title: Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life.
abstract: BACKGROUND
  Communicating prognosis to enable shared decision-making is strongly endorsed by heart failure (HF) guidelines. Patients are concerned with both their quantity and quality of life (QoL). To facilitate the recognition of patients at high risk for unfavorable future QoL or death, we created a simple prognostic tool to estimate this combined outcome.
  
  
  RESULTS
  We identified factors associated with 6-month mortality or persistently unfavorable QoL, defined by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores <45 at 1 and 24 weeks after hospital discharge, among 1458 patients from the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST). Within 24 weeks of discharge, 478 (32.8%) patients had died and 192 (13.2%) patients had serial KCCQ scores <45. After adjusting for 23 predischarge covariates, independent predictors of the combined end point included low admission KCCQ score, high B-type natriuretic peptide, hyponatremia, tachycardia, hypotension, absence of β-blocker therapy, and history of diabetes mellitus and arrhythmia. A simplified predischarge HF score for subsequent death or unfavorable QoL had moderate discrimination (c-statistic 0.72). Predischarge clinical covariates were substantially different in predicting the QoL end point as compared with traditional death or rehospitalization end points.
  
  
  CONCLUSIONS
  At the time of hospital discharge, readily available clinical characteristics are associated with HF patients at high risk for persistently unfavorable QoL or death over the next 6 months. Such information can target patients for whom aggressive treatment options (eg, devices or transplantation) and/or end-of-life discussions should be strongly considered before hospital discharge.
authors.affiliation: Colorado Cardiovascular Outcomes Research Group, University of Colorado-Denver, Aurora, CO 80045, USA. larry.allen@ucdenver.edu
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hauptman
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007010:Hyponatremia; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010351:Patient Discharge; D011379:Prognosis; D011788:Quality of Life; D012306:Risk; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013610:Tachycardia
chemical_list: D020097:Natriuretic Peptide, Brain