Changes over time in patient-reported outcomes in patients with heart failure

Abstract

Aim: This paper describes the trajectory during 1 year of four patient-reported outcomes (PROs), namely, sleep, depressive symptoms, health-related quality of life (HrQoL), and well-being, in patients with heart failure (HF), their relationship and the patient characteristics associated with changes in these PROs.

Methods and results: Data analyses of PROs from 603 patients (mean age 67 years; 29% female, 60% NYHA II) enrolled in the HF-Wii study. On short term, between baseline and 3 months, 16% of the patients experienced continuing poor sleep, 11% had sustained depressive symptoms, 13% had consistent poor HrQoL, and 13% consistent poor well-being. Across the entire 1-year period only 21% of the patients had good PRO scores at all timepoints (baseline, 3, 6, and 12 months). All others had at least one low score in any of the PROs at some timepoint during the study. Over the 12 months, 17% had consistently poor sleep, 17% had sustained symptoms of depression, 15% consistently rated a poor HrQoL, and 13% poor well-being. Different patient characteristics per PRO were associated with a poor outcomes across the 12 months. Age, education, New York Heart Association, and length of disease were related to two PRO domains and submaximal exercise capacity (6 min test), co-morbidity, and poor physical activity to one.

Conclusion: In total, 79% of the patients with HF encountered problems related to sleep, depressive symptoms, HrQoL, and well-being at least once during a 1-year period. This underscores the need for continuous monitoring and follow-up of patients with HF and the need for dynamic adjustments in treatment and care regularly throughout the HF trajectory.

Keywords: Heart failure; Patient‐reported outcomes; Quality of life; Symptoms.

Figure 1

Trajectories of the PROs between baseline and 3 months. Cut‐off values of the PROs.: Sleep problem is a score on the minimal insomnia sleep scale (MISS) of ≥6. Depression is a subscale depression score on the HADS scale of ≥7. Poor Health‐related Quality of Life defined as the Minnesota Living with Heart Failure Questionnaire score >45. Poor well‐being was defined as a score of ≤5.

Figure 2

Distribution of the summed scores on the fur different PRO's on 5 timepoints min 0 and max 16 (N = 603).