title: Health behaviors contribute to quality of life in patients with advanced heart failure independent of psychological and medical patient characteristics.
abstract: BACKGROUND
  Little is known about the contribution of health behaviors to quality of life (QoL) in heart transplant candidates. We examined physical activity, dietary habits, psychological, and medical patient characteristics as correlates of QoL among patients enrolled in the multisite Waiting for a New Heart Study.
  
  
  METHODS
  QoL (Minnesota Living with Heart Failure Questionnaire), demographic variables, psychological variables (e.g., depression, coping styles), and health behaviors (physical activity, dietary habits) were assessed in 318 patients (82% male, 53 ± 11 years) at the time of wait-listing and analyzed in 312 patients (excluding six underweight patients). Eurotransplant provided BMI and medical variables to compute the Heart Failure Survival Score (HFSS). Hierarchical multiple regression models were used to assess the independent contribution of health behaviors to QoL.
  
  
  RESULTS
  The HFSS was unrelated to QoL. As expected, psychological characteristics (depression, anxiety, vigilant coping style) contributed to impaired QoL, accounting for 22.9, 35.9, and 12.9% of the variance in total, emotional, and physical QoL, respectively. Physical inactivity further impaired QoL (total: 4.1%, p < 0.001; physical: 7.4%, p < 0.001). Dietary habits typically considered as unhealthy (i.e., infrequent consumption of fruits/vegetables/legumes; frequent intake of foods high in saturated fats) were related to enhanced physical QoL, but only among the overweight and obese patients.
  
  
  CONCLUSIONS
  Lifestyle interventions to modify negative emotions and to increase physical activity could help to improve QoL in heart transplant candidates, regardless of their disease severity. The role of eating habits in QoL among obese and overweight patients needs further exploration.
authors.affiliation: Department of Psychology, Johannes Gutenberg-University, Binger Str. 14-16, 55099, Mainz, Germany.
authors.forename: Vina
authors.initials: V
authors.lastname: Bunyamin
authors.forename: Heike
authors.initials: H
authors.lastname: Spaderna
authors.forename: Gerdi
authors.initials: G
authors.lastname: Weidner
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006333:Heart Failure / Q000523:psychology* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires