title: Quality of life monitoring in ambulatory heart failure patients: temporal changes and prognostic value.
abstract: OBJECTIVE
  Heart failure (HF) is a chronic condition that typically affects a patient's quality of life (QoL). Little is known about long-term QoL monitoring in HF. This study aimed to evaluate the temporal changes and prognostic value of QoL assessment in a real-life cohort of HF patients.
  
  
  RESULTS
  The Minnesota Living with Heart Failure Questionnaire was used to monitor QoL at baseline and at 1, 3, and 5 years for 1151 consecutive patients {71.7% men, median age 69 years [25th-75th percentiles (P(25)-P(75)) 59-76]} in an HF unit. Follow-up for prognosis assessment was extended to 6 years. The number of answered questionnaires was 1151 at baseline, 746 at 1 year, 268 at 3 years, and 240 at 5 years. QoL scores showed a steep decrease (indicating QoL improvement) during the first year [29 (P(25)-P(75) 16-43) at baseline vs. 15 (P(25)-P(75) 8-27) at 1 year, P < 0.001], which was tempered, yet significant up to 5 years [12 (P(25)-P(75) 7-23) at 3 years vs. 10 (P(25)-P(75) 5-21) at 5 years, P = 0.012]. We recorded 457 deaths during follow-up. In a comprehensive multivariable Cox regression analysis, baseline QoL remained a significant prognosticator during follow-up [hazard ratio (HR)(Cox) for death 1.012, 95% confidence interval 1.006-1.018, P < 0.001]. QoL monitoring showed that a score increase ≥10% between consecutive assessments stratified high-risk patients within the next 12 months (P = 0.008).
  
  
  CONCLUSIONS
  Both baseline and follow-up QoL monitoring were useful for patient risk stratification in a real-life HF cohort. Worse QoL may warn of a worse prognosis. Widespread QoL monitoring in routine clinical practice is recommended.
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Lupón
authors.forename: Paloma
authors.initials: P
authors.lastname: Gastelurrutia
authors.forename: Marta
authors.initials: M
authors.lastname: de Antonio
authors.forename: Beatriz
authors.initials: B
authors.lastname: González
authors.forename: Lucía
authors.initials: L
authors.lastname: Cano
authors.forename: Roser
authors.initials: R
authors.lastname: Cabanes
authors.forename: Agustín
authors.initials: A
authors.lastname: Urrutia
authors.forename: Crisanto
authors.initials: C
authors.lastname: Díez
authors.forename: Ramón
authors.initials: R
authors.lastname: Coll
authors.forename: Salvador
authors.initials: S
authors.lastname: Altimir
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D011795:Surveys and Questionnaires