• New treatment targets in heart failure: Patient reported outcome measures and subjective well-being

      Russo, Marguerite M.; Wiegand, Debra J. Lynn-McHale (2015)
      Background: Despite costly advances in heart failure management, heart failure is characterized by pervasive adverse and complex symptoms, functional decline, and poor quality of life. A robust theoretical framework comprehending provider and patient paradigms guided this study seeking new treatment targets to augment existing advanced therapies. Aims: The aim of this study is to examine subjective well-being associations with other patient reported outcome measures, and disease and treatment outcomes, in individuals with heart failure. Methods: This cross sectional, correlational study used data collected from 88 individuals undergoing inpatient heart failure treatment in a large urban academic medical center (50% male, average age 67±6. 9, median duration of heart failure >4 years, mean vEF =32%). Following consent, patients completed a 30 minute interview consisting of valid, reliable ‘patient reported outcome measures’ of subjective well-being, symptom burden, intrusion of illness and treatment in meaningful life pursuits, and health related quality of life. Disease, treatment and social characteristics were abstracted from medical records. Data analyses were conducted using correlation, non parametric statistics and regression models. Results: ‘Patient reported outcome measures’ had good internal reliability (Cronbach’s alpha >.8). Subjective well-being scores detected differences based on age, functional, employment and insurance statuses. Health related quality of life and subjective well-being measures correlated with illness intrusiveness (.53, -.40). The most prevalent symptoms reported (75-97%), were xerostomia, dyspnea, fatigue, pain, worry and sleep disruption. In multiple regression models, illness intrusiveness predicted subjective well-being (R2 change=.29, p≤.01) health related quality of life (R2 change= .24, p≤.01), after controlling for functional and insurance statuses. Conclusion: ‘Patient reported outcome measures’ including subjective well-being scales contribute unique findings to inform individualized heart failure treatment. New heart failure treatment targets identified in this sample include multidimensional symptom management, functional support, prognostication and advance care planning, all components of primary palliative care.