What does this research mean for the field?

Developing new-onset heart failure (either HFrEF or HFpEF) leads to a significant decline in physical functioning and role physical scores over time, whereas patients with pre-existing heart failure experience little further decline but remain at persistently low baseline levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 2, 2022ESC Heart FailureOpen Access

Long Term Changes in Health-Related Quality of Life for People with Heart Failure: The ECHOES Study

View Full Paper

Ask AI

Bookmark

Why the study?

Heart failure impairs all aspects of health-related quality of life, but little is known about the effect of developing heart failure on health-related quality of life over time.

Structured PICO

Population

1,618 adults aged 45 years and over from the UK, rescreened from an original community cohort of 6,162 patients, including those who developed HFrEF (n=82), HFpEF (n=68), had previous HF (n=26), or no HF (n=1420).

Comparator

Participants without heart failure at baseline and follow-up (n=1420)

Outcome

Change in health-related quality of life (HRQoL) measured by the SF-36 questionnaire (Version 1) over a 13-year periodpatient reported

Developing heart failure, regardless of ejection fraction, is associated with a significant long-term decline in physical functioning and role physical scores compared to those without heart failure.

Limitations

Small numbers of individuals in the HF-related health status groups
Timing of when the HF diagnosis was established within the follow-up period is unknown
Screening took place before newer HF treatments became available
Only 26% of those with SF-36 at baseline were rescreened, with those followed up being younger and having fewer comorbidities
Assumption of data missing at random is unlikely due to 44% mortality between screenings

Implication

HF development associated with greater physical functioning decline over 13 years; leaves open whether prevention preserves long-term HRQoL.

Abstract

AIMS: Heart failure (HF) impairs all aspects of health-related quality of life (HRQoL), but little is known about the effect of developing HF on HRQoL over time. We aimed to report changes in HRQoL over a 13-year period. METHODS AND RESULTS: HRQoL was measured in the Echocardiographic Heart of England Screening (ECHOES) study and the ECHOES-X follow-up study (N = 1618) using the SF-36 questionnaire (Version 1). Mixed modelling compared changes in HRQoL across diagnostic groups, adjusting for potential predictors and design variables. Patients who had developed HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF) at rescreening had significantly greater reduction in physical functioning (PF) and role physical (RP) scores compared with those without HF; adjusted mean difference in PF: HFrEF -16.1, [95% confidence interval (CI) -22.2 to -10.1]; HFpEF -14.6, (95% CI -21.2 to -8.1); in RP: HFrEF -20.7, (95% CI -31.8 to -9.7); HFpEF -19.3, (95% CI -31.0 to -7.6). Changes in HRQoL of those with a HF diagnosis at baseline and rescreen, with exception of role emotion, were similar to those without HF but started from a much lower baseline score. CONCLUSIONS: People with a new diagnosis of HF at rescreening had a significant reduction in HRQoL. Conversely, for those with HF detected on initial screening, little change was observed in HRQoL scores on rescreening. Further research is required to understand the development of HF over time and to test interventions designed to prevent decline in HRQoL, potentially through earlier diagnosis and treatment optimization.