Patient reported outcome in HFpEF: Sex-specific differences in quality of life and association with outcome. (15th September 2018)

• Record Type: Journal Article
• Authors: Faxén, Ulrika Ljung; Hage, Camilla; Donal, Erwan; Daubert, Jean-Claude; Linde, Cecilia; Lund, Lars H.
• Is Part Of: International journal of cardiology. Volume 267(2018)
• Page Start: 128
• Page End: 132
• Publication Date: 2018-09-15
• Subjects: Heart failure -- HFpEF -- Sex -- Patient reported outcome -- Quality of life; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.04.102
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Heart failure with preserved ejection fraction (HFpEF) is associated with poor quality of life (QoL), or patient reported outcome (PRO). Despite female predominance in HFpEF, sex-specific differences in PROs remain poorly studied. We assessed PRO measures and their association with HF-severity and outcome in HFpEF by sex. Methods and results: In 378 patients with HFpEF from the KaRen study, EQ-5D-3L® and Minnesota Living with Heart Failure Questionnaire® (MLHFQ) were assessed. Characteristics and comorbidities were largely similar in women (n = 212, 57%) and men. Women expressed worse QoL in EQ-5D-3L®(EQ-VAS), independent of age and HF-severity, mean (SD), 57 (20) vs. 61 (19), p = 0.010. There was no difference in MLHFQ, 31 (21) vs. 29 (21), p = 0.269. Spearman's correlations with HF-severity (NYHA-class) were for MLHFQ in women r s 0.37 vs. men 0.41, p for both <0.001, and for EQ-VAS r s −0.28, p = 0.001 vs. −0.45, p < 0.001. Correlations with natriuretic peptides were for MLHFQ r s 0.21, p = 0.003 in women vs. men 0.27, p < 0.001, and for EQ-VAS r s −0.17 vs. −0.27, p both < 0.001. Associations between PRO and the composite of HF hospitalisation or all-cause death were present in men only, adjusted HR per 5 units increase in MLHFQ 1.06, 95% confidence interval (CI) 1.01–1.11, p = 0.02 and EQ-VAS, HR 0.93, 95% CI 0.88–0.98, p = 0.010. Conclusion: In HFpEF, women had worse general but similar disease specific QoL compared to men. QoL was more strongly associated with HF-severity in men, and associated with outcomes only in men. In women with HFpEF, QoL appears less determined by HF itself and potentially more by other unknown factors. Highlights: HFpEF is associated with poor quality of life. Women with HFpEF express worse quality of life than men. Quality of life in women with HFpEF is less linked to heart failure. Poor quality of life is associated with poor prognosis in HFpEF in men only.