Health-Related Quality of Life and Mortality in Heart Failure The Global Congestive Heart Failure Study of 23000 Patients From 40 Countries
Por:
Johansson, I, Joseph, P, Balasubramanian, K, McMurray, JJV, Lund, LH, Ezekowitz, JA, Kamath, D, Alhabib, K, Bayes-Genis, A, Budaj, A, Dans, ALL, Dzudie, A, Probstfield, JL, Fox, KAA, Karaye, KM, Makubi, A, Fukakusa, B, Teo, K, Temizhan, A, Wittlinger, T, Maggioni, AP, Lanas, F, Lopez-Jaramillo, P, Silva-Cardoso, J, Sliwa, K, Dokainish, H, Grinvalds, A, McCready, T and Yusuf, S
Publicada:
1 jun 2021
Ahead of Print:
28 abr 2021
Resumen:
BACKGROUND: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries.
METHODS: We used the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years.
RESULTS: The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction >= 40%. Average HRQL differed between regions (lowest in Africa [mean +/- SE, 39.5 +/- 0.3], highest in Western Europe [62.5 +/- 0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17-1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03-1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21-1.42]; interaction P<0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14-1.19] and HR, 1.14 [95% CI, 1.12-1.17]; interaction P=0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13-1.17] versus 1.09 [95% CI, [1.07-1.11]; interaction P<0.0001). HR for death was greater in ejection fraction >= 40 versus <40% (HR, 1.23 [95% CI, 1.20-1.26] and HR, 1.15 [95% CI, 1.13-1.17]; interaction P<0.0001).
CONCLUSION: HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction.
Filiaciones:
Johansson, I:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
McMaster Univ, Fac Hlth Sci, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Joseph, P:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Balasubramanian, K:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
McMurray, JJV:
Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow, Lanark, Scotland
Lund, LH:
Karolinska Inst, Div Cardiol, Dept Med, Stockholm, Sweden
Karolinska Univ Hosp, Heart & Vasc Theme, Stockholm, Sweden
Ezekowitz, JA:
Univ Alberta, Fac Med & Dent, Canadian VIGOUR Ctr, Edmonton, AB, Canada
Kamath, D:
St Johns Res Inst, Div Clin Res & Training, Bengaluru, India
Alhabib, K:
King Saud Univ, Dept Cardiac Sci, King Fahad Cardiac Ctr, Coll Med, Riyadh, Saudi Arabia
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona, Spain
Univ Autonoma Barcelona, Dept Med, CIBERCV, Barcelona, Spain
Budaj, A:
Grochowski Hosp, Dept Cardiol, Ctr Postgrad Med Educ, Warsaw, Poland
Dans, ALL:
Univ Philippines, Dept Cardiac Sci, Manila, Philippines
Dzudie, A:
Douala Gen Hosp, Douala, Cameroon
Clin Res Educ Networking & Consultancy, Douala, Cameroon
Univ Yaounde I, Fac Med & Biomed Sci, Yaounde, Cameroon
Probstfield, JL:
Univ Washington, Sch Med, Div Cardiol, Seattle, WA USA
Fox, KAA:
Univ Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Karaye, KM:
Aminu Kano Teaching Hosp, Dept Med, Kano, Nigeria
Bayero Univ Kano, Kano, Nigeria
Makubi, A:
Muhimbili Univ Hlth & Allied Sci, Dar Es Salaam, Tanzania
Fukakusa, B:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Teo, K:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Temizhan, A:
Univ Hlth Sci, Ankara City Hosp, Dept Cardiol, Ankara, Turkey
Wittlinger, T:
Goslar Hosp, Dept Cardiol, Goslar, Germany
Maggioni, AP:
Assoc Nazl Med Cardiol Osped, ANMCO Res Ctr, Florence, Italy
Lanas, F:
Univ La Frontera, Temuco, Chile
Lopez-Jaramillo, P:
UDES, Masira Res Inst, Bucaramanga, Colombia
UTE, Fac Ciencias Salud, Quito, Ecuador
Silva-Cardoso, J:
Univ Porto, Sao Joao Univ Hosp Ctr, Fac Med, Porto, Portugal
Sliwa, K:
Univ Cape Town, Hatter Inst Cardiovasc Res Africa, Dept Med, Fac Hlth Sci, Rondebosch, South Africa
Dokainish, H:
Circulate Cardiac & Vasc Ctr, Echocardiog Lab, Burlington, ON, Canada
Grinvalds, A:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
McCready, T:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Yusuf, S:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
McMaster Univ, Fac Hlth Sci, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Bronze
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