Changing health related quality of life and outcomes in heart failure by age, sex and subtype

Claire A Lawson; Lina Benson; Iain Squire; Francesco Zaccardi; Mohammad Ali; Simon Hand; Umesh Kadam; Wan Ting Tay; Ulf Dahlstrom; Lars H Lund; Gianluigi Savarese; Carolyn S P Lam; Kamlesh Khunti; Anna Strömberg

doi:10.1016/j.eclinm.2023.102217

Changing health related quality of life and outcomes in heart failure by age, sex and subtype

EClinicalMedicine. 2023 Sep 14:64:102217. doi: 10.1016/j.eclinm.2023.102217. eCollection 2023 Oct.

Authors

Claire A Lawson^{1

2}, Lina Benson³, Iain Squire^{1

2

3}, Francesco Zaccardi^{4

5

6}, Mohammad Ali^{1

2}, Simon Hand⁷, Umesh Kadam⁷, Wan Ting Tay⁸, Ulf Dahlstrom⁹, Lars H Lund^{3

10}, Gianluigi Savarese³, Carolyn S P Lam⁸, Kamlesh Khunti^{4

5

6}, Anna Strömberg¹¹

Affiliations

¹ Department of Cardiovascular Sciences, University of Leicester, United Kingdom.
² NIHR Leicester Biomedical Research Centre -Cardiology, Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicestershire, United Kingdom.
³ Karolinska Institutet, Stockholm, Sweden.
⁴ Leicester Real World Evidence Unit, University of Leicester, Leicestershire, United Kingdom.
⁵ Diabetes Centre, University of Leicester, Leicestershire, United Kingdom.
⁶ National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), University of Leicester, Leicestershire, United Kingdom.
⁷ Health Sciences, University of Leicester, Leicestershire, United Kingdom.
⁸ Heart Centre Singapore, Singapore.
⁹ Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.
¹⁰ Duke-National University of Singapore, Singapore.
¹¹ Department of Health, Medicine and Caring Sciences, and Department of Cardiology, Linkoping University, Sweden.

Abstract

Background: There are calls to integrate serial recordings of health related quality of life (HRQoL) into routine care, clinical trials and prognosis. Little is known about the relationship between change in HRQoL and outcomes in heart failure (HF) patients by age, sex and HF subtype.

Method: From the Swedish Heart Failure Registry (SwedeHF; 2008-2019), patients were categorised by reduced (<40%, HFrEF), mildly-reduced (40-49%, HFmrEF) and preserved (≥50%, HFpEF) ejection fraction. HRQoL was measured using Euro-QoL-5D visual analogue scale (EQ5D-vas), collected at baseline and 1-year. Baseline EQ5D-vas scores were categorised by: "best" (76-100), "good" (51-75), "bad" (26-50), and "worst" (0-25). Change in EQ5D-vas was categorised as 'no significant change' (<5 points increase/decrease); some worsening (5-9 points decrease); considerable worsening (≥10 points decrease); some improvement (5-9 points increase); considerable improvement (≥10 points increase). Associations with admission and death were estimated and interactions with patient sub-groups tested.

Findings: Among 23,553 patients (median age 74 [66-81] years, 8000 [34%] female), baseline EQ5D-vas was worse in older patients, women, and those with HFpEF compared to their respective counterparts. Compared to patients with the "best" EQ5D-vas, the adjusted associations for admission for those with "good", "bad" and "worst" EQ5D-vas were, respectively: HR 1.09 (1.04, 1.14), 1.27 (1.21, 1.33) and 1.39 (1.28, 1.51). Compared to no significant change in EQ5D-vas, the adjusted estimates for admission following some improvement, considerable improvement, some worsening and considerable worsening were, respectively: HR 0.91 (0.82, 1.01), 0.75 (0.70, 0.81), 1.04 (0.92, 1.16) and 1.25 (1.16, 1.35). Results were similar amongst groups and for HF admission and death.

Interpretation: Change in HRQoL was an independent indicator of risk of admission and death in people with all HF subtypes, irrespective of age and sex.

Funding: NIHR.

Keywords: Health; Heart failure; Hospitalization; Mortality; Prognosis.