Burdensome Physical and Depressive Symptoms Predict Heart Failure-Specific Health Status Over One Year

Abstract

Context: Heart failure (HF)-specific health status (symptom burden, functional status, and health-related quality of life) is an important patient-reported outcome that is associated with palliative care needs, hospitalizations, and death.

Objectives: To identify potentially modifiable patient-reported factors that predict HF-specific health status over one year.

Methods: This was a prospective cohort study using data from the Patient-Centered Disease Management trial. Participants were identified using population-based sampling of all patients with an HF diagnosis at four VA Medical Centers. Patients were enrolled with reduced HF-specific health status (i.e., significant HF symptoms, limited functional status, and poor quality of life, defined by a Kansas City Cardiomyopathy Questionnaire [KCCQ] score <60). Patient-reported factors at baseline were chest pain, other noncardiac pain, dry mouth, numbness/tingling, constipation, nausea, cough, dizziness, depressive symptoms (Patient Health Questionnaire-9), and spiritual well-being (validated, single-item measure). Patients reported HF-specific health status (KCCQ) at 3, 6, and 12 months.

Results: Of 384 U.S. veterans, 42% screened positive for depression and 76% described burdensome physical symptoms at baseline. In bivariate analyses, all patient-reported factors were correlated with KCCQ score over one year. Multivariable mixed-effect modeling showed that baseline chest pain, numbness/tingling, depressive symptoms, and higher comorbidity count predicted HF-specific health status over the following year.

Conclusion: Burdensome physical and depressive symptoms independently predicted subsequent HF-specific health status in patients with symptomatic HF. Whether addressing these aspects of the patient experience can improve health status and well-being in symptomatic HF should be studied further.

Trial registration: ClinicalTrials.gov NCT00461513.

Keywords: Heart failure; depression; health status; spirituality; symptoms.

Fig. 1

Baseline prevalence of patient-reported physical symptoms, depression, and spiritual well-being in 384 patients with heart failure. a) Symptoms based on how bothersome each symptom was: 0—dsymptom not present; 1—dsymptom not at all bothersome; 5—dsymptom extremely bothersome. b) Depression based on PHQ-9 category: minimal (0—4), mild (5—9), moderate (10—14), moderately severe (15—19), severe (≥20). c) Spiritual well-being based on “I feel at peace,” from completely to not at all on five-point Likert scale. PHQ-9 = Patient Health Questionnairee—9.