Patient reported outcome in HFpEF: Sex-specific differences in quality of life and association with outcome

Abstract

BackgroundHeart failure with preserved ejection fraction (HFpEF) is associated with poor quality of life (QoL), or patient reported outcome (PRO). Despite female predominance in HFpEF, sex-specific differences in PROs remain poorly studied. We assessed PRO measures and their association with HF-severity and outcome in HFpEF by sex. Methods and resultsIn 378 patients with HFpEF from the KaRen study, EQ-5D-3L® and Minnesota Living with Heart Failure Questionnaire® (MLHFQ) were assessed. Characteristics and comorbidities were largely similar in women (n = 212, 57%) and men. Women expressed worse QoL in EQ-5D-3L®(EQ-VAS), independent of age and HF-severity, mean (SD), 57 (20) vs. 61 (19), p = 0.010. There was no difference in MLHFQ, 31 (21) vs. 29 (21), p = 0.269.Spearman's correlations with HF-severity (NYHA-class) were for MLHFQ in women rs 0.37 vs. men 0.41, p for both <0.001, and for EQ-VAS rs −0.28, p = 0.001 vs. −0.45, p < 0.001. Correlations with natriuretic peptides were for MLHFQ rs 0.21, p = 0.003 in women vs. men 0.27, p < 0.001, and for EQ-VAS rs −0.17 vs. −0.27, p both < 0.001.Associations between PRO and the composite of HF hospitalisation or all-cause death were present in men only, adjusted HR per 5 units increase in MLHFQ 1.06, 95% confidence interval (CI) 1.01–1.11, p = 0.02 and EQ-VAS, HR 0.93, 95% CI 0.88–0.98, p = 0.010. ConclusionIn HFpEF, women had worse general but similar disease specific QoL compared to men. QoL was more strongly associated with HF-severity in men, and associated with outcomes only in men. In women with HFpEF, QoL appears less determined by HF itself and potentially more by other unknown factors.