Systolic function as a predictor of mortality and quality of life in long-term survivors with heart failure.
BACKGROUND
Patients with heart failure (HF) and preserved ejection fraction (EF) have been shown to have high mortality rates, comparable to those with reduced EF. Thus, long-term survivors of HF, regardless of ejection fraction, are a select group. Little is known about disease-related quality of life (QOL) and health status in these patients.


OBJECTIVE
Preserved EF in patients with heart failure independently predicts long-term survival, health related quality of life (QOL), or functional status.


METHODS
The study followed a cohort of 413 patients consecutively hospitalized for HF between March 1996 and September 1998. In July 2005, information was collected about their mortality, health related QOL as defined by disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, and functional decline as defined by limitations in Activities of Daily Living (ADL) scores.


RESULTS
The primary outcomes were mortality, QOL, and functional decline. At follow-up, 8.1 years after enrollment, overall mortality was 76% (314/413). Adjusted for age, gender, renal insufficiency, diabetes mellitus, hypertension, HF, and respiratory disease, those with decreased ejection fraction (EF < 40%) had higher mortality compared with those with preserved ejection fraction (hazard ratio [HR] 1.42; confidence interval [CI] = 1.13, 1.80, p = 0.003). The KCCQ scores, including Clinical Summary Scores and Symptom Limitation Scores, as well as ADL limitations, were not significantly different in the survivors with preserved or decreased EF.


CONCLUSIONS
Heart failure patients with preserved EF have a modest survival advantage compared with those with decreased EF, but health related QOL scores and functional decline in survivors are similar regardless of systolic function.
Austin
Bethany A
BA
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.
Wang
Yongfei
Y
Smith
Grace L
GL
Vaccarine
Viola
V
Krumholz
Harlan M
HM
McNamara
Robert L
RL
D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013599:Systole; D013997:Time Factors