Quality of life and prognosis in heart failure: results of the Beta-Blocker Evaluation of Survival Trial (BEST).
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.
Tate
Charles W
CW
Division of Cardiology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
Robertson
Alastair D
AD
Zolty
Ronald
R
Shakar
Simon F
SF
Lindenfeld
Joann
J
Wolfel
Eugene E
EE
Bristow
Michael R
MR
Lowes
Brian D
BD
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
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C024307:bucindolol