title: Burdensome Physical and Depressive Symptoms Predict Heart Failure-Specific Health Status Over One Year.
abstract: Heart failure (HF)-specific health status (symptom burden, functional status, and health-related quality of life) is an important patient-reported outcome that is associated with palliative care needs, hospitalizations, and death.
  
  
  
  To identify potentially modifiable patient-reported factors that predict HF-specific health status over one year.
  
  
  
  This was a prospective cohort study using data from the Patient-Centered Disease Management trial. Participants were identified using population-based sampling of all patients with an HF diagnosis at four VA Medical Centers. Patients were enrolled with reduced HF-specific health status (i.e., significant HF symptoms, limited functional status, and poor quality of life, defined by a Kansas City Cardiomyopathy Questionnaire [KCCQ] score <60). Patient-reported factors at baseline were chest pain, other noncardiac pain, dry mouth, numbness/tingling, constipation, nausea, cough, dizziness, depressive symptoms (Patient Health Questionnaire-9), and spiritual well-being (validated, single-item measure). Patients reported HF-specific health status (KCCQ) at 3, 6, and 12 months.
  
  
  
  Of 384 U.S. veterans, 42% screened positive for depression and 76% described burdensome physical symptoms at baseline. In bivariate analyses, all patient-reported factors were correlated with KCCQ score over one year. Multivariable mixed-effect modeling showed that baseline chest pain, numbness/tingling, depressive symptoms, and higher comorbidity count predicted HF-specific health status over the following year.
  
  
  
  Burdensome physical and depressive symptoms independently predicted subsequent HF-specific health status in patients with symptomatic HF. Whether addressing these aspects of the patient experience can improve health status and well-being in symptomatic HF should be studied further.
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA. Electronic address: Hillary.lum@ucdenver.edu.
authors.forename: Hillary D
authors.initials: HD
authors.lastname: Lum
authors.affiliation: Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Carey
authors.affiliation: University of Colorado School of Public Health, Aurora, Colorado, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Fairclough
authors.affiliation: Cardiology (111B), Denver, Colorado, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Plomondon
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Hutt
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Cardiology (111B), Denver, Colorado, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000071066:Patient Reported Outcome Measures; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014728:Veterans
keywords: Heart failure; depression; health status; spirituality; symptoms