Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure

J Card Fail. 2009 Nov;15(9):763-9. doi: 10.1016/j.cardfail.2009.05.003. Epub 2009 Jun 25.


Background: Health-related quality of life (HRQOL) is a major clinical outcome for heart failure (HF) patients. We aimed to determine the frequency, durability, and prognostic significance of improved HRQOL after hospitalization for decompensated HF.

Methods and results: We analyzed HRQOL, measured serially using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), for 425 patients who survived to discharge in a multicenter randomized clinical trial of pulmonary artery catheter versus clinical assessment to guide therapy for patients with advanced HF. All patients enrolled had 1 or more prior HF hospitalizations or chronic high diuretic doses and 1 or more symptom and 1 sign of fluid overload at admission. Improvement, defined as a decrease of more than 5 points in MLHFQ total score, occurred in 68% of patients by 1 month and stabilized. The degree of 1-month improvement differed (P < .0001 group x time interaction) between 6-month survivors and non-survivors. In a Cox regression model, after adjustment for traditional risk factors for HF morbidity and mortality, improvement in HRQOL by 1 month compared to worsening at 1 month or no change predicted time to subsequent event-free survival (P=.013).

Conclusions: In patients hospitalized with severe HF decompensation, HRQOL is seriously impaired but improves substantially within 1 month for most patients and remains improved for 6 months. Patients for whom HRQOL does not improve by 1 month after hospital admission merit specific attention both to improve HRQOL and to address high risk for poor event-free survival.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Health Status*
  • Heart Failure / mortality
  • Heart Failure / therapy*
  • Hospitalization / trends*
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Quality of Life*
  • Risk Factors
  • Survival Rate / trends