Systolic function as a predictor of mortality and quality of life in long-term survivors with heart failure

• Type of Material: Article
• Authors: Robert L. McNamara, Yale New Haven Hospital; Bethany A. Austin, Cleveland Clinic Foundation; Yongfei Wang, Yale New Haven Hospital; Grace L. Smith, Yale University; Viola Vaccarino, Emory University; Harlan M. Krumholz, Yale‐New Haven Hospital
• Language: English
• Date: 2008-03-01
• Publisher: Wiley Open Access: Various Creative Commons Licenses
• Publication Version: Final Published Version
• Copyright Statement: © 2008 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/clc.20118
• Title of Journal or Parent Work: Clinical Cardiology
• ISSN: 0160-9289
• Volume: 31
• Issue: 3
• Start Page: 119
• End Page: 124
• Keywords: quality of life; VENTRICULAR EJECTION FRACTION; Cardiovascular System & Cardiology; PREVALENCE; Life Sciences & Biomedicine; HEALTH; Science & Technology; HOSPITALIZATION; heart failure; COMMUNITY; AGE; mortality; ENALAPRIL; READMISSION; PROGNOSIS; OUTPATIENTS; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background: Patients with heart failure (HF) and preserved ejection fraction (EF) have been shown to have high mortality rates, comparable to those with reduced EF. Thus, long-term survivors of HF, regardless of ejection fraction, are a select group. Little is known about disease-related quality of life (QOL) and health status in these patients. Hypothesis: Preserved EF in patients with heart failure independently predicts long-term survival, health related quality of life (QOL), or functional status. Methods: The study followed a cohort of 413 patients consecutively hospitalized for HF between March 1996 and September 1998. In July 2005, information was collected about their mortality, health related QOL as defined by disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, and functional decline as defined by limitations in Activities of Daily Living (ADL) scores. Results: The primary outcomes were mortality, QOL, and functional decline. At follow-up, 8.1 years after enrollment, overall mortality was 76% (314/413). Adjusted forage, gender, renal insufficiency, diabetes mellitus, hypertension, HF, and respiratory disease, those with decreased ejection fraction (EF < 40%) had higher mortality compared with those with preserved ejection fraction (hazard ratio [HR] 1.42; confidence interval [CI] = 1.13, 1.80, p = 0.003). The KCCQ scores, including Clinical Summary Scores and Symptom Limitation Scores, as well as ADL limitations, were not significantly different in the survivors with preserved or decreased EF. Conclusions: Heart failure patients with preserved EF have a modest survival advantage compared with those with decreased EF, but health related QOL scores and functional decline in survivors are similar regardless of systolic function.