Evidence-based treatment and quality of life in heart failure.
OBJECTIVE
To explore whether prescription of evidence-based drug therapy is associated with better quality of life (QoL) in patients with heart failure (HF).


METHODS
Patients (n = 62) were recruited in the outpatient clinic of Groningen University Hospital. Inclusion criteria were previous diagnosis of HF, age 40-80 years; ejection fraction of less than 45%, free from other serious disease (such as cancer) and psychiatric problems in the last year. QoL was assessed with the RAND 36-item health survey questionnaire, on five scales: physical functioning, mental health, social functioning, vitality and general health perception. Medication prescribed for 1 to 6 months before the QoL assessment was classified as either evidence-based treatment or under-treatment, according to the 2001 European guidelines on optimal HF treatment. The study had a cross-sectional design.


RESULTS
QoL did not differ significantly between evidence-based and under-treated patients, unadjusted or after adjustment for significant patient imbalances.


CONCLUSIONS
Conventional step-up medication approach in HF may have a positive impact on survival or morbidity, but it seems not beneficial in relation to QoL. Other interventions should be designed to improve QoL of patients with HF.
Dobre
Daniela
D
Northern Centre for Health Care Research, Department of Health Sciences, University of Groningen, The Netherlands. d.dobre@med.rug.nl
van Jaarsveld
Cornelia H M
CH
Ranchor
Adelita V
AV
Arnold
Rosemarie
R
de Jongste
Mike J L
MJ
Haaijer Ruskamp
Flora M
FM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D013148:Spironolactone / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D013148:Spironolactone