title: Additive prognostic value of subjective assessment with respect to clinical cardiological data in patients with chronic heart failure.
abstract: BACKGROUND
  Health-related quality of life tools that better reflect the unique subjective perception of heart failure (HF) are needed for patients with this disorder. The aim of this study was to explore whether subjective satisfaction of HF patients about daily life may provide additional prognostic information with respect to clinical cardiological data.
  
  
  METHODS
  One hundred and seventy-eight patients (age 51 ± 9 years) with moderate to severe HF [New York Heart Association (NYHA) class 2.0 ± 0.7; left ventricular ejection fraction (LVEF) 29 ± 8%] in stable clinical condition underwent a standard clinical evaluation and compiled the Satisfaction Profile (SAT-P) questionnaire focusing on subjective satisfaction with daily life. Cox regression analysis was used to assess whether SAT-P factors (psychological functioning, physical functioning, work, sleep/eating/leisure, social functioning) had any prognostic value.
  
  
  RESULTS
  Forty-six cardiac deaths occurred during a median of 30 months. Patients who died had higher NYHA class, more depressed left ventricular function, reduced systolic blood pressure (SBP), increased heart rate (HR), and worse biochemistry (all p < 0.05). Among the SAT-P factors, only physical functioning (PF) was significantly reduced in the patients who died (p = 0.003). Using the best subset selection procedure, resistance to physical fatigue (RPF) was selected from among the items of the PF factor. RPF showed independent predictive value when entered into a prognostic model including NYHA class, LVEF, SBP, and HR with an adjusted hazard ratio of 0.86 per 10 units increase (95% CI 0.75-0.98, p = 0.02).
  
  
  CONCLUSIONS
  Patients' dissatisfaction with physical functioning is associated with reduced long-term survival, after adjustment for known risk factors in HF. Given its user-friendly structure, simplicity, and significant prognostic value, the RPF score may represent a useful instrument in clinical practice.
authors: Psychology Unit, Scientific Institute of Montescano, Salvatore Maugeri Foundation IRCCS, Pavia, Italy. giuseppina.majani@fsm.it
authors: Giuseppina
authors: G
authors: Majani
authors: Antonia
authors: A
authors: Pierobon
authors: Gian Domenico
authors: GD
authors: Pinna
authors: Anna
authors: A
authors: Giardini
authors: Roberto
authors: R
authors: Maestri
authors: Maria Teresa
authors: MT
authors: La Rovere
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000523:psychology; D006339:Heart Rate; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers