Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables

Abstract

Objective: To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables.

Setting: University hospital.

Patients and design: A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test.

Results: Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life.

Conclusions: In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.

Figure 1

Comparison of total heart failure (CHF) sample with other diseases and with the normal population. SF-36 scores of the total CHF sample (n = 205; that is, not stratified by NYHA classification) compared with selected disease groups: patients on chronic haemodialysis (n = 120), patients with hepatitis C (n = 70), and patients with major depression (n = 502). The values for a normal population (Norm pop; n = 906) are also shown. The eight scales of the SF-36 short form health survey (SF-36) instrument are physical functioning (PF), role limitations due to physical limitations (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations caused by emotional problems (RE), and mental health (MH).

Figure 2

SF-36 scores for patients with congestive heart failure (CHF) stratified into prognostically relevant subgroups according to somatic indices. (A) Stratification of the patients by New York Heart Association functional class (NYHA I, n = 24; NYHA II, n = 98; NYHA III, n = 83). (B) Patients split at a peak oxygen uptake of 14 ml/kg/min (≤ 14 ml/kg/min, n = 95; > 14 ml/kg/min, n = 110). (C) Patients split at a walking distance of 450 m covered during a six minute walk test (≤ 450 m: n =79; > 405 m, n = 126). (D) Patients split at a left ventricular ejection fraction (LVEF) of 20% (≤ 20%, n = 100; > 20%, n = 105). The respective values of a normal population (Norm pop, n = 906) are shown for comparison. The eight scales of the 36 item short form health survey (SF-36) instrument are physical functioning (PF), role limitations due to physical limitations (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). Peak Vo₂, peak oxygen uptake; 6`WT, six minute walk test.