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Improving Quality of Life in Heart Failure

  • Psychological Aspects of Cardiovascular Diseases (A Steptoe and IM Kronish , Section Editors)
  • Published:
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Abstract

Purpose of Review

Heart failure has substantial effects on health-related quality of life. Maintaining or improving quality of life is an important goal of heart failure therapy, and many patients value better quality of life over greater longevity.

Recent Findings

The symptoms and functional severity of heart failure, medical comorbidities, and depression are the strongest predictors of poor quality of life. Guideline-recommended medical and behavioral interventions for HF, including exercise training and cardiac rehabilitation, self-care interventions, and treatment of depression, can help to improve quality of life.

Summary

Heart failure is, in most cases, a progressive condition with a poor prognosis. However, poor quality of life is not inevitable, and a variety of medical, surgical, and nonpharmacological interventions can help to maintain or improve quality of life in patients with heart failure.

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References

Papers of particular interest, published recently, have been highlighted as:

    • Of importance

      •• Of major importance

      1. Kraai IH, Vermeulen KM, Luttik ML, Hoekstra T, Jaarsma T, Hillege HL. Preferences of heart failure patients in daily clinical practice: quality of life or longevity? Eur J Heart Fail. 2013;15(10):1113–21.

        Article  Google Scholar 

      2. Stevenson LW, Hellkamp AS, Leier CV, Sopko G, Koelling T, Warnica JW, et al. Changing preferences for survival after hospitalization with advanced heart failure. J Am Coll Cardiol. 2008;52(21):1702–8.

        Article  Google Scholar 

      3. Kelkar AA, Spertus J, Pang P, Pierson RF, Cody RJ, Pina IL, et al. Utility of patient-reported outcome instruments in heart failure. JACC Heart Fail. 2016;4(3):165–75.

        Article  Google Scholar 

      4. Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota living with heart failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J. 1992;124(4):1017–25.

      5. Green CP, 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(5):1245–55.

        Article  CAS  Google Scholar 

      6. Spertus JA, Jones PG. Development and validation of a short version of the Kansas City cardiomyopathy questionnaire. Circ Cardiovasc Qual Outcomes. 2015;8(5):469–76.

        Article  Google Scholar 

      7. Burns DJP, Arora J, Okunade O, Beltrame JF, Bernardez-Pereira S, Crespo-Leiro MG, et al. International Consortium for Health Outcomes Measurement (ICHOM): standardized patient-centered outcomes measurement set for heart failure patients. JACC Heart Fail. 2020;8(3):212–22.

        Article  Google Scholar 

      8. •• Greene SJ, Butler J, Spertus JA, Hellkamp AS, Vaduganathan M, DeVore AD, et al. Comparison of New York Heart Association class and patient-reported outcomes for heart failure with reduced ejection fraction. JAMA Cardiol. 2021. https://doi.org/10.1001/jamacardio.2021.0372This prospective study found that improvement in quality of life was independently associated with decreased mortality and a reduced risk of heart failure hospitalization.

        Article  PubMed  Google Scholar 

      9. Spertus JA, Jones PG, Sandhu AT, Arnold SV. Interpreting the Kansas City cardiomyopathy questionnaire in clinical trials and clinical care: JACC state-of-the-art review. J Am Coll Cardiol. 2020;76(20):2379–90.

        Article  Google Scholar 

      10. Comín-Colet J, Martín Lorenzo T, González-Domínguez A, Oliva J, Jiménez MS. Impact of non-cardiovascular comorbidities on the quality of life of patients with chronic heart failure: a scoping review. Health Qual Life Outcomes. 2020;18(1):329.

        Article  Google Scholar 

      11. Baert A, De Smedt D, De Sutter J, De Bacquer D, Puddu PE, Clays E, et al. Factors associated with health-related quality of life in stable ambulatory congestive heart failure patients: systematic review. Eur J Prev Cardiol. 2018;25(5):472–81.

        Article  Google Scholar 

      12. Cascino TM, Kittleson MM, Lala A, Stehlik J, Palardy M, Pamboukian SV, et al. Comorbid conditions and health-related quality of life in ambulatory heart failure patients: REVIVAL (Registry Evaluation of Vital Information for VADs in Ambulatory Life REVIVAL). Circ Heart Fail. 2020;13(5):e006858.

      13. James S, Barton D, O’Connell E, Voon V, Murtagh G, Watson C, et al. Life expectancy for community-based patients with heart failure from time of diagnosis. Int J Cardiol. 2015;178:268–74.

        Article  Google Scholar 

      14. • Sepehrvand N, Savu A, Spertus JA, Dyck JRB, Anderson T, Howlett J, et al. Change of health-related quality of life over time and its association with patient outcomes in patients with heart failure. J Am Heart Assoc. 2020;9(17): e017278. https://doi.org/10.1161/jaha.120.017278This analysis of data from the Alberta Heart Failure Aetiology and Analysis Team (HEART) cohort showed that decline in quality of life predicts adverse outcomes over 12 months in patients with HFpEF.

        Article  PubMed  PubMed Central  Google Scholar 

      15. Luo N, O’Connor CM, Cooper LB, Sun JL, Coles A, Reed SD, et al. Relationship between changing patient-reported outcomes and subsequent clinical events in patients with chronic heart failure: insights from HF-ACTION. Eur J Heart Fail. 2019;21(1):63–70.

        Article  Google Scholar 

      16. Albuquerque de Almeida F, Al MJ, Koymans R, Riistama J, Pauws S, Severens JL. Impact of hospitalisation on health-related quality of life in patients with chronic heart failure. Health Qual Life Outcomes. 2020;18(1):262.

      17. Mentz RJ, Felker GM. Contemporary medical therapy for heart failure patients with reduced ejection fraction. In: Felker GM, Mann DL, editors. Heart failure: a companion to Braunwald’s heart disease. Fourth edition. ed. Philadelphia, PA: Elsevier; 2020. p. 520–48.

      18. Fedson S, Misra A, Deswal A. Treatment of heart failure with preserved ejection fraction. In: Felker GM, Mann DL, editors. Heart failure: a companion to Braunwald’s heart disease. Fourth edition. ed. Philadelphia, PA: Elsevier; 2020. p. 568–85.

      19. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137–61.

        Article  Google Scholar 

      20. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):1810–52.

        Article  Google Scholar 

      21. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200.

        Article  Google Scholar 

      22. Jankowska EA, Tkaczyszyn M, Suchocki T, Drozd M, von Haehling S, Doehner W, et al. Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur J Heart Fail. 2016;18(7):786–95.

        Article  CAS  Google Scholar 

      23. Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK, et al. Sotagliflozin in patients with diabetes and recent worsening heart failure. N Engl J Med. 2021;384(2):117–28.

        Article  CAS  Google Scholar 

      24. McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381(21):1995–2008.

        Article  CAS  Google Scholar 

      25. Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;383(15):1413–24.

        Article  CAS  Google Scholar 

      26. Petrie MC, Verma S, Docherty KF, Inzucchi SE, Anand I, Belohlávek J, et al. Effect of dapagliflozin on worsening heart failure and cardiovascular death in patients with heart failure with and without diabetes. JAMA. 2020;323(14):1353–68.

        Article  CAS  Google Scholar 

      27. Brandt EJ, Ross JS, Grady JN, Ahmad T, Pawar S, Bernheim SM, et al. Impact of left ventricular assist devices and heart transplants on acute myocardial infarction and heart failure mortality and readmission measures. PloS One. 2020;15(3):e0230734.

      28. Stehlik J, Estep JD, Selzman CH, Rogers JG, Spertus JA, Shah KB, et al. Patient-reported health-related quality of life is a predictor of outcomes in ambulatory heart failure patients treated with left ventricular assist device compared with medical management: results from the ROADMAP Study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management). Circ Heart Fail. 2017;10(6).

      29. Burns JL, Serber ER, Keim S, Sears SF. Measuring patient acceptance of implantable cardiac device therapy: initial psychometric investigation of the Florida Patient Acceptance Survey. J Cardiovasc Electrophysiol. 2005;16(4):384–90.

        Article  Google Scholar 

      30. Tosto C, Adamo L, Craddock H, Di Blasi M, Girgenti R, Clemenza F, et al. Relationship between device acceptance and patient-reported outcomes in left ventricular assist device (LVAD) recipients. Sci Rep. 2019;9(1):10778.

        Article  Google Scholar 

      31. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1439–50.

        Article  CAS  Google Scholar 

      32. Flynn KE, Piña IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, et al. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1451–9.

        Article  CAS  Google Scholar 

      33. Blumenthal JA, Babyak MA, O’Connor C, Keteyian S, Landzberg J, Howlett J, et al. Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA. 2012;308(5):465–74.

        Article  CAS  Google Scholar 

      34. Kamiya K, Sato Y, Takahashi T, Tsuchihashi-Makaya M, Kotooka N, Ikegame T, et al. Multidisciplinary cardiac rehabilitation and long-term prognosis in patients with heart failure. Circ Heart Fail. 2020;13(10):e006798.

      35. Bjarnason-Wehrens B, Nebel R, Jensen K, Hackbusch M, Grilli M, Gielen S, et al. Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: the Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF): a systematic review and meta-analysis. Eur J Prev Cardiol. 2020;27(9):929–52.

        Article  Google Scholar 

      36. Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, et al. Impact of exercise rehabilitation on exercise capacity and quality-of-life in heart failure: individual participant meta-analysis. J Am Coll Cardiol. 2019;73(12):1430–43.

        Article  Google Scholar 

      37. Taylor RS, Long L, Mordi IR, Madsen MT, Davies EJ, Dalal H, et al. Exercise-based rehabilitation for heart failure: Cochrane systematic review, meta-analysis, and trial sequential analysis. JACC Heart Fail. 2019;7(8):691–705.

        Article  Google Scholar 

      38. Imran HM, Baig M, Erqou S, Taveira TH, Shah NR, Morrison A, et al. Home-based cardiac rehabilitation alone and hybrid with center-based cardiac rehabilitation in heart failure: a systematic review and meta-analysis. J Am Heart Assoc. 2019;8(16):e012779.

      39. Gomes-Neto M, Durães AR, Conceição LSR, Roever L, Liu T, Tse G, et al. Effect of aerobic exercise on peak oxygen consumption, VE/VCO(2) slope, and health-related quality of life in patients with heart failure with preserved left ventricular ejection fraction: a systematic review and meta-analysis. Curr Atheroscler Rep. 2019;21(11):45.

        Article  CAS  Google Scholar 

      40. Golwala H, Pandey A, Ju C, Butler J, Yancy C, Bhatt DL, et al. Temporal trends and factors associated with cardiac rehabilitation referral among patients hospitalized with heart failure: findings from Get With the Guidelines-Heart Failure Registry. J Am Coll Cardiol. 2015;66(8):917–26.

        Article  Google Scholar 

      41. Deka P, Pozehl B, Williams MA, Yates B. Adherence to recommended exercise guidelines in patients with heart failure. Heart Fail Rev. 2017;22(1):41–53.

        Article  Google Scholar 

      42. Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347(5):305–13.

        Article  Google Scholar 

      43. Riegel B, Dickson VV, Faulkner KM. The situation-specific theory of heart failure self-care: revised and updated. J Cardiovasc Nurs. 2016;31(3):226–35.

        Article  Google Scholar 

      44. Musekamp G, Schuler M, Seekatz B, Bengel J, Faller H, Meng K. Does improvement in self-management skills predict improvement in quality of life and depressive symptoms? A prospective study in patients with heart failure up to one year after self-management education. BMC Cardiovasc Disord. 2017;17(1):51.

        Article  Google Scholar 

      45. Kessing D, Denollet J, Widdershoven J, Kupper N. Self-care and health-related quality of life in chronic heart failure: a longitudinal analysis. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2017;16(7):605–13.

        Article  Google Scholar 

      46. Auld JP, Mudd JO, Gelow JM, Hiatt SO, Lee CS. Self-care moderates the relationship between symptoms and health-related quality of life in heart failure. J Cardiovasc Nurs. 2018;33(3):217–24.

        Article  Google Scholar 

      47. Jonkman NH, Westland H, Groenwold RH, Agren S, Atienza F, Blue L, et al. Do self-management interventions work in patients with heart failure? An individual patient data meta-analysis Circulation. 2016;133(12):1189–98.

        CAS  PubMed  Google Scholar 

      48. • Patel N, Chakraborty S, Bandyopadhyay D, Amgai B, Hajra A, Atti V, et al. Association between depression and readmission of heart failure: a national representative database study. Prog Cardiovasc Dis. 2020;63(5):585–90. https://doi.org/10.1016/j.pcad.2020.03.014This analysis of data from the Nationwide Readmission Database found that depression predicts a higher risk of all-cause readmission in patients hospitalized with heart failure.

        Article  PubMed  Google Scholar 

      49. Jiang W, O’Connor C, Silva SG, Kuchibhatla M, Cuffe MS, Callwood DD, et al. Safety and efficacy of sertraline for depression in patients with CHF (SADHART-CHF): a randomized, double-blind, placebo-controlled trial of sertraline for major depression with congestive heart failure. Am Heart J. 2008;156(3):437–44.

        Article  CAS  Google Scholar 

      50. Angermann CE, Gelbrich G, Stork S, Gunold H, Edelmann F, Wachter R, et al. Effect of escitalopram on all-cause mortality and hospitalization in patients with heart failure and depression: the MOOD-HF randomized clinical trial. JAMA. 2016;315(24):2683–93.

        Article  CAS  Google Scholar 

      51. Freedland KE, Carney RM, Rich MW, Steinmeyer BC, Rubin EH. Cognitive behavior therapy for depression and self-care in heart failure patients: a randomized clinical trial. JAMA Intern Med. 2015;175(11):1773–82.

        Article  Google Scholar 

      52. Herbeck Belnap B, Anderson A, Abebe KZ, Ramani R, Muldoon MF, Karp JF, et al. Blended collaborative care to treat heart failure and comorbid depression: rationale and study design of the Hopeful Heart Trial. Psychosom Med. 2019;81(6):495–505.

        Article  Google Scholar 

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      Freedland, K.E., Rich, M.W. & Carney, R.M. Improving Quality of Life in Heart Failure. Curr Cardiol Rep 23, 159 (2021). https://doi.org/10.1007/s11886-021-01588-y

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