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. 2021 Aug 1;6(8):957-962.
doi: 10.1001/jamacardio.2021.0939.

Quality of Life in Patients With Heart Failure With Recovered Ejection Fraction

Peter Wohlfahrt  1   2   3 , Jose Nativi-Nicolau  1 , Mingyuan Zhang  1 , Craig H Selzman  1 , Thomas Greene  1 , Jorge Conte  1 , Joshua E Biber  1   4 , Rachel Hess  1 , Favel L Mondesir  1 , Omar Wever-Pinzon  1 , Stavros G Drakos  1 , Edward M Gilbert  1 , Line Kemeyou  1 , Bernie LaSalle  1 , Benjamin A Steinberg  1 , Rashmee U Shah  1 , James C Fang  1 , John A Spertus  5 , Josef Stehlik  1   6
Affiliations

Quality of Life in Patients With Heart Failure With Recovered Ejection Fraction

Peter Wohlfahrt et al. JAMA Cardiol. .

Abstract

Importance: Heart failure with recovered ejection fraction (HFrecEF) is a recently recognized phenotype of patients with a history of reduced left ventricular ejection fraction (LVEF) that has subsequently normalized. It is unknown whether such LVEF improvement is associated with improvements in health status.

Objective: To examine changes in health-related quality of life in patients with heart failure with reduced ejection fraction (HFrEF) whose LVEF normalized, compared with those whose LVEF remains reduced and those with HF with preserved EF (HFpEF).

Design, setting, and participants: This prospective cohort study was conducted at a tertiary care hospital from November 2016 to December 2018. Consecutive patients seen in a heart failure clinic who completed patient-reported outcome assessments were included. Clinical data were abstracted from the electronic health record. Data analysis was completed from February to December 2020.

Main outcomes and measures: Changes in Kansas City Cardiomyopathy Questionnaire overall summary score, Visual Analog Scale score, and Patient-Reported Outcomes Measurement Information System domain scores on physical function, fatigue, depression, and satisfaction with social roles over 1-year follow-up.

Results: The study group included 319 patients (mean [SD] age, 60.4 [15.5] years; 120 women [37.6%]). At baseline, 212 patients (66.5%) had HFrEF and 107 (33.5%) had HFpEF. At a median follow-up of 366 (interquartile range, 310-421) days, LVEF had increased to 50% or more in 35 patients with HFrEF (16.5%). Recovery of systolic function was associated with heart failure-associated quality-of-life improvement, such that for each 10% increase in LVEF, the Kansas City Cardiomyopathy Questionnaire score improved by an mean (SD) of 4.8 (1.6) points (P = .003). Recovery of LVEF was also associated with improvement of physical function, satisfaction with social roles, and a reduction in fatigue.

Conclusions and relevance: Among patients with HFrEF in this study, normalization of left ventricular systolic function was associated with a significant improvement in health-related quality of life.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Wohlfahrt reported grants from the American Heart Association during the conduct of the study. Dr Nativi-Nicolau reported clinical trial and/or consulting involvement with Pfizer, Alnylam, Akcea, and Eidos outside the submitted work. Dr Conte reported grants from American Heart Association during the conduct of the study. Mr Biber reported enrollment as a PhD candidate within the University of Utah School of Medicine; he is a former employee of Optum Patient Insights. Dr Hess reported data safety monitoring board membership from Astellas Pharmaceuticals outside the submitted work. Dr Drakos reported personal fees from Abbott outside the submitted work. Dr Steinberg reported grants from the National Institutes of Health/National Heart, Lung, and Blood Institute during the conduct of the study. Dr Shah reported grants from the National Heart, Lung, and Blood Institute, a donation from Women as One, and personal fees from American College of Cardiology outside the submitted work. Dr Fang reported grants from the American Heart Association during the conduct of the study and outside the submitted work and additional relationships with Novartis, Amgen, and the National Institutes of Health. Dr Spertus reported personal fees from Novartis, Janssen, Bayer, Mercl, Amgen, Myokardia, United Healthcare, and Blue Cross Blue Shield of Kansas City outside the submitted work; in addition, Dr Spertus had a patent and copyright to the Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire, and Peripheral Artery Questionnaire with royalties paid, as well as equity in Health Outcomes Sciences. Dr Wever-Pinzon reported grants from the National Heart, Lung, and Blood Institute. Dr Stehlik reported grants from the American Heart Association and personal fees from Medtronic. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
HFpEF indicates heart failure with preserved ejection fraction; HFrecEF, heart failure with recovered ejection fraction; HFrEF, heart failure with reduced ejection fraction; LVAD, left ventricular assist device; PROs, patient-reported outcomes.
Figure 2.
Figure 2.. Quality of Life Change Between Baseline and Follow-up by Heart Failure Category
KCCQ indicates Kansas City Cardiomyopathy Questionnaire.
See this image and copyright information in PMC

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References

    1. Basuray A, French B, Ky B, et al. . Heart failure with recovered ejection fraction: clinical description, biomarkers, and outcomes. Circulation. 2014;129(23):2380-2387. doi:10.1161/CIRCULATIONAHA.113.006855 - DOI - PMC - PubMed
    1. Punnoose LR, Givertz MM, Lewis EF, Pratibhu P, Stevenson LW, Desai AS. Heart failure with recovered ejection fraction: a distinct clinical entity. J Card Fail. 2011;17(7):527-532. doi:10.1016/j.cardfail.2011.03.005 - DOI - PubMed
    1. Spertus JA, Jones PG. Development and validation of a short version of the Kansas City Cardiomyopathy Questionnaire. Circ Cardiovasc Qual Outcomes. 2015;8(5):469-476. doi:10.1161/CIRCOUTCOMES.115.001958 - DOI - PMC - PubMed
    1. Pokharel Y, Khariton Y, Tang Y, et al. . Association of serial Kansas City Cardiomyopathy Questionnaire assessments with death and hospitalization in patients with heart failure with preserved and reduced ejection fraction: a secondary analysis of 2 randomized clinical trials. JAMA Cardiol. 2017;2(12):1315-1321. doi:10.1001/jamacardio.2017.3983 - DOI - PMC - PubMed
    1. Stehlik J, Rodriguez-Correa C, Spertus JA, et al. . Implementation of real-time assessment of patient-reported outcomes in a heart failure clinic: a feasibility study. J Card Fail. 2017;23(11):813-816. doi:10.1016/j.cardfail.2017.09.009 - DOI - PubMed

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