Quality of life and frailty in an outpatient population with heart failure

Abstract

Introduction: Heart failure (HF) is one of the most important chronic diseases that cause quality of life (QOL) impairment. The Minnesota Living with Heart Failure Questionnaire (MLWHFQ) is probably the most comprehensively used tool for studying QoL in HF patients. It is a disease-specific questionnaire, but it can be related to frailty, as we previously observed in elderly patients. Geriatric evaluations have been applied successfully to general population regardless the age. Objective and methods: To assess the relationship between the MLWHFQ score and the results obtained in a basic geriatric evaluation with standardised geriatric scales such as Barthel Index, OARS Scale, Pfeiffer Test, and abbreviate Geriatric Depression Scale (GDS), in a general population admitted to a HF Unit. The MLWHFQ and the basic geriatric evaluation were performed at the first visit to the Unit. Predefined criteria (Barthel 3 (±1 depending on educational grade) and 1 positive depression response in abbreviate GDS), were considered abnormal. Every patient having at least one abnormal evaluation was considered frail. Results: 1405 patients were evaluated (1015 men and 390 women). Median age was 69 years (P25-75 59-76). 44.2% of patients (621) fulfilled frailty criteria. Two hundred and eighty six patients (20.4%) had a Barthel Index <90; 183 patients (13%) had an anomalous OARS Scale; the score in Pfeiffer Test was abnormal in 71 patients (5.1%); and 439 patients (31.2%) had a positive depression response in abbreviate GDS. We found a strong correlation between the MLWHFQ score and the presence of frailty and also with all of its components (all p<0.001). This relationship was found both in patients younger and older than 75 years. All relationships showed a p value < 0.001 except for the Pfeiffer test in younger patients (< 75 years; p=0.007). In the multivariable regression analysis QoL (logarithmic form of MLWHFQ) remained significantly associated with frailty after adjustment for age, sex, etiology of HF, NYHA functional class, diabetes mellitus and LVEF, both in younger and older patients (p<0.001). Conclusions: Although designed as a specific QoL questionnaire for patients with HF, the MLWHQ score showed a high relationship with several parameters of frailty assessed with a basic geriatric evaluation, using standardised geriatric scales, in a general HF population regardless the age.