title: Health Status Trajectories Among Outpatients With Heart Failure.
abstract: Health status (i.e., symptoms, function, and quality of life) is an important palliative care outcome in patients with heart failure; however, patterns of health status over time (i.e., trajectories) are not well described.
  
  
  
  The objective of this study was to identify health status trajectories in outpatients with heart failure and assess whether depression, symptom burden, or sense of peace predict health status trajectory.
  
  
  
  This is an observational study utilizing data from the Patient-Centered Disease Management for Heart Failure trial. Participants completed Kansas City Cardiomyopathy Questionnaires at baseline, three, six, and 12 months. Latent class growth analysis identified health status trajectories; multinomial logistic regression models identified predictors of trajectory membership.
  
  
  
  Patients (n = 384) were primarily men (97%) and older (mean age 67.6 ± 10.1). Three health status trajectories were identified. All three trajectories improved at three months; however, the marked improvement health status trajectory (n = 19) showed progressive improvement over one year, whereas the poor (n = 119) and moderate (n = 246) health status trajectories had little change after three months. In adjusted analyses, worse baseline depression (odds ratio 1.10; 95% confidence interval 1.01-1.20), symptom burden (1.45; 1.15-1.83), and sense of peace (0.41; 0.22-0.75) predicted membership in the poor vs. moderate health status trajectory.
  
  
  
  We identified three one-year health status trajectories in patients with heart failure, with the two most common trajectories characterized by early improvement followed by limited change. Future research should assess these findings in nonveterans and women and explore whether treatment of depression, high symptom burden, and low sense of peace leads to improved long-term heart failure health status trajectory.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA. Electronic address: kelsey.flint@ucdenver.edu.
authors.forename: Kelsey M
authors.initials: KM
authors.lastname: Flint
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schmiege
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA; Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Division of Cardiovascular Diseases, St. Luke's Mid-American Heart Institute, University of Missouri, Kansas City, Missouri, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Fendler
authors.affiliation: American College of Cardiology, Washington, District of Columbia, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rumsfeld
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA; VA Eastern Colorado Health Care System, Denver, Colorado, USA; Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bekelman
mesh_terms: D000367:Age Factors; D000368:Aged; D018450:Disease Progression; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011788:Quality of Life; D012737:Sex Factors; D063189:Symptom Assessment
keywords: Heart failure; depression; health status; peace; spirituality; symptom burden