title: Quality of life and prognosis in heart failure: results of the Beta-Blocker Evaluation of Survival Trial (BEST).
abstract: BACKGROUND
  Quality of life (QOL) was a prespecified secondary end point in the Beta-Blocker Evaluation of Survival Trial. The Beta-Blocker Evaluation of Survival Trial used four QOL questionnaires to evaluate patient health status over time in response to treatment with placebo or bucindolol. The goal of the current study was to determine the relationship between the different questionnaires, assess the effect of treatment on health status, and evaluate the association between changes in health status and prognosis.
  
  
  METHODS
  The San Diego Heart Failure (SDHF), Minnesota Living with Heart Failure (MLHF), Patient Global Assessment (PGA), and Physician Global Assessment (PhyGA) questionnaires were measured at baseline through 48 months of follow-up. For SDHF and MLHF, changes from baseline were calculated. Spearman correlation was used to assess relationships, and Cox Proportional Hazards regression was used to predict time to all-cause mortality, and mortality or heart failure hospitalization, bivariately and multivariately. To determine whether beta-blocker treatment affected QOL, the Wilcoxon rank-sum test was used to compare treatment groups.
  
  
  RESULTS
  At 12 months, SDHF (r = +0.56, P = .0001), PGA (r = +0.36, P = .0001), and PhyGA (r = +0.37, P = .0001) correlated with MLHF. SDHF (P = .0001), MLHF (P = .0004), PGA (P = .0001), and PhyGA (P = .0001) were all strongly associated with all-cause mortality, with low values of each associated with a lower hazard. For the combined end point of all-cause mortality or heart failure hospitalization, change in QOL with each instrument had a P value of .0001. At 12 months, bucindolol-treated patients had improvement in both PhyGA and PGA compared with placebo; neither the SDHF nor the MLWF instrument distinguished between the two treatment groups unless a worst-rank assignment was used for patients who died.
  
  
  CONCLUSIONS
  The four instruments correlate with each other and predict clinical end points, suggesting that each is a valid measure of health status. According to the PGA and the PhyGA, bucindolol improves QOL.
authors.affiliation: Division of Cardiology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Tate
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Robertson
authors.forename: Ronald
authors.initials: R
authors.lastname: Zolty
authors.forename: Simon F
authors.initials: SF
authors.lastname: Shakar
authors.forename: Joann
authors.initials: J
authors.lastname: Lindenfeld
authors.forename: Eugene E
authors.initials: EE
authors.lastname: Wolfel
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bristow
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lowes
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use*; D011581:Psychological Tests; D011594:Psychometrics; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires
chemical_list: D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C024307:bucindolol