Skip to main content

Advertisement

Log in

Assessment of quality of life in severe heart failure

  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Improvement of health-related quality of life (HRQL) is increasingly recognized as a priority in the management of heart failure (HF). In this review, we highlight the dramatic improvement in HRQL often observed in patients with severe HF and give particular emphasis to the nonpharmacologic therapy of cardiac resynchronization therapy, left ventricular assist devices, and cardiac rehabilitation. We juxtapose this to the less consistent improvement in HRQL seen with interventions aimed at treatment of acute HF syndromes. Conflicting data wherein HRQL improves in parallel to a detrimental or neutral effect on cardiovascular morbidity and mortality are also presented. We conclude with future directions and make the case for HF-specific instruments intended for the assessment of HRQL in hospitalized patients, longitudinal studies in which HRQL is followed over time, and continued attention to the preferences of those with severe and acute HF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Konstam V, Salem D, Pouleur H, et al.: Baseline quality of life as a predictor of mortality and hospitalization in 5025 patients with congestive heart failure. Am J Cardiol 1996, 78:890–895.

    Article  PubMed  CAS  Google Scholar 

  2. Testa MA, Simonson DC: Assessment of quality-of-life outcomes. N Engl J Med 1996, 334:835–840.

    Article  PubMed  CAS  Google Scholar 

  3. Lewis EF, Lamas GA, O’Meara E, et al.: Characterization of health-related quality of life in heart failure patients with preserved versus low ejection fraction in CHARM. Eur J Heart Fail 2007, 9:83–91.

    Article  PubMed  Google Scholar 

  4. Guyatt GH, Feeny DH, Patrick DL: Measuring health-related quality of life. Ann Int Med 1993, 118:622–629.

    PubMed  CAS  Google Scholar 

  5. EuroQoL—a new facility for the measurement of health-related quality of life. Health Policy 1990, 16:199–208.

  6. Hunt SM, McKenna SP, McEwen J, et al.: A quantitative approach to perceived health status: a validation study. J Epidemiol Community Health 1980, 34:281–286.

    Article  PubMed  CAS  Google Scholar 

  7. Ware JE, Sherbourne CD: The MOS 36-item short-form health survey (SF 36): conceptual framework and item selection. Med Care 1992, 30:473–485.

    Article  PubMed  Google Scholar 

  8. Bergner M, Bobbitt RA, Pollard WE, et al.: The sickness impact profile: validation of a health status measure. Med Care 1976, 14:57–67.

    Article  PubMed  CAS  Google Scholar 

  9. Berry C, McMurray J: A review of quality-of-life evaluations in patients with congestive heart failure. Pharmacoeconomics 1999, 16:247–271.

    Article  PubMed  CAS  Google Scholar 

  10. Rector TS, Kubo SH, Cohn JN: Patients’ self-assessment of their congestive heart failure: II. Content, reliability, and validity of a new measure—the Minnesota Living with Heart Failure Questionnaire. Heart Failure 1987, 3:198–209.

    Google Scholar 

  11. Wiklund I, Lindvall K, Swedberg K, Zupkis RV: Self-assessment of quality of life in severe heart failure. Scand J Psychol 1987, 28:220–225.

    PubMed  CAS  Google Scholar 

  12. Green PC, Porter CB, Bresnahan DR, Spertus JA: Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol 2000, 35:1245–1255.

    Article  PubMed  CAS  Google Scholar 

  13. Hak T, Willems D, van der Wal G, Visser F: A qualitative validation of the Minnesota Living with Heart Failure Questionnaire. Qual Life Res 2004, 13:417–426.

    Article  PubMed  Google Scholar 

  14. Sneed NV, Paul S, Michel Y, et al.: Evaluation of three quality of life measurement tools in patients with chronic heart failure. Heart Lung 2001, 30:332–340.

    Article  PubMed  CAS  Google Scholar 

  15. Cazeau S, Leclercq C, Lavergne T, et al.: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001, 344:873–880.

    Article  PubMed  CAS  Google Scholar 

  16. Auricchio A, Stellbrink C, Sack S, et al.: Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 2002, 39:2026–2033.

    Article  PubMed  Google Scholar 

  17. Leclercq C, Walker S, Linde C, et al.: Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J 2002, 23:1780–1787.

    Article  PubMed  CAS  Google Scholar 

  18. Abraham WT, Fisher WG, Smith AL, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002, 346:1845–1853.

    Article  PubMed  Google Scholar 

  19. Young JB, Abraham WT, Smith AL, et al.: Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA 2003, 289:2685–2694.

    Article  PubMed  Google Scholar 

  20. Krahn AD, Snell L, Yee R, et al.: Biventricular pacing improves quality of life and exercise tolerance in patients with heart failure and intraventricular conduction delay. Can J Cardiol 2002, 18:380–387.

    PubMed  Google Scholar 

  21. Higgins SL, Hummel JD, Niazi IK, et al.: Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol 2003, 42:1454–1459.

    Article  PubMed  Google Scholar 

  22. Bristow MR, Saxon LA, Boehmer J, et al.: Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004, 350:2140–2150.

    Article  PubMed  CAS  Google Scholar 

  23. Cleland J, Daubert JC, Erdmann E, et al.: The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005, 352:1539–1549.

    Article  PubMed  CAS  Google Scholar 

  24. Rose EA, Gelijns AC, Moskowitz AJ, et al.: Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001, 345:1435–1443.

    Article  PubMed  CAS  Google Scholar 

  25. Stevenson LW, Miller LW, Desvigne-Nickens P, et al.: Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy: a subset analysis from REMATCH. Circulation 2004, 110:975–981.

    Article  PubMed  Google Scholar 

  26. Grady KL, Meyer PM, Dressler D, et al.: Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation. Ann Thorac Surg 2004, 77:1321–1327.

    Article  PubMed  Google Scholar 

  27. Birks EJ, Tansley PD, Hardy J, et al.: Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med 2006, 355:1873–1884.

    Article  PubMed  CAS  Google Scholar 

  28. Moskowitz AJ, Weinberg AD, Mehmet CO, Williams DL: Quality of life with implantable left ventricular assist device. Ann Thorac Surg 1997, 64:1764–1769.

    Article  PubMed  CAS  Google Scholar 

  29. Kavanagh T, Myers MG, Baigrie RS, et al.: Quality of life and cardiorespiratory function in chronic heart failure: effects of 12 months’ aerobic training. Heart 1996, 76:42–49.

    Article  PubMed  CAS  Google Scholar 

  30. Koch M, Douard H, Broustet JP: The benefit of graded physical exercise in chronic heart failure. Chest 1992, 101:231S–235S.

    Article  PubMed  CAS  Google Scholar 

  31. Wilson JR, Groves J, Rayos G: Circulatory status and response to cardiac rehabilitation in patients with heart failure. Circulation 1996, 94:1567–1572.

    PubMed  CAS  Google Scholar 

  32. Gottlieb SS, Fisher ML, Freudenberger R, et al.: Effects of exercise training on peak performance and quality of life in congestive heart failure. J Card Fail 1999, 5:188–194.

    Article  PubMed  CAS  Google Scholar 

  33. Felker GM, Adams KF Jr, Konstam MA, et al.: The problems of decompensated heart failure: nomenclature, classification, and risk stratification. Am Heart J 2003, 145(Suppl):S18–S25.

    Article  PubMed  Google Scholar 

  34. Hunt SA, Baker DW, Chin MH, et al.: ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2001, 104:2996–3007.

    Article  PubMed  CAS  Google Scholar 

  35. Publications committee for the VMAC investigators: Intravenous nesiritide vs. nitroglycerin for treatment of decompensated congestive heart failure. JAMA 2002, 287:1531–1540.

    Article  Google Scholar 

  36. Torre-Amione G, Young JB, Colucci WS, et al.: Hemodynamic and clinical effects of tezosentan, an intravenous dual endothelin receptor antagonist, in patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2003, 42:140–147.

    Article  PubMed  CAS  Google Scholar 

  37. Follath F, Cleland JG, Just H, et al.: Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet 2002, 360:196–202.

    Article  PubMed  CAS  Google Scholar 

  38. Bart BA, Boyle A, Bank AJ, et al.: Ultrafiltration versus usual care for hospitalized patients with heart failure. J Am Coll Cardiol 2005, 46:2043–2046.

    Article  PubMed  Google Scholar 

  39. Jaagosild P, Dawson NV, Thomas C, et al.: Outcomes of acute exacerbation of severe congestive heart failure: quality of life, resource use, and survival. SUPPORT Investigators. The Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatments. Arch Intern Med 1998, 158:1081–1089.

    Article  PubMed  CAS  Google Scholar 

  40. The ESCAPE Investigators and the ESCAPE Study Coordinators: Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness (the ESCAPE Trial). JAMA 2005, 294:1625–1632.

    Article  Google Scholar 

  41. Feldman AM, Bristow MR, Parmley WW, et al.: Effects of vesnarinone on morbidity and mortality in patients with heart failure. N Engl J Med 1993, 329:149–155.

    Article  PubMed  CAS  Google Scholar 

  42. Cohn JN, Goldstein SO, Greenberg BH, et al.: A dose-dependent increase in mortality with vesnarinone among patients with severe heart failure. N Engl J Med 1998, 339:1810–1816.

    Article  PubMed  CAS  Google Scholar 

  43. Oliva F, Latini R, Politi A, et al.: Intermittent 6-month low-dose dobutamine infusion in severe heart failure: DICE multicenter trial. Am Heart J 1999, 138:247–253.

    Article  PubMed  CAS  Google Scholar 

  44. Lopez-Candales A, Vora T, Gibbons W, et al.: Symptomatic improvement in patients treated with intermittent infusion of inotropes: a double-blind placebo controlled pilot study. J Med 2002, 33:129–146.

    PubMed  CAS  Google Scholar 

  45. Cesario D, Clark J, Maisel A: Beneficial effects of intermittent home administration of the inotrope/vasodilator milrinone in patients with end-stage congestive heart failure: a preliminary study. Am Heart J 1998, 135:121–129.

    Article  PubMed  CAS  Google Scholar 

  46. Cuffe MS, Califf RM, Adams KF, et al.: Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA 2002, 287:1541–1547.

    Article  PubMed  CAS  Google Scholar 

  47. Baligadoo SJ, Subratty H, Manraz M, et al.: Effects of enoximone on quality of life. Int J Cardiol 1990, 28(Suppl 1):S29–S32.

    Article  PubMed  Google Scholar 

  48. Uretsy BF, Jessup M, Konstam MA: Multicenter trial of oral enoximone in patients with moderate to moderately severe congestive heart failure. Circulation 1990, 82:774–780.

    Google Scholar 

  49. Xamoterol in severe heart failure. Lancet 1990, 336:1–6.

  50. Colucci WS, Sonnenblick EH, Adams KF, et al.: Efficacy of phosphodiesterase inhibition with milrinone in combination with converting enzyme inhibitors in patients with heart failure. J Am Coll Cardiol 1993, 22(Suppl A):113A–118A.

    Article  PubMed  CAS  Google Scholar 

  51. Massie BM, Berk MR, Brozena SC, et al.: Can further benefit be achieved by adding flosequinan to patients with congestive heart failure who remain symptomatic on diuretic, digoxin, and angiotensin converting enzyme inhibitor? Circulation 1993, 88:492–501.

    PubMed  CAS  Google Scholar 

  52. Cowley AJ, Skene AM: Treatment of severe heart failure: quantity or quality of life: a trial of enoximone. Br Heart J 1994, 72:226–230.

    Article  PubMed  CAS  Google Scholar 

  53. Hampton JR, van Veldhuisen DJ: Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure. Lancet 1997, 349:971–977.

    Article  PubMed  CAS  Google Scholar 

  54. Califf RM, Adams KF, McKenna WJ, et al.: A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: The Flolan International Randomized Survival Trial (FIRST). Am Heart J 1997, 134:44–54.

    Article  PubMed  CAS  Google Scholar 

  55. O’Connor CM, Gattis WA, Uretsky BF, et al.: Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial. A Heart J 1999, 138:78–86.

    Article  CAS  Google Scholar 

  56. Lowes BD, Higginbotham M, Petrovich L, et al.: Low-dose enoximone improves exercise capacity in chronic heart failure. Enoximone Study Group. J Am Coll Cardiol 2000, 36:501–508.

    Article  PubMed  CAS  Google Scholar 

  57. Costanzo MR, Saltzberg M, O’sullivan J, Sobotka P: Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol 2005, 46:2047–2051.

    Article  PubMed  Google Scholar 

  58. Costanzo MR, Guglin ME, Saltzberg MT, et al.: Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2007, 49:675–683.

    Article  PubMed  CAS  Google Scholar 

  59. Lewis EF, Johnson PA, Johnson W, et al.: Preferences for quality of life or survival expressed by patients with heart failure. J Herat Lung Transplant 2001, 20:1016–1024.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eldrin F. Lewis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vaishnava, P., Lewis, E.F. Assessment of quality of life in severe heart failure. Curr Heart Fail Rep 4, 170–177 (2007). https://doi.org/10.1007/s11897-007-0037-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-007-0037-y

Keywords

Navigation