Heart failure: please take into account the patient’s information on the state of health!

Finding

• The risk of hospitalization and death was increased in patients with heart failure (HI) in those who were in good health according to medical judgement but reported poor health.

Why this matters

• Tools for measuring patient-reported health-related quality of life are recommended, but underused in routine clinical practice.

Study design

• Retrospective cohort study with 4,818  HI patients from 11 asian regions (ASIAN-HF Registry).
• The patient’s reported health-related quality of life was defined by the overall score in the Kansas City Cardiomyopathy Questionnaire: ≥ 71.9 (good) vs.<71,9 (bad).
• The severity of HI symptoms assessed by the physician was defined according to the New York Heart Association classification: I or II (good) vs. III or IV (bad).
• Main outcome: combination of HIV-related hospitalisation or death after 1  Year
• Funding: Boston Scientific Investigator-Sponsored Research Program, other sponsors

Key results

• About baseline:
  • 43 % of patients were consistently in good health.
  • 23 % were consistently in poor health.
  • 7 % had a mismatched state of health, which was judged worse by the doctor.
  • 27 % had a mismatched state of health, which the patient judged to be worse.
• Compared to the group with consistent good health, a higher 1-year adjusted risk of HIV-related hospitalisation or death was observed for the other groups:
  • the risk was  174 % higher in the group with consistent poor health.
  • The risk was 75 % higher in the group with mismatched health, according to patients.
  • The risk was 54-_% higher in the group with mismatched health, which according to the doctor was worse.
• Whether the patients had a preserved or reduced ejection fraction did not result in significant modifications of these associations.
• Patients with abnormal health status reported as worse by the patient tended to be younger and presented the highest prevalences of hypertension and AF of all groups.

• 43 % of patients were consistently in good health.
• 23 % were consistently in poor health.
• 7 % had a mismatched state of health, which was judged worse by the doctor.
• 27 % had a mismatched state of health, which the patient judged to be worse.

• the risk was  174 % higher in the group with consistent poor health.
• The risk was 75 % higher in the group with mismatched health, according to patients.
• The risk was 54-_% higher in the group with mismatched health, which according to the doctor was worse.

Limitations

• The two instruments used are designed to scale different HI severity levels.
• Generalizability of results to non-Asian patients uncertain.

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