Health-related quality of life and its association with outcomes in adults with congenital heart disease and heart failure: Insight from FRESH-ACHD registry

Abstract

QoL is an important prognostic factor in Heart Failure (HF) of patients with acquired cardiac disease. The aim of this study was to determine the predictive value of Quality of Life (QoL) on outcomes in adults with congenital heart disease (ACHD) and HF. QoL of 196 ACHD patients with clinical HF (mean age: 44.3 ± 13.8 years; 51% male, 56% with complex CHD; 47% NYHA III/IV) included in the prospective multicentric registry FRESH-ACHD was assessed using SF-36 auto-questionnaire. The primary endpoint was defined by all-cause death, HF-related hospitalisation, heart transplantation or mechanical circulatory support. During a median follow-up of 12 months IQR [11.7–12], 28 (14%) patients reached the combined endpoint. Patients with low QoL experienced more frequently major adverse events ( Fig. 1 [ML1], Logrank P = 0.013). On univariate analysis, lower score at physical functioning (HR = 0.98; 95% CI 0.97–0.99, P = 0.008), role limitations related to physical health (HR = 0.98; 95% CI 0.97–0.99, P = 0.008) and general health dimensions of the SF-36 (HR = 0.97 95% CI 0.95–0.99, P = 0.002) were significantly predictive of cardiovascular events. Physical and general components of QoL were associated with worse outcomes in ACHD patients with HF, making QoL evaluation and rehabilitation programs essential to change this trajectory.