A systematic review of non-procedural contributors to quality of life in heart valve disease

Background: Quality of life (QOL) is an important outcome in patients with heart valve disease, in cohorts that have received a valve replacement as well as those that have not. Existing reviews on this topic, however, focus primarily on the effect of valve intervention. This systematic review was conducted to provide an overview of non-procedural predictors of QOL in multiple forms of heart valve disease. Measures of QOL can compare outcomes between populations (‘generic’ measures) or within a specific disease state or population (‘specific’). Methods: Pubmed was searched in July 2021 for papers reporting associations of non-procedural factors with QOL. Results: 14 papers with 8433 participants in total were included in the final selection, most of which were aortic valve intervention cohorts. Studies using both generic and specific measures of QOL were included. Sex and body mass index had minimal association with QOL in HVD, while ejection fraction displayed no association. In longitudinal studies, more severe cardiac symptoms before valve intervention were associated with worse QOL after valve intervention. Conclusion: There is limited information on non-procedural contributions to QOL in patients with heart valve disease. Sex, BMI, age, and ejection fraction appear to have little effect. The association of worse long term QOL post-intervention in those with worse pre-intervention symptoms raises the possibility that earlier intervention may be beneficial. Variability of results in different cohorts and between measures of quality of life indicate the need for a disease-specific measure of QOL in heart valve disease.