Baseline Quality of Life as a Predictor of Mortality and Hospitalization in 5,025 Patients With Congestive Heart Failure

Abstract

This study examined the independent relation of health-related quality of life (HRQL) to mortality and congestive heart failure (CHF)-related hospitalizations in patients with an ejection fraction of <0.35 followed for a mean of 36.5 months. A brief HRQL questionnaire was administered at baseline to patients randomized to placebo or enalapril in the Studies of Left Ventricular Dysfunction (SOLVD) trial. Participants had an ejection fraction of <0.35 and either symptomatic CHF (treatment trial, n = 2,465) or asymptomatic CHF (prevention trial, n = 2,560). Baseline assessment of HRQL predicted mortality and CHF-related hospitalizations in symptomatic and asymptomatic patients randomized to enalapril and placebo treatment. Domains that were the stronger univariate predictors of mortality and CHF-related hospitalizations were activities of daily living (relative risk [RR] for mortality: 1.163, p <0.000; for hospitalization: 1.215, p <0.000), general health (RR for mortality: 1.205, p <0.000; for hospitalization: 1.188, p <0.000), and social functioning (RR for mortality 1.098, p <0.000; for hospitalization: RR 1.156, p <0.000). In the multivariate model, activities of daily living (RR for mortality 1.41, p <0.000; for hospitalization: RR 1.43, p <0.002), general health (RR for mortality 1.21, p <0.000; for hospitalization RR 1.16, p <0.013) and heart failure symptoms (RR for mortality 1.02, p <0.025; for hospitalization RR 1.03, p <0.004) were found to be independent risk factors. HRQL independently predicted mortality and CHF-related hospitalizations after adjustment for ejection fraction, age, treatment, and New York Heart Association classification in patients with an ejection fraction of <0.35, randomized to enalapril and placebo treatment. HRQL provides additional clinical information regarding disease course and outcome that is not captured by traditional indexes of clinical status. (Am J Cardiol 1996;78:890–895)