Quality of life and outcomes in heart failure patients with ejection fractions in different ranges

Abstract

Aims: Guidelines divide patients with heart failure (HF) into 3 distinct groups based on left ventricular ejection fraction (LVEF) We used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to quantify the health-related quality of life in patients with HF.

Methods: Patients were stratified into three cohorts: preserved LVEF (>50%), mid-range LVEF (40-49%) and reduced LVEF (<40%). The MLHFQ scores were evaluated using one-way ANOVA, and differences were observed among the groups. The association of New York Heart Association (NYHA) class with the physical scores was analyzed by Spearman's correlation analysis. The predictive utility of the total MLHFQ scores was assessed with Kaplan-Meier curves for death and HF-related hospitalization. The Cox proportional hazards model was used to identify the risk factors for prognosis. Internal reliability was assessed with Cronbach's α.

Results: There were significant differences in the total MLHFQ scores and the MLHFQ subscale scores among the three groups (p<0.05). MLHFQ domains demonstrated high internal consistency among the three groups (Cronbach's α = 0.92, 0.96 and 0.93). The MLHFQ physical subscale scores were significantly associated with NYHA class in HFrEF (r = 0.59, p<0.001) and HFmrEF patients (r = 0.537, p<0.001). The survival analysis indicated that there was a significant difference among the three groups regarding high MLHFQ scores (p = 0.038). In the groups with low MLHFQ scores, the HFmrEF group exhibited significantly increased rates of death and HF-related hospitalization compared with the HFpEF group (p = 0.035).

Conclusions: The features and clinical outcomes varied among heart failure patients with different EF values. The MLHFQ appears to be a valid and reliable measurement of health status and offers excellent prognostic ability.

Fig 1. Comparison of MLHFQ scores among three groups with different ejection fraction range.

Fig 2. Kaplan-Meier cumulative survival at 1 years’ follow-up.

Fig 3. Kaplan-Meier survival analysis by baseline MLHFQ score tercile.

(A) Kaplan-Meier survival analysis of the first quartile (score 0–28). (B) Kaplan-Meier survival analysis of the second quartile (score 28–39). (C) Kaplan-Meier survival analysis of the third quartile (score 39–48). (D) Kaplan-Meier survival analysis of the forth quartile (score >48).

Fig 4. Kaplan-Meier survival analysis of the subgroup of clinical factors.