title: Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality.
abstract: OBJECTIVE
  Chronic heart failure (CHF) due to left ventricular systolic dysfunction is associated with poor quality of life (QoL). This study aimed to assess factors affecting health-related QoL in CHF patients and their carers and the impact of QoL on clinical outcomes.
  
  
  RESULTS
  Demographic, social, and clinical data were collected for consecutive CHF patients in an academic hospital setting. All patients (n = 179) and informal carers (n = 131) completed a generic QoL questionnaire (EQ-5D) and patients also completed a CHF-specific QoL questionnaire (Minnesota Living with Heart Failure Questionnaire, MLHFQ). Patients were then followed up for 3 years to assess subsequent hospitalizations and mortality. Minnesota Living with Heart Failure Questionnaire score was independently predicted by NYHA class, socioeconomic deprivation and lack of an informal carer. Severity of heart failure, anaemia, and cancer co-morbidity in CHF patients were associated with poor QoL in carers. Chronic heart failure patients with poor baseline QoL (MLHFQ > median) were at increased risk of hospital admissions [hazard ratios (HR) 7.3, P < 0.001] and death (HR 1.5, P = 0.09). Mortality was also independently associated with repeat hospitalization (HR 6.0, P < 0.001) and lack of beta-blocker therapy (HR 1.8, P = 0.03).
  
  
  CONCLUSIONS
  Severe heart failure, poor socioeconomic status and lack of social support results in poor QoL in CHF patients which in turn leads to an increased risk of hospital admissions and death. Quality of life in carers is lower in female carers, those with socioeconomic deprivation and those caring for patients with higher NYHA class or having a cancer. Quality of life assessment may complement clinical prognostic markers to identify CHF patients at high risk of adverse events.
authors.affiliation: Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh EH16 4TJ, Edinburgh, UK.
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.forename: Loraine
authors.initials: L
authors.lastname: Francis
authors.forename: Janet
authors.initials: J
authors.lastname: Reid
authors.forename: Scott
authors.initials: S
authors.lastname: Murray
authors.forename: Martin
authors.initials: M
authors.lastname: Denvir
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013997:Time Factors