = .003), self-reported health (t(2968) = 4.85, p < .001), and self-reported physical functioning (t(3139) = 3.16, p = .002) deteriorated more in those diagnosed with HF than in an age/gender matched comparison group over a similar period. In Cox proportional hazard regression, changes in self-reported physical functioning in the year of HF diagnosis and self-reported health prior to diagnosis contributed independently to mortality after adjusting for age, gender, and functional status (walk time). Mortality risk increased 9% for every one-point worsening in physical functioning from before to after diagnosis (HR 1.09, 95%CI 1.02, 1.17) and 17% for every one-point worse self-reported health prior to diagnosis (HR 1.17, 95%CI 1.04, 1.33). Missing data introduced potential selection bias. Understanding the contributors to mortality in HF may help develop interventions and assist in the selection of patient centered treatment options. Assessment of HRQL in routine practice is recommended. Further research is needed to improve the sensitivity of HRQL measures to detect change.