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Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis

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Abstract

Purpose

Heart failure is a global health concern and associated with poor health-related quality of life and increased mortality. There is a disproportionate burden on patients and health systems in low- and middle-income countries. This systematic review and meta-analysis estimates the health-related quality of life of people with heart failure in low- and middle-income countries.

Methods

A systematic literature search was conducted to identify relevant studies from January 2012 to November 2022 using the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Scopus and JBI EBP database. Study screening, quality appraisal and data extraction were conducted using JBI methodology. A random-effects model was used to perform the meta-analysis. Heterogeneity was assessed using the I2 statistic. All statistical analyses were done in STATA version 17.

Results

A total of 33 studies with 5612 participants were included in this review. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short-Form-36 questionnaire (SF-36) were the most used instruments across 19 and 8 studies, respectively. The pooled mean MLHFQ and SF-36 scores using the random-effects model were 46.08 (95% CI 35.06, 57.10) and 41.23 (95% CI 36.63, 45.83), respectively. In a subgroup analysis using both instruments, the highest health-related quality-of-life scores occurred in studies with inpatient participants.

Conclusion

The overall health-related quality of life of people with heart failure in low- and middle-income countries is poor. Strategies should be strategically developed to improve the health-related quality of life of people with heart failure in these countries.

Systematic review registration

PROSPERO CRD42022377781.

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Availability of data and materials

All the data are available from the corresponding author up on request.

Abbreviations

HF:

Heart failure

HRQoL:

Health-related quality of life

JBI:

Joanna Briggs Institute

KCCQ:

Kansas City Cardiomyopathy Questionnaire

LMICs:

Low- and middle-income countries

LVD-36:

Left Ventricular Dysfunction Questionnaire-36

MLHFQ:

Minnesota Living with Heart Failure Questionnaire

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

SF-36:

Short-Form-36 Questionnaire

WHOQOL-BREEF:

WHO Quality of Life-BREF

References

  1. Bragazzi, N. L., Zhong, W., Shu, J., Abu Much, A., Lotan, D., Grupper, A., et al. (2021). Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. European Journal of Preventive Cardiology, 28(15), 1682–1690.

    Article  PubMed  Google Scholar 

  2. Reddy, Y. N., Rikhi, A., Obokata, M., Shah, S. J., Lewis, G. D., AbouEzzedine, O. F., et al. (2020). Quality of life in heart failure with preserved ejection fraction: Importance of obesity, functional capacity, and physical inactivity. European Journal of Heart Failure, 22(6), 1009–1018.

    Article  CAS  PubMed  Google Scholar 

  3. Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart failure. European Journal of Heart Failure, 22(8), 1342–1356.

    Article  PubMed  Google Scholar 

  4. Lippi, G., & Sanchis-Gomar, F. (2020). Global epidemiology and future trends of heart failure. AME Medical Journal, 5(15), 1–6.

    Google Scholar 

  5. Ruan, Y., Guo, Y., Zheng, Y., Huang, Z., Sun, S., Kowal, P., et al. (2018). Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: Results from SAGE wave 1. BMC Public Health, 18(1), 1–13.

    Article  Google Scholar 

  6. Guo, L., Guo, X., Chang, Y., Yang, J., Zhang, L., Li, T., et al. (2016). Prevalence and risk factors of heart failure with preserved ejection fraction: A population-based study in Northeast China. International Journal of Environmental Research and Public Health, 13(8), 770.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Karimi, M., & Brazier, J. (2016). Health, health-related quality of life, and quality of life: What is the difference? Pharmacoeconomics, 34(7), 645–649.

    Article  PubMed  Google Scholar 

  8. Lee, K. S., Lennie, T. A., & Moser, D. K. (2020). Prospective evaluation of association between negative emotions and heart failure symptom severity. Psychology Research and Behavior Management, 13, 1299.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Alpert, C. M., Smith, M. A., Hummel, S. L., & Hummel, E. K. (2017). Symptom burden in heart failure: Assessment, impact on outcomes, and management. Heart Failure Reviews, 22(1), 25–39.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Audi, G., Korologou, A., Koutelekos, I., Vasilopoulos, G., Karakostas, K., Makrygianaki, K., et al. (2017). Factors affecting health related quality of life in hospitalized patients with heart failure. Cardiology Research and Practice, 2017, 4690458.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Agbor, V. N., Ntusi, N. A., & Noubiap, J. J. (2020). An overview of heart failure in low-and middle-income countries. Cardiovascular Diagnosis and Therapy, 10(2), 244.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Long, L., Mordi, I. R., Bridges, C., Sagar, V. A., Davies, E. J., Coats, A. J., et al. (2019). Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD003331

    Article  PubMed  PubMed Central  Google Scholar 

  13. Erceg, P., Despotovic, N., Milosevic, D. P., Soldatovic, I., Mihajlovic, G., Vukcevic, V., et al. (2019). Prognostic value of health-related quality of life in elderly patients hospitalized with heart failure. Clinical Interventions in Aging, 14, 935.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Moradi, M., Daneshi, F., Behzadmehr, R., Rafiemanesh, H., Bouya, S., & Raeisi, M. (2020). Quality of life of chronic heart failure patients: A systematic review and meta-analysis. Heart Failure Reviews, 25(6), 993–1006.

    Article  PubMed  Google Scholar 

  15. Aromataris, E., Munn, Z. (2020). JBI manual for evidence synthesis. JBI: Adelaide, Australia.

  16. Malik, M., Dawood, Z. S., Janjua, M., Chauhan, S. S. B., & Ladak, L. A. (2021). Health-related quality of life in adults with tetralogy of fallot repair: A systematic review and meta-analysis. Quality of Life Research, 30(10), 2715–2725.

    Article  PubMed  Google Scholar 

  17. The World Bank. (2022). World development indicators/the world by income and region. https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html.

  18. Munn, Z., Moola, S., Lisy, K., Riitano, D., & Tufanaru, C. (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. International Journal of Evidence-Based Healthcare, 13(3), 147–153.

    Article  PubMed  Google Scholar 

  19. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. International Journal of Surgery, 88, 105906.

    Article  PubMed  Google Scholar 

  20. Munn, Z., Moola, S., Lisy, K., Riitano, D., & Tufanaru, C. (2017). Systematic reviews of prevalence and incidence. Joanna Briggs Institute reviewer’s manual Adelaide, South Australia: The Joanna Briggs Institute, 5, 1–5.

    Google Scholar 

  21. Tufanaru, C., Munn, Z., Stephenson, M., & Aromataris, E. (2015). Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness. International Journal of Evidence-Based Healthcare, 13(3), 196–207.

    Article  PubMed  Google Scholar 

  22. Alemoush, R. A., Al-Dweik, G., & AbuRuz, M. E. (2021). The effect of persistent anxiety and depressive symptoms on quality of life among patients with heart failure. Applied Nursing Research, 62, 151503.

    Article  PubMed  Google Scholar 

  23. Thida, M., Asdornwised, U., Thosingha, O., Dumavibhat, C., & Chansatitporn, N. (2021). Symptom experience, symptom management strategies, and health related quality of life among people with heart failure. Pacific Rim International Journal of Nursing Research, 25(3), 359–374.

    Google Scholar 

  24. Chu, S. H., Lee, W. H., Yoo, J. S., Kim, S. S., Ko, I. S., Oh, E. G., et al. (2014). Factors affecting quality of life in Korean patients with chronic heart failure. Japan Journal of Nursing Science, 11(1), 54–64.

    Article  PubMed  Google Scholar 

  25. Jeong, Y., Yu, H., & Hwang, B. (2022). Self-care behaviors mediate the impacts of social support and disease knowledge on health-related quality of life in patients with heart failure. Clinical Nursing Research, 31(7), 1308–1315.

    Article  PubMed  Google Scholar 

  26. Lee, H., Park, G., Lee, K. S., Jin, H., Chun, K.-J., & Kim, J. H. (2020). Knowledge, adherence to lifestyle recommendations, and quality of life among Koreans with heart failure. Journal of Cardiovascular Pharmacology and Therapeutics, 25(4), 324–331.

    Article  PubMed  Google Scholar 

  27. Alaloul, F., AbuRuz, M. E., Moser, D. K., Hall, L. A., & Al-Sadi, A. (2017). Factors associated with quality of life in Arab patients with heart failure. Scandinavian Journal of Caring Sciences, 31(1), 104–111.

    Article  PubMed  Google Scholar 

  28. Odeh, Iyad Mahmoud Hassan., Hasan, Tariq Yousef Khaled., & Alhassan, M. A. (2019). Health related quality of life in Jordanian patients with heart failure. Research Journal of Medical Sciences, 13, 53–9.

    Article  Google Scholar 

  29. AbuRuz, M. E. (2018). Anxiety and depression predicted quality of life among patients with heart failure. Journal of Multidisciplinary Healthcare, 11, 367–373.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Asadi, P., Ahmadi, S., Abdi, A., Shareef, O. H., Mohamadyari, T., & Miri, J. (2019). Relationship between self-care behaviors and quality of life in patients with heart failure. Heliyon, 5(9), e02493.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Poorshadan, S., Fallahi, M., Abdi, A., Mahdavikian, S., Miri, J., & Azami, H. (2019). Quality of life and its predictors in hospitalized patients with heart failure at hospitals affiliated to Kermanshah-Iran University of medical sciences. Journal of Cardiovascular Disease Research, 10(1), 16–19.

    Article  Google Scholar 

  32. An, Y., Zhang, Y., Wang, L., Chen, C., & Fan, X. (2022). The relationship between uncertainty in illness and quality of life in patients with heart failure: Multiple mediating effects of perceived stress and coping strategies. Journal of Cardiovascular Nursing, 37(3), 257–265.

    Article  PubMed  Google Scholar 

  33. Zhang, J., Gilmour, S., Liu, Y., & Ota, E. (2020). Effect of health literacy on quality of life among patients with chronic heart failure in China. Quality of Life Research, 29(2), 453–461.

    Article  PubMed  Google Scholar 

  34. Molla, S., Yitayal, M., & Amare, G. (2021). Health-related quality of life and associated factors among adult patients with heart failure in Wolaita Zone Governmental Hospitals, Southern Ethiopia. Risk Management and Healthcare Policy, 14, 263.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tarekegn, G. E., Gezie, L. D., Birhan, T. Y., & Ewnetu, F. (2021). Health-related quality of life among heart failure patients attending an outpatient clinic in the university of Gondar comprehensive specialized hospital Northwest, Ethiopia, 2020: Using structural equation modeling approach. Patient Related Outcome Measures, 12, 279.

    Article  Google Scholar 

  36. Costa, L. L., Islam, M. S., Anowar, M. N., & Latif, M. A. (2020). Quality of life of chronic heart failure patients. Open Journal of Nursing, 10(9), 831–857.

    Article  Google Scholar 

  37. Sousa, MMd., Oliveira, Jd. S., Soares, M. J. G. O., Bezerra, S. MMd. S., Araújo, AAd., & Oliveira, SHd. S. (2017). Association of social and clinical conditions to the quality of life of patients with heart failure. Revista gaucha de enfermagem. https://doi.org/10.1590/1983-1447.2017.02.65885

    Article  PubMed  Google Scholar 

  38. Paz, LFd. A., Medeiros, Cd. A., Martins, S. M., Bezerra, S. MMd. S., Oliveira, Wd., & Silva, M. B. A. (2019). Quality of life related to health for heart failure patients. Revista brasileira de enfermagem, 72, 140–6.

    Article  PubMed  Google Scholar 

  39. de Sousa, M. M., dos Santos, O. J., Soares, M. J. G. O., Maria, S., da Silva, B. M., & dos Santos Oliveira, S. H. (2017). Physical and psychosocial effects of heart failure in perceived quality of life. Cogitare Enferm., 22(2), e49783.

    Google Scholar 

  40. Jorge, A. J. L., Rosa, M. L. G., Correia, DMd. S., Martins, Wd. A., Ceron, D. M. M., Coelho, L. C. F., et al. (2017). Evaluation of quality of life in patients with and without heart failure in primary care. Arquivos Brasileiros de Cardiologia, 109, 248–52.

    PubMed  PubMed Central  Google Scholar 

  41. Wang, G., & Yang, Q. (2020). Factors associated with health-related quality of life in Chinese patients with heart failure: A cross-sectional study. Collegian, 27(5), 512–520.

    Article  Google Scholar 

  42. Afsharipour, Z., Khademiyeh, M., Arab, M., & Soltani-Nezhad, N. (2016). Evaluating the quality of life in hospitalized patients with heart failure at hospitals affiliated to Kerman University of medical sciences, Iran, during 2012. Nursing Practice Today, 3(2), 51–56.

    Google Scholar 

  43. Seid, M. A. (2020). Health-related quality of life and extent of self-care practice among heart failure patients in Ethiopia. Health and Quality of Life Outcomes, 18(1), 1–7.

    Article  Google Scholar 

  44. DeWolfe, A., Gogichaishvili, I., Nozadze, N., Tamariz, L., Quevedo, H. C., Julian, E., et al. (2012). Depression and quality of life among heart failure patients in Georgia, Eastern Europe. Congestive Heart Failure, 18(2), 107–111.

    Article  PubMed  Google Scholar 

  45. Borumandpour, M., Valizadeh, G., Dehghan, A., Pourmarjani, A., & Ahmadifar, M. (2016). Application of WHOQOL-BREF for the evaluation of the quality of life in elderly patients with heart failure. Bioscience Biotechnology Research Communications, 9(4), 878–883.

    Article  Google Scholar 

  46. Ahmeti, A., Ibrahimi, P., Bytyci, I., Haliti, E., Olloni, R., Elezi, S., et al. (2016). Use of the “Minnesota living with heart failure questionnaire” quality of life questionnaire in Kosovo’s heart failure patients. International Cardiovascular Forum Journal, 9

  47. Mbakwem, A., Aina, F., Amadi, C., Akinbode, A., Mokwunyei, J. (2013). Comparative analysis of the quality of life of heart failure patients in South Western Nigeria

  48. Erceg, P., Despotovic, N., Milosevic, D. P., Soldatovic, I., Zdravkovic, S., Tomic, S., et al. (2013). Health-related quality of life in elderly patients hospitalized with chronic heart failure. Clinical Interventions in Aging, 8, 1539–1546.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Jovanić, M., Zdravković, M., Stanisavljević, D., & Jović, V. A. (2018). Exploring the importance of health literacy for the quality of life in patients with heart failure. International Journal of Environmental Research and Public Health, 15(8), 1761.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Tsabedze, N., Kinsey, J. L. H., Mpanya, D., Mogashoa, V., Klug, E., & Manga, P. (2021). The prevalence of depression, stress and anxiety symptoms in patients with chronic heart failure. International Journal of Mental Health Systems, 15(1), 44.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Son, Y.-J., Song, Y., Nam, S., Shin, W.-Y., Lee, S.-J., & Jin, D.-K. (2012). Factors associated with health-related quality of life in elderly Korean patients with heart failure. Journal of Cardiovascular Nursing, 27(6), 528–538.

    Article  PubMed  Google Scholar 

  52. Barutcu, C. D., & Mert, H. (2013). The relationship between social support and quality of life in patients with heart failure. JPMA the Journal of the Pakistan Medical Association, 63(4), 463–467.

    PubMed  Google Scholar 

  53. Gok Metin, Z., & Gulbahar, M. (2021). The prevalence of complementary and integrative health approach use and quality of life among patients with heart failure: A cross-sectional, descriptive, and comparative study. Holistic Nursing Practice, 35(3), 123–132.

    Article  PubMed  Google Scholar 

  54. Silavanich, V., Nathisuwan, S., Phrommintikul, A., & Permsuwan, U. (2019). Relationship of medication adherence and quality of life among heart failure patients. Heart and Lung, 48(2), 105–110.

    Article  PubMed  Google Scholar 

  55. Molavynejad, S., Babazadeh, M., Zarea, K., & Ataeeara, S. (2019). Anxiety, depression and quality of life among patients with heart failure. Journal of Research in Medical and Dental Science, 7(3), 69–77.

    Google Scholar 

  56. Wu, J.-R., Lennie, T. A., Frazier, S. K., & Moser, D. K. (2016). Health-related quality of life, functional status and cardiac event-free survival in patients with heart failure. The Journal of Cardiovascular Nursing, 31(3), 236.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Ramos, S., Prata, J., Rocha-Gonçalves, F., Bettencourt, P., & Coelho, R. (2017). Quality of life predicts survival and hospitalisation in a heart failure Portuguese population. Applied Research in Quality of Life, 12(1), 35–48.

    Article  Google Scholar 

  58. Johansson, I., Joseph, P., Balasubramanian, K., McMurray, J. J., Lund, L. H., Ezekowitz, J. A., et al. (2021). Health-related quality of life and mortality in heart failure: The global congestive heart failure study of 23,000 patients from 40 countries. Circulation, 143(22), 2129–2142.

    Article  CAS  PubMed  Google Scholar 

  59. Rector, T. S. (2017). FDA medical device development tool (MDDT) qualification package for the Minnesota living with heart failure questionnaire (MLHFQ), 2017

  60. Audi, G., Korologou, A., Koutelekos, I., Vasilopoulos, G., Karakostas, K., Makrygianaki, K., et al. (2017). Factors affecting health related quality of life in hospitalized patients with heart failure. Cardiology Research and Practice, 2017

  61. Hsu, T. W., Chang, H. C., Huang, C. H., Chou, M. C., Yu, Y. T., & Lin, L. Y. (2018). Identifying cut-off scores for interpretation of the heart failure impact questionnaire. Nursing Open, 5(4), 575–582.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Curry, C., Zuhlke, L., Mocumbi, A., & Kennedy, N. (2018). Acquired heart disease in low-income and middle-income countries. Archives of disease in Childhood, 103(1), 73–77.

    Article  PubMed  Google Scholar 

  63. Nugent, R. (2008). Chronic diseases in developing countries: Health and economic burdens. Annals of the New York Academy of Sciences, 1136(1), 70–79.

    Article  PubMed  Google Scholar 

  64. Negesa, L. B., Magarey, J., Rasmussen, P., & Hendriks, J. M. (2019). Cardiovascular risk behaviour is an emerging health issue in developing countries: A cross-sectional study. European Journal of Cardiovascular Nursing, 18(8), 679–690.

    Article  PubMed  Google Scholar 

  65. Trevisol, D. J., Moreira, L. B., Kerkhoff, A., Fuchs, S. C., & Fuchs, F. D. (2011). Health-related quality of life and hypertension: A systematic review and meta-analysis of observational studies. Journal of Hypertension, 29(2), 179–188.

    Article  CAS  PubMed  Google Scholar 

  66. Guo, N., Marra, F., & Marra, C. A. (2009). Measuring health-related quality of life in tuberculosis: A systematic review. Health and Quality of Life Outcomes, 7(1), 14.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Phyo, A. Z. Z., Freak-Poli, R., Craig, H., Gasevic, D., Stocks, N. P., Gonzalez-Chica, D. A., et al. (2020). Quality of life and mortality in the general population: A systematic review and meta-analysis. BMC Public Health, 20(1), 1–20.

    Article  Google Scholar 

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Acknowledgements

We would like to thank UTS Faculty of Health librarian and all authors of the included studies in this systematic review and meta-analysis.

Funding

There was no funding for this systematic review. It is part of a PhD thesis by HM. HM is a higher degree research candidate at the University of Technology Sydney (UTS), funded by the International Research Training Program (IRTP). The IRTP is a commonwealth scholarship funded by the Australian government and the Department of Education and Training. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Amhara Region, Ethiopia

    Henok Mulugeta

  2. Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia

    Henok Mulugeta, Peter M. Sinclair & Amanda Wilson

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Contributions

HM conceived the study and drafted the protocol. PS and AW provided support and guidance on the search strategy and screening process. All three authors (HM, PS and AW) were involved in data extraction, quality assessment and analysis. All authors have read, edited and approved the final draft of the manuscript.

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Correspondence to Henok Mulugeta.

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Mulugeta, H., Sinclair, P.M. & Wilson, A. Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis. Qual Life Res 33, 1175–1189 (2024). https://doi.org/10.1007/s11136-023-03563-2

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