Distance between patients' subjective perceptions and objectively evaluated disease severity in chronic heart failure.
BACKGROUND
Chronic heart failure (CHF) is a socially relevant condition carrying an adverse prognosis. Systematic analysis is needed of the relationship between quality of life (QoL) - what patients are most interested in - and objective parameters of CHF severity - which largely determines physicians' care.


METHODS
We prospectively investigated QoL, as ascertained by the Minnesota Living with Heart Failure Questionnaire, alongside all the currently used objective clinical/instrumental (electrocardiographic, echocardiographic, hemodynamic and functional capacity) indicators of disease severity in 106 consecutive CHF patients.


RESULTS
Besides persistence of sinus rhythm (p = 0.007), the only objective parameters that correlated with QoL were NYHA class (p < 0.001) and distance covered during the six minutes walking test (p < 0.001) (two indications of patients' ability to attend to their daily needs). Presence of left bundle branch block was associated with a worse QoL only in patients with CHF due to ischemic heart disease (p = 0.032). All the other clinical/instrumental parameters showed no relation with QoL (p > 0.150 in all cases).


CONCLUSIONS
Objective indicators of disease severity, which largely determine physicians' care, appear to have little bearing on QoL, suggesting that current treatment for CHF fails to satisfy patients' perceived needs. The possibility of cost-effective nonpharmaceutical therapeutic protocols (e.g. psychological interventions) specifically designed to improve patients' QoL deserves investigation as a much needed new approach to the management of CHF.
Grigioni
Francesco
F
Institute of Cardiology S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Carigi
Samuela
S
Grandi
Silvana
S
Potena
Luciano
L
Coccolo
Fabio
F
Bacchi-Reggiani
Letizia
L
Magnani
Gaia
G
Tossani
Eliana
E
Musuraca
Anna Chiara
AC
Magelli
Carlo
C
Branzi
Angelo
A
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000145:classification* / Q000473:pathology* / Q000523:psychology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index