What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Chronic heart failure (n=91). Intervention: Clinical indices (LVEF, exercise capacity, NYHA classification). Primary outcome: Correlation between clinical indices and health-related quality of life measured by MOS SF36.

January 1, 2003Open Access

Health-Related Quality of Life of Japanese Patients With Chronic Heart Failure. Assessment Using the Medical Outcome Study Short Form 36.

Key Result

Exercise capacity and cardiothoracic ratio correlated with physical health-related quality of life in chronic heart failure patients, whereas left ventricular ejection fraction did not correlate with any quality of life subscales.

Study Design

Type

Cross-Sectional (n=91)

Multicenter

Yes

Structured PICO

How does health-related quality of life correlate with clinical indices of cardiac function and exercise capacity in patients with chronic heart failure?

Population

91 clinically stable outpatients in Japan with chronic heart failure and an LVEF <40%, assessed cross-sectionally to evaluate the relationship between clinical indices and quality of life.

Outcome

Relationship between cardiac function, exercise capacity, clinical classification, and health-related quality of life (HRQOL) measured by the Medical Outcome Study Short Form 36patient reported

Health-related quality of life provides independent information from traditional clinical indices like LVEF and NYHA class in heart failure patients, highlighting the importance of subjective patient assessment.

Limitations

Relatively small sample size which might reduce statistical power to detect potential relationships.
Reliance on the Specific Activity Scale to measure exercise capacity rather than objective tests like treadmill or 6-minute walk tests.
Use of a generic HRQOL measurement (SF-36) which may not be sensitive enough to detect disease-specific associations.
Cross-sectional and observational design precludes causal inferences.
Self-administered questionnaires may be affected by cultural, socioeconomic, and other non-clinical factors.

Abstract

Chronic heart failure is characterized by impaired cardiac function, but the relationship between clinical indices and subjective perception is not clear. This study was undertaken to investigate the relationship between cardiac function, exercise capacity and clinical classification, and the health-related quality of life (HRQOL) in 91 outpatients with an left ventricular ejection fraction (LVEF) less than 40%. Exercise capacity was evaluated by the Specific Activity Scale, and HRQOL by the Medical Outcome Study Short Form 36. Exercise capacity and the cardiothoracic ratio were correlated with the HRQOL related to physical functioning, although the correlation between exercise capacity and mental health was not significant. LVEF was not related to HRQOL. Factor analysis revealed (1) LVEF was independent of physical functioning; (2) physical function and exercise capacity comprise a factor reflecting physical HRQOL; and (3) socio-emotional functioning is the third factor independent of LVEF and physical function. Physical and socio-mental HRQOL measurement included information independent of the widely used clinical indices such as LVEF and New York Heart Association classification. The evaluation of HRQOL should be included in the assessment of patient status.

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