title: Dose-dependent relationship of physical and depressive symptoms with health-related quality of life in patients with heart failure.
abstract: BACKGROUND
  Patients with heart failure (HF) have poor health-related quality of life (HRQOL). The vast majority of patients have physical symptoms, and about 30-40% have depressive symptoms. The combined effects of physical and depressive symptoms on HRQOL have not been examined fully in HF.
  
  
  OBJECTIVE
  To examine the combined effects of physical and depressive symptoms on HRQOL using repeated measures, controlling for covariates (i.e. age, education level, New York Heart Association (NYHA) functional class, financial status, and health perception).
  
  
  METHODS
  Patients (N = 224, 62 ± 12 years old, 67% male, 38% NYHA functional class III/IV) provided data on physical (Symptom Status Questionnaire) and depressive symptoms (Beck Depression Inventory II) at baseline and HRQOL (Minnesota Living with Heart Failure Questionnaire) at baseline and 12 months. Patients were divided into three groups based on presence of physical and depressive symptoms: a) no symptom group, b) one symptom group (dyspnea or fatigue), and c) two symptom group (physical and depressive symptoms). Repeated measures ANOVA was used to analyze the data.
  
  
  RESULTS
  The least squares mean scores of baseline and 12-month HRQOL differed significantly in the three groups after controlling for the covariates (26.4 vs. 36.6 vs. 53.1, respectively, all pairwise p values < 0.001). There was no time-by-group interaction or time main effect.
  
  
  CONCLUSIONS
  Physical and depressive symptoms have a dose-response relationship with HRQOL. Further research is needed to provide effective interventions to improve physical and depressive symptoms, in turn, HRQOL.
authors.affiliation: 1University of Arkansas for Medical Sciences, College of Nursing, USA.
authors.forename: Seongkum
authors.initials: S
authors.lastname: Heo
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Pressler
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.forename: JinShil
authors.initials: J
authors.lastname: Kim
authors.forename: Songthip
authors.initials: S
authors.lastname: Ounpraseuth
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
mesh_terms: D000368:Aged; D064646:Cardiovascular Nursing / Q000379:methods*; D003863:Depression / Q000451:nursing / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000451:nursing / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Heart failure; depressive symptoms; quality of life; symptoms