Health-related quality of life and long-term morbidity and mortality in patients hospitalised with systolic heart failure.
BACKGROUND
Health-related quality of life has been shown to impact prognosis in chronic heart failure, however with limited long-term follow-up. We analysed data spanning 8-12 years to assess the impact of health-related quality of life using the Nottingham Health Profile on first hospitalisation and mortality, for cardiovascular and all causes.


METHODS
We included 208 patients aged ≥60 years with New York Heart Association class II-IV and left ventricular systolic dysfunction hospitalised in Stockholm during 1996-99. Data on hospital admissions, discharge diagnoses and date and cause of death were collected from administrative databases and medical records until 2007. Cox proportional hazard models were employed to analyse the time to event for mortality and hospitalisations.


RESULTS
Mean age was 76 years, 58% were male and mean ejection fraction was 34%. Median survival was 4.6 years (range 6 days-11.9 years); 148 patients died. All-cause and cardiovascular mortality were determined by physical mobility (by Nottingham Health Profile), age, gender, diuretic dose and haemoglobin level. Glomerular filtration rate was significant for all-cause mortality, while atrioventricular plane displacement was predictive of cardiovascular mortality. Median time to first all-cause and cardiovascular hospitalisation was 5.7 and 11.2 months, respectively. Time to first all-cause hospitalisation was determined by physical mobility, emotional reactions, age, gender and haemoglobin level, while only physical mobility and diuretic dose predicted time to first cardiovascular hospitalisation.


CONCLUSIONS
In conclusion, in patients with systolic chronic heart failure, physical mobility as part of health-related quality of life is an independent prognostic marker for cardiovascular and all-cause readmissions and mortality over 12 years.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; OptumInsight, Stockholm, Sweden.
Jenny
J
Berg
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden ; IVBAR, Stockholm, Sweden.
Peter
P
Lindgren
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Thomas
T
Kahan
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Owe
O
Schill
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Hans
H
Persson
Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Magnus
M
Edner
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ; Department of Medicine, Ersta Hospital, Stockholm, Sweden.
Märit
M
Mejhert
Factor analysis; Nottingham Health Profile; heart failure; hospitalisation; mortality; prognosis; quality of life; survival analysis