title: Heart failure severity scoring system and medical- and health-related quality-of-life outcomes: the HEMO study.
abstract: BACKGROUND
  Cardiac disease is the leading cause of death in US prevalent hemodialysis (HD) patients. There is a lack of data about the impact of the severity of heart failure (HF) on outcomes and health-related quality of life (HRQoL) in HD patients. We aimed to determine the prognostic importance of the Index of Disease Severity (IDS) of the Index of Coexistent Disease (ICED) scoring system as an HF severity measure.
  
  
  METHODS
  Subanalysis of the Hemodialysis (HEMO) Study, a randomized controlled trial. Relationships between HF severity and mortality and cardiac hospitalizations were determined using Cox proportional hazards models. The relationship between HF severity and HRQoL scores was modeled using linear regression and generalized estimating equations.
  
  
  METHODS
  1,846 long-term HD patients at 15 clinical centers including 72 dialysis units.
  
  
  METHODS
  HF severity classified using the IDS of the ICED scoring system.
  
  
  RESULTS
  Mortality (all cause and cause specific), cardiac hospitalizations, and HRQoL.
  
  
  METHODS
  All-cause, cardiac, and infectious deaths; cardiac hospitalizations; and HRQoL scores from the Kidney Disease Quality of Life-Long Form.
  
  
  RESULTS
  HF was present in 40% of HD patients. Increasing severity of HF was associated with older age, greater likelihood of diabetes, and lower serum albumin level (all P < 0.001). Adjusted HRs for all-cause mortality were 1.31 (95% CI, 1.12-1.53), 1.48 (95% CI, 1.19-1.85), and 2.11 (95% CI, 1.43-3.11) for mild, moderate, and severe HF, respectively (P < 0.001). All-cause, cardiac, and infectious mortality and cardiac hospitalizations increased with increasing severity of HF. Increasing HF severity was associated with decreases in HRQoL, particularly in physical functioning and sleep quality.
  
  
  CONCLUSIONS
  This study is limited by the small sample size in the most severe HF group.
  
  
  CONCLUSIONS
  Increasing severity of HF is associated with increased mortality and cardiac hospitalizations and worse HRQoL, especially in perceived physical limitations. These findings emphasize the utility of the IDS of the ICED score as a valid prognostic tool for medical and HRQoL outcomes in the HD population with HF.
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA 15261, USA. liangk@upmc.edu
authors.forename: Kelly V
authors.initials: KV
authors.lastname: Liang
authors.forename: Francis
authors.initials: F
authors.lastname: Pike
authors.forename: Christos
authors.initials: C
authors.lastname: Argyropoulos
authors.forename: Lisa
authors.initials: L
authors.lastname: Weissfeld
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Teuteberg
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011788:Quality of Life; D006435:Renal Dialysis; D012307:Risk Factors; D012720:Severity of Illness Index