Key result
Heart failure symptom severity, such as NYHA class III versus I/II, was the strongest correlate of lower health-related quality of life (estimated coefficient -12.1; 95% CI -12.8 to -11.4).
Why the study?
Clinical and social correlates of health-related quality of life needed evaluation across heart failure patients from high-, upper middle-, lower middle-, and low-income countries.
Cross-Sectional (n=23,292)
Yes
Answers are grounded in this paper and cite their sources.
Heart failure symptom severity is the most important correlate of health-related quality of life, regardless of country income level, though absolute quality of life scores are significantly lower in lower-income countries.
Aims To examine clinical and social correlates of health‐related quality of life (HRQL) in patients with heart failure (HF) from high‐ (HIC), upper middle‐ (UMIC), lower middle‐ (LMIC) and low‐income (LIC) countries. Methods and results Between 2017 and 2020, 23 292 patients with HF (32% inpatients, 61% men) from 40 countries were enrolled in the Global Congestive Heart Failure study. HRQL was recorded at baseline using the Kansas City Cardiomyopathy Questionnaire (KCCQ)‐12. In a cross‐sectional analysis, we compared age‐ and sex‐adjusted mean KCCQ‐12 summary scores (SS: 0–100, higher = better) between patients from different country income levels. We used multivariable linear regression examining correlations (estimated coefficients) of KCCQ‐12‐SS with sociodemographic, comorbidity, treatment and symptom covariates. The adjusted model (37 covariates) was informed by univariable findings, clinical importance and backward selection. Mean age was 63 years and 40% of patients were in New York Heart Association (NYHA) class III–IV. Average HRQL was 55 SD 27. It was 62.5 (95% confidence interval [CI] 62.0–63.1) in HIC, 56.8 (56.1–57.4) in UMIC, 48.6 (48.0–49.3) in LMIC, and 38.5 (37.3–39.7) in LICs ( p < 0.0001). Strong correlates (estimated coefficient [95% CI]) of KCCQ‐12‐SS were NYHA class III versus class I/II (−12.1 [−12.8 to −11.4] and class IV versus class I/II (−16.5 [−17.7 to −15.3]), effort dyspnoea (−9.5 [−10.2 to −8.8]) and living in LIC versus HIC (−5.8 [−7.1 to −4.4]). Symptoms explained most of the KCCQ‐12‐SS variability (partial R 2 = 0.32 of total adjusted R 2 = 0.51), followed by sociodemographic factors (R 2 = 0.12). Results were consistent in populations across income levels. Conclusion The most important correlates of HRQL in HF patients relate to HF symptom severity, irrespective of country income level.
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Johansson et al. (2022) conducted a cross-sectional in Heart failure (n=23,292). NYHA class III vs. NYHA class I/II was evaluated on KCCQ-12 summary score (estimated coefficient -12.1, 95% CI -12.8 to -11.4). Heart failure symptom severity, such as NYHA class III versus I/II, was the strongest correlate of lower health-related quality of life (estimated coefficient -12.1; 95% CI -12.8 to -11.4).
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