Quality of Life and its Determinants in Heart Failure Patients at a Major Tertiary Academic Center in Ontario, Canada

Background Heart failure (HF) greatly impacts quality of life (QoL). Objectives We evaluated QoL, its determinants and associations with major outcomes in HF patients at our institution, Hamilton Health Sciences (HHS), a tertiary academic centre in Ontario. Methods We enrolled 270 patients in a HF registry with standardized recording of data on demographics, social and educational status, living conditions, HF etiology, symptoms, comorbidities, physical exam, medication use, ECG, echocardiographic and biochemical measurements. QoL was measured using the KCCQ-12 questionnaire. Patients are followed prospectively and at the time of this analysis all patients had completed 6 months follow-up. Results Patients' mean age was 70.6±11.2 yrs, 32% were women, 55.6% were married, 25.6% lived alone, 74.4% were enrolled from the outpatient HF clinic and 25.6% during a HF hospitalization. Mean LVEF was 40.1%, 53.2% had HFrEF, 30.3% HFpEF and 16.5% HFmEF. The most common HF etiology was IHD, 48.1% had NYHA class III or IV functional status and 64.4% had 2 or more comorbidities. Average KCCQ-12 summary score was 57.5±27.7, consistent with fair disability level and overall good QoL. 14.1% had severe disability (KCCQ-12 score between 0 and 25) and 33.3% had little or no disability and excellent QoL (KCCQ-12 score between 76 and 100). HFpEF patients had on average a lower KCCQ-12 summary score than HFrEF patients (53.2±28.6 vs. 58.1±27.1, p=0.027) and a higher proportion had a score of 25 or lower consistent with severe disability (21.4% vs. 11.4%). In bivariate analysis lower KCCQ-12 summary score was associated with older age, inpatient status, living alone, NYHA class, time from diagnosis of HF, history of diabetes, COPD, total number of comorbidities, LVEF, heart rate and BMI. However, in multivariate analysis only NYHA class III or IV, inpatient status and COPD emerged as independent predictors of a lower KCCQ-12 summary score. Patients in the upper third of KCCQ-12 scores had the lowest rates of HF hospitalizations, all-cause hospitalizations, CV death, all-cause death and the composite of HF hospitalization and all-cause death. Conclusions Inspite of living with HF, many patients in our registry have fair disability level and good QoL. Patients with HFpEF had worse QoL than those with HFrEF. Advanced NYHA class, inpatient status and COPD were independent predictors of poorer QoL. We observed a strong association between the KCCQ-12 summary score and major CV outcomes.