DGK Herztage 2025. Clin Res Cardiol (2025). https://doi.org/10.1007/s00392-025-02737-x
1Universitätsklinikum Würzburg Medizinische Klinik und Poliklinik I, ZIM Kardiologie Würzburg, Deutschland; 2Universitätsklinikum Würzburg Institut für Diagnostische und Interventionelle Neuroradiologie Würzburg, Deutschland; 3Universitätsklinikum Würzburg Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie Würzburg, Deutschland; 4Universitätsklinikum Würzburg Medizinische Klinik und Poliklinik I Würzburg, Deutschland; 5Universitätsklinikum Würzburg Neurologische Klinik und Poliklinik Würzburg, Deutschland; 6Universitätsklinikum Würzburg Deutsches Zentrum für Herzinsuffizienz/DZHI Würzburg, Deutschland
BACKGROUND:
Quality of life (QoL) in patients with chronic heart failure (HF) is frequently severely compromised and impacts both mortality and morbidity. There is a paucity of data on its longitudinal course over time. We aimed to describe six-year trajectories of QoL, identify its predictors, and examine the prognostic relevance of changes in QoL in patients with chronic stable HF.
Quality of life (QoL) in patients with chronic heart failure (HF) is frequently severely compromised and impacts both mortality and morbidity. There is a paucity of data on its longitudinal course over time. We aimed to describe six-year trajectories of QoL, identify its predictors, and examine the prognostic relevance of changes in QoL in patients with chronic stable HF.
METHODS:
The prospective single-center Cognition.Matters-HF cohort study included patients with stable HF of any etiology. In addition to regular cardiological work-up, patients underwent QoL assessment at baseline and after 6, 12, 36 and 69 months. QoL was assessed using the following self-reported questionnaires: Short Form 36 (SF36), European Quality of Life 5 Dimensions (EQ-5D) and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Depressed mood was assessed using the Patient Health Questionnaire 9 (PHQ-9). Cognitive performance tests quantified attention, memory and visual/verbal fluency. Multivariable linear and Cox proportional hazards regression models were used for statistical analysis. Death was ascertained through resident registration offices, in July 2024.
The prospective single-center Cognition.Matters-HF cohort study included patients with stable HF of any etiology. In addition to regular cardiological work-up, patients underwent QoL assessment at baseline and after 6, 12, 36 and 69 months. QoL was assessed using the following self-reported questionnaires: Short Form 36 (SF36), European Quality of Life 5 Dimensions (EQ-5D) and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Depressed mood was assessed using the Patient Health Questionnaire 9 (PHQ-9). Cognitive performance tests quantified attention, memory and visual/verbal fluency. Multivariable linear and Cox proportional hazards regression models were used for statistical analysis. Death was ascertained through resident registration offices, in July 2024.
RESULTS:
Of 148 enrolled HF patients at baseline, 62 patients (42%) completed all follow-up visits. Their median age was 61 years (quartiles 53, 69 years) and five patients (8%) were women. 58% were in New York Heart Association (NYHA) functional class II and median NT-proBNP levels were 358 pg/ml (182, 724). 57 patients (92%) received optimal guideline-directed treatment.
Of 148 enrolled HF patients at baseline, 62 patients (42%) completed all follow-up visits. Their median age was 61 years (quartiles 53, 69 years) and five patients (8%) were women. 58% were in New York Heart Association (NYHA) functional class II and median NT-proBNP levels were 358 pg/ml (182, 724). 57 patients (92%) received optimal guideline-directed treatment.
Participants who died during follow-up time were older, had longer duration of HF, higher NT-proBNP levels, worse NYHA functional class and shorter 6-minute walking distances at baseline compared to those who completed follow-up. No disparities in baseline QoL or depressed mood was apparent between these groups.
During the follow-up period, most of the QoL domains remained stable. Only the EQ-5D Visual Analogue Scale and the SF36-Bodily Pain deteriorated from baseline to 69-months follow-up. Baseline age, sex, NT-proBNP, duration of HF, left ventricular ejection fraction, left atrial volume index, left ventricular end-diastolic volume and E/e’ ratio were not associated with changes in domains of QoL or depressed mood. As a uniform finding we observed that baseline measurements of QoL or depressed mood predicted the changes over time in the respective domains.
Moreover, higher PHQ-9 scores independently predicted a future decline in KCCQ-Overall Summary Scale, KCCQ-Clinical Summary Scale and SF36-Mental Component Summary Score. Almost all QoL domains concomitantly worsened with worsening of depressive symptoms. There was no association between cognitive domains and changes in QoL.
Regarding the prognostic utility of changes in QoL domains over time, only lower ΔKCCQ-Overall Summary Scale (HR per 1-point change: 0.96, 95%CI 0.92-0.99; p=0.018) and ΔEQ-5D Visual Analogue Scale predicted death (HR per 1-point change: 0.97, 95% CI 0.95-0.99; p=0.044) in the univariable, but not in the multivariable model.
CONCLUSIONS:
In a primarily male cohort with guideline-based treatment for chronic stable HF, domains of QoL and depressed mood remained largely stable over a 6-year period. Baseline information on QoL and depressive symptoms were robust predictors of respective changes in these domains over time. Our results underscore the necessity for mental health interventions to address potential challenges during the disease.
In a primarily male cohort with guideline-based treatment for chronic stable HF, domains of QoL and depressed mood remained largely stable over a 6-year period. Baseline information on QoL and depressive symptoms were robust predictors of respective changes in these domains over time. Our results underscore the necessity for mental health interventions to address potential challenges during the disease.