Minnesota Living With Heart Failure Questionnaire Score Research Articles

Iron deficiency in new onset heart failure: association with clinical factors and quality of life.

The prevalence of iron deficiency (ID) in newly diagnosed heart failure (HF) and the progression of ID in patients after initiation of HF therapy are unknown. We aimed to describe the natural trajectory of ID in patients with new onset HF during the first year after HF diagnosis, assessing associations between ID, clinical factors, and quality of life (QoL). A prospective cohort of patients with new onset HF in hospitals or outpatient clinics at five major hospitals in Stockholm, Sweden, during 2015-2018 were analysed with clinical assessment, electrocardiogram, blood samples including iron levels, Minnesota living with heart failure questionnaire (MLHFQ), and echocardiogram at baseline and after 12months. Of 547 patients with new-onset HF, 482 (88%) had complete iron data at baseline. Mean age was 70years (interquartile range 61-77) and 311 (65%) were men; 55% of patients had ejection fraction (EF)≤40%, 19% had EF 41-49%, and 26% had HF with preserved EF (HFpEF). At baseline, 163 patients (34%) had ID defined as ferritin <100μg/L or ferritin 100-299μg/L and transferrin saturation <20%. After 12months of follow-up, 119 (32%) had ID of the 368 patients who had complete iron data both at baseline and after 12months and did not receive intravenous (i.v.) iron during follow-up. During the first year after HF diagnosis, 19% had persistent ID, 13% developed ID, 11% resolved ID, and 57% never had ID, consequently 24% changed their classification. Anaemia at baseline was the strongest independent predictor of ID 1year after diagnosis [odds ratio (OR) 3.91, 95% confidence interval (CI) 1.88-8.13, P<0.001], followed by HF hospitalization (OR 2.21, 95% CI 1.24-3.95, P<0.01), female sex (OR 2.04, 95% CI 1.25-3.32, P<0.01), HFpEF (OR 1.96, 95% CI 1.13-3.39, P<0.05), and diabetes mellitus (OR 1.92, 95% CI 1.06-3.48, P<0.05). ID was associated with low QoL at baseline (MLHFQ score mean difference 7.4 points, 95% CI 3.1-11.7, P<0.001), but not at follow-up. About one third of patients with new onset HF had ID both at the time of HF diagnosis and after 1year, though a quarter of the patients changed their ID status. Patients with anaemia, HF hospitalization, female gender, HFpEF, or diabetes mellitus at baseline were more likely to have ID after 1year implying that these should be carefully screened for ID to find those in need of i.v. iron treatment.

A follow-up program in patients after hospitalization for heart failure: long-term health related quality of life and associated factors.

The well-being of individuals with chronic heart failure (HF) is significantly influenced by their health-related quality of life (HRQoL), which serves as a crucial measure indicating how HF affects their daily activities. Monitoring programs aimed at reducing the number of hospitalizations and improving functional conditions are currently being offered to patients with chronic HF. To examine the long-term health-related quality of life changes in patients with heart failure enrolled in a follow-up program after hospitalization and to evaluate the factors associated with quality of life of patients with heart failure. This prospective study was conducted between 2019 and 2020 at the Department of Cardiology of Lithuanian University of Health Sciences. Patients were divided into two groups: Group I consisted of 71 patients (60.2%) where the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score decreased by more than 10 points at 4th visit if compared to the 1st one; and Group II consisted of 47 patients (39.8%) where the MLHFQ score remained unchanged or increased by less than 10 points at the 4th visit if compared to the 1st visit. Statistically significant differences were observed between groups. In Group II, a history of myocardial infarction was more frequent (p = 0.038), and there was a significantly higher occurrence of significant coronary artery disease (p = 0.006). Laboratory parameters indicating liver function exhibited statistically significant deterioration among patients in Group II. Specifically, AST (p = 0.050), ALT (p = 0.010), and GGT (p = 0.031) levels significantly increased. Upon analyzing the echocardiographic data, a statistically significant difference was found between the groups in relation to the left ventricular ejection fraction (LVEF) (p = 0.043) and TAPSE (p = 0.031). An analysis of changes in dimensions related to QoL was conducted during the long-term follow-up program, which revealed statistically significant differences between groups in overall changes based on the MLHFQ (p < 0.001). This difference was also observed across all dimensions, including the emotional, physical, and social aspects (p < 0.001). Patients who had a higher LVEF at baseline, as well as those with an etiology of ischemic heart disease (IHD), better liver function, and fewer manifestations of edema, demonstrated a statistically significant improvement in their quality of life throughout the course of the patient monitoring program.

The Effectiveness of Lifestyle Interventions in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Network Meta-Analysis

AimsTo perform a network meta-analysis to determine the effectiveness of lifestyle interventions on exercise tolerance and quality of life (QoL) in people with HFpEF. METHODSTen databases were searched for randomised controlled trials that evaluated a diet and/or exercise intervention in people with HFpEF up until May 2022. The co-primary outcomes were peak oxygen uptake (V̇O2peak) and QoL as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). We synthesised data using network meta-analysis. RESULTSThirteen trials were identified including a total of 869 participants and incorporated six different interventions. Improvements in V̇O2peak compared to controls were seen for all exercise interventions (2.88 [95%CI: 1.36; 4.39]ml/kg/min) for high intensity interval training (HIIT); 2.37 [95%CI: 1.02; 3.71] ml/kg/min for low intensity exercise (LIT) combined with a hypocaloric diet; 2.05 [95%CI: 0.81; 3.29]ml/kg/min for moderate intensity continuous training (MICT); 1.94 [95%CI: 0.59; 3.29] ml/kg/min for LIT; 1.85 [95%CI: 0.27; 3.44]ml/kg/min for MICT combined with resistance training) but not a hypocaloric diet alone (1.26 [95%CI: -0.08; 2.61]ml/kg/min). Only HIIT (-14.45 [95%CI: -24.81; -4.10] points) and LIT (95%CI: -11.05 [-20.55; -1.54] ml/kg/min) significantly improved MLHFQ score. Network meta-analysis indicated HIIT was the most effective intervention for improving both V̇O2peak (mean improvement 2.88 [95%CI: 1.36; 4.39]ml/kg/min, follow up (FU) range 4 weeks- 3 years) and QoL (-14.45 [95%CI: -24.81; -4.10] points, FU range 12-26 weeks) compared to usual care. CONCLUSIONSThis network meta-analysis indicates that HIIT is the most effective lifestyle intervention studied to improve exercise capacity and QoL with mean improvements exceeding the minimum clinically meaningful thresholds. HIIT is likely to be an underused management strategy in HFpEF, but further studies are needed to confirm long-term improvements in symptoms and clinical outcomes.

Comparison of the efficacy of combining left bundle branch pacing with either sacubitril/valsartan or enalapril in the treatment of chronic heart failure: A retrospective observational analysis.

To assess the efficacy of left bundle branch pacing (LBBP) combined with either sacubitril/valsartan or enalapril in the treatment of chronic heart failure (CHF). We retrospectively reviewed the records of 138 patients with CHF admitted to Dazhou Central Hospital between June 2020 and June 2022 to extract clinical data. We divided the data into two treatment groups for the analysis: 71 patients received LBBP combined with sacubitril/valsartan treatment (sacubitril/valsartan group), and 67 received LBBP combined with enalapril treatment (enalapril group). The levels of cardiac and cardiopulmonary function indicators, levels of myocardial injury markers, and the scores of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before and after the treatment were compared between the two groups. After six months of treatment, patients in the sacubitril/valsartan group had lower myocardial injury markers, higher cardiopulmonary function indicators, and lower MLHFQ scores (P<0.05). In CHF patients, the combination of LBBP with sacubitril/valsartan had a better therapeutic effect compared to LBBP with enalapril, with more effective improvement of the cardiopulmonary function, reduction of myocardial injury, and improvement in quality of life.

Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis.

Heart failure is a global health concern and associated with poor health-related quality of life and increased mortality. There is a disproportionate burden on patients and health systems in low- and middle-income countries. This systematic review and meta-analysis estimates the health-related quality of life of people with heart failure in low- and middle-income countries. A systematic literature search was conducted to identify relevant studies from January 2012 to November 2022 using the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Scopus and JBI EBP database. Study screening, quality appraisal and data extraction were conducted using JBI methodology. A random-effects model was used to perform the meta-analysis. Heterogeneity was assessed using the I2 statistic. All statistical analyses were done in STATA version 17. A total of 33 studies with 5612 participants were included in this review. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short-Form-36 questionnaire (SF-36) were the most used instruments across 19 and 8 studies, respectively. The pooled mean MLHFQ and SF-36 scores using the random-effects model were 46.08 (95% CI 35.06, 57.10) and 41.23 (95% CI 36.63, 45.83), respectively. In a subgroup analysis using both instruments, the highest health-related quality-of-life scores occurred in studies with inpatient participants. The overall health-related quality of life of people with heart failure in low- and middle-income countries is poor. Strategies should be strategically developed to improve the health-related quality of life of people with heart failure in these countries. PROSPERO CRD42022377781.

Health-related quality of life and its influencing factors among people with heart failure in Ethiopia: using the revised Wilson and Cleary model

Heart failure is a challenging public health problem associated with poor health-related quality of life (HRQoL). Data on the quality of life of people with heart failure are limited in Ethiopia. This study aimed to assess the HRQoL and its influencing factors in people with heart failure in Ethiopia. A hospital-based, cross-sectional study design was conducted in the cardiac outpatient clinics of two tertiary-level hospitals in Addis Ababa, Ethiopia. Data were collected from people with heart failure who met the inclusion criteria using an interviewer-administered questionnaire. The HRQoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). A multiple linear regression model was fitted to identify factors that influenced HRQoL. All statistical analyses were conducted using STATA version 17 software. A total of 383 people with heart failure participated in the study. The mean age of the participants was 55 years. The MLHFQ score was 48.03±19.73, and 54% of participants had poor HRQoL. Multiple linear regression analysis revealed that age (β= 0.12, 95% CI 0.11, 0.28), diabetes mellitus comorbidity (β= 4.47, 95% CI 1.41, 7.54), social support score (β= − 1.48, 95% CI − 1.93, − 1.03), and depression score (β = 1.74, 95% CI 1.52, 1.96) were significant factors influencing overall HRQoL (p < 0.05). This study found that people in Ethiopia with heart failure had poor HRQoL, influenced by several factors. The findings can help health professionals identify appropriate interventions to improve the HRQoL of people with heart failure.

Assessment of health-related quality of life in patients with Chagas cardiomyopathy using Minnesota living with heart failure questionnaire: A validation study.

Chagas cardiomyopathy (ChC) is the most severe clinical form of Chagas disease and, in association with psychosocial factors, can compromise the health-related quality of life (HRQoL) of affected patients. To date, there is no specific instrument to assess the HRQoL of these patients, and the Minnesota Living with Heart Failure Questionnaire (MLwHFQ), specific for heart failure, is being used both in research and current clinical practice. Therefore, we aimed to verify the validity of the MLwHFQ in the assessment of HRQoL of patients with ChC. Fifty patients with ChC (50.6 ± 10.1 years, NYHA I-III) were evaluated. The MLwHFQ, Short-Form of Health Survey (SF-36), Beck Depression Inventory (BDI), and Human Activity Profile (HAP) were applied. All patients underwent echocardiography and Cardiopulmonary Exercise Testing (CPET). The MLwHFQ score correlated with almost all SF-36 domains (with r-value ranging from -0.38 to -0.69), except pain (p = 0.118). The MLwHFQ score also correlated with the BDI score (r = 0.748; p < 0.001), HAP score (r = -0.558; p = 0.001), peak oxygen uptake (r = -0.352; p = 0.01), and left ventricular ejection fraction (r = -0.329; p = 0.021). There was no significant difference in the score found on the MLwHFQ among NYHA classes (p = 0.101), as well as between patients with systolic dysfunction (n = 30) and preserved cardiac function (n = 20) (p = 0.058). Similarly, there was no significant difference in the score found on the physical (p = 0.423) and mental (p = 0.858) components of SF-36 between patients with systolic dysfunction and preserved cardiac function (p = 0.271 and p = 0.609, respectively). There was also no difference in the mental component of SF-36 among NYHA classes (p = 0.673). However, the HRQoL using the physical component of SF-36 was worse in advanced NYHA classes (p = 0.014). MLwHF correlated with most SF-36 HRQoL domains, depressive symptoms, physical activity, and systolic function and seems to be valid in assessing the HRQoL of ChC patients.

Predictive utility of health-related quality of life and the 6-minute walking test in transthyretin amyloid cardiomyopathy - a comparison

Abstract Introduction Both health-related quality of life (HR-QoL) as well as submaximal physical performance as assessed using the 6-minute walking test (6-MWT) have been shown to predict outcome in heart failure. However, it is currently unclear how the predictive utility of different HR-QoL measurement tools compares to the 6-MWT in transthyretin amyloid cardiomyopathy (ATTR-CM). Aims To evaluate predictive utility of the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the EuroQol Five Dimensions Questionnaire (EQ-5D) in comparison to the 6-MWT in patients with ATTR-CM. Methods and results 186 patients diagnosed with ATTR-CM were included and data from 474 visits (2.55 per patient) was analysed. All scores and distance walked in the 6-MWT were transformed into Z-values by subtracting the mean and dividing by the standard deviation. In a cox regression analysis for all-cause mortality adjusted for age and sex, the KCCQ [Hazard Ratio (HR): 0.560, p = &amp;lt; 0.001], the EQ-5D visual analogue scale (HR: 0.712, p = 0.005) and the MLHFQ (HR: 0.613, p = &amp;lt; 0.001) proved predictive of outcome. For heart failure hospitalisation, the KCCQ (HR: 0.455, p = &amp;lt; 0.001), the EQ-5D overall score (HR: 0.753, p = 0.007), the EQ-5D visual analogue scale (HR: 0.631, p = &amp;lt; 0.001) and the MLHFQ score (HR: 0.466, p = &amp;lt; 0.001) were shown to be of high predictive utility. In comparison, the 6-MWT HRs were 0.434 and 0.544 for mortality and heart failure hospitalisation, respectively (p = &amp;lt; 0.001). Conclusion Prognostic utility of the KCCQ and MLHFQ scores is non-inferior to the 6-MWT in ATTR-CM. While much more simplistic, the EQ-5D is lacking behind the other tested questionnaires with regard to predictive utility.

Total 25-Hydroxyvitamin D Is an Independent Marker of Left Ventricular Ejection Fraction in Heart Failure with Reduced and Mildly Reduced Ejection Fraction.

Vitamin D emerged as an important prognostic biomarker in heart failure (HF), with currently highly debated therapeutic implications. Several trials on vitamin D supplementation in HF showed improvements in left ventricular (LV) remodeling and function and health-related quality of life (HRQoL), which did not translate into mid- to long-term beneficial effects regarding physical performance and mortality. We addressed total 25-hydroxyvitamin D (25(OH)D), serum albumin, and uric acid (UA) levels, focusing mainly on vitamin D deficiency, as potential markers of LV systolic dysfunction in HF with reduced and mildly reduced ejection fraction (HFrEF, HFmrEF). Seventy patients with LVEF < 50% were comprehensively evaluated using ECG, echocardiography, lung ultrasound (LUS), blood sampling, and the six-minute walk test (6MWT). HRQoL was also assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Statistically significant positive correlations were found between LVEF, 25(OH)D, serum UA, and albumin, respectively (p = 0.008, p = 0.009, and p = 0.001). Serum UA (7.4 ± 2.4 vs. 5.7 ± 2.1, p = 0.005), NT-proBNP levels (1090.4 (675.2-2664.9) vs. 759.0 (260.3-1474.8), p = 0.034), and MLHFQ scores (21.0 (14.0-47.0) vs. 14.5 (4.5-25.5), p = 0.012) were significantly higher, whereas 25(OH)D concentrations (17.6 (15.1-28.2) vs. 22.7 (19.5-33.8), p = 0.010) were lower in subjects with severely reduced LVEF. Also, 25(OH)D was independently associated with LVEF in univariate and multiple regression analysis, maintaining its significance even after adjusting for confounders such as age, NT-proBNP, the presence of chronic coronary syndrome, hypertension, and anemia. According to our current findings, 25(OH)D is closely associated with LVEF, further supporting the need to establish correct vitamin D supplementation schemes and dietary interventions in HF. The changes in LVEF, 25(OH)D, serum UA, and albumin levels in HFrEF and HFmrEF indicate a similar pathophysiological background.

Adjuvant treatment with shenfu injection improve quality of life in chronic heart failure patients: A meta-analysis of randomized controlled trials

ObjectiveShenfu Injection (SFI) derived from Shenfu decoction, has been widely used for treating heart failure in China. This meta-analysis aimed to assess the effect of SFI as an adjuvant therapy on quality of life in patients with chronic heart failure (CHF). MethodsA systematic literature search was conducted in CKNI, VIP, Wanfang, Sinomed, Cochrane Library, PubMed, and Embase database until March 16, 2023. Randomized controlled trials (RCTs) evaluating the effect of SFI plus conventional therapy versus conventional therapy alone for treating CHF were included. Outcome measures were quality of life defineded by the Minnesota Living with Heart Failure questionnaire (MLHFQ), left ventricular ejection fraction (LVEF), 6-min walking distance, and blood brain natriuretic peptide (BNP)/N-terminal pro-brain natriuretic peptide (NT-proBNP) level. ResultsThirteen RCTs enrolling 1042 CHF patients were included. SFI plus conventional therapy significantly reduced the total MLHFQ score (mean difference [MD] −8.69 points; 95% confidence intervals [CI] −13.46 to −3.91) compared with the conventional therapy alone. Moreover, adjuvant treatment with SFI significantly improved the 6-min walking distance (MD 65.42 m; 95% CI 44.23 to 86.62), LVEF (MD 3.89; 95% CI 1.03 to 6.75), and blood level of BNP/NT-proBNP (SMD -1.73; 95% CI -2.43 to −1.03). ConclusionsAdjuvant treatment with SFI can achieve additional benefits in improving quality of life and exercise tolerance in patients with CHF. These beneficial effects of SFI may correlate with its improving cardiac function. However, our findings should be interpreted with presence of significant heterogeneity and suboptimal quality of the analyzed trials.

Effect of Newly Approved Medications Sacubitril/Valsartan, Empagliflozin and Dapagliflozin on the Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction

ABSTRACT Background Per the guidelines established by the European Society of Cardiology (ESC) guidelines for diagnosing and managing chronic and acute heart failure, Sacubitril/Valsartan, Empagliflozin, and Dapagliflozin are suggested to replace an angiotensin-converting enzyme (ACE) inhibitor to significantly minimize the heart failure (HF) associated risks including hospitalization and possible death of HF ambulatory patients with reduced ejection fraction that remain symptomatic. Objective This work aimed to evaluate the health-related quality of life (HRQOL) changes in HFrEF patients throughout treatment with newly approved medications sacubitril/valsartan, Dapagliflozin, and empagliflozin using Minnesota living with heart failure questionnaire (MLHFQ) and Kansas City Cardiomyopathy Questionnaire (KCCQ) -12 at baseline, 3 months, and 6 months of treatment. Methods This prospective study was conducted on 500 patients with chronic HF with 35% or less LVEF, New York Heart Association class III or IV symptoms who visited Minia university cardiothorasic hospital, cardiology outpatient clinic from period of March 2022 to May 2023. Patients were treated using maximum tolerated doses of guideline-directed medical therapy; angiotensin-converting enzyme inhibitors (ACEIs), ß-blocker (BB), mineralocorticoid receptor antagonist (MRA), and systolic blood pressure greater than 105 mmHg. A total of 3 visits were done (baseline visit, months 3 and 6). At the baseline visit, patients were on ACEIs, BB, MRA, and diuretics and quality of life (QOL) was assessed for this regimen by MLHFQ and KCCQ.12 Then dapagliflozin or empagliflozin was added to the previous regimen, and a reevaluation of patients' QOL was done at 3 months. The ACEI or ARBs was replaced by sacubitril/valsartan, and the reevaluation of QOL was evaluated at 6 months. Results Systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), E/e′ ratio, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were remarkably decreased at 6 months compared to baseline (P value &amp;lt;0.001), at 6 months compared to 3 months (P value &amp;lt;0.001), and at 3 months compared to baseline (P value &amp;lt;0.001). Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and potassium were significantly increased at 6 months compared to baseline (P value &amp;lt;0.001), at 6 months compared to 3 months (P value &amp;lt;0.001), and at 3 months compared to baseline (P value &amp;lt;0.001). MLHFQ and KCCQ-23 scores were significantly improved at 6 months compared to baseline (P value &amp;lt;0.001), compared to 3 months (P value &amp;lt;0.001), and at 3 months compared to baseline (P value &amp;lt;0.001). 28 (5.6%) patients had stopped the medications due to adverse events (AEs). Conclusions Treatment of HFrEF patients with sodium-glucose Co-transporter-2 inhibitors (SGLT2i) and/or sacubitril/valsartan is associated with rapid and significant improvement in patients' QOL according to both KCCQ and MLHFQ scores.

A Cross sectional descriptive study to investigate the different effects of using approved therapeutic regimens options on the quality of life for chronic heart disease patients with reduced ejection fraction

Abstract Aim Investigate the different effects on the quality of life (QOL) between the approved regimens used for Heart failure patients with reduced ejection fraction (HFrEF) treatment in clinical practice. Methods Cross Sectional descriptive study on (HFrEF) patients was conducted from December 2021 to Mars 2023 at governmental and private hospitals in Egypt and Saudi Arabia, the 118 patients were receiving different treatment regimens divided into 4 groups, all groups have B-blockers and mineralocorticoid receptor antagonist (MRA); 1.Conventional therapy group of 33 patients: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARBs), 2. Group of 22 patients: Sacubitril/Valsartan as an angiotensin receptor-neprilysin inhibitor (ARNI), 3. Group of 33 patients (ACEi/ARBs) + Sodium−glucose co-transporter 2 inhibitors (SGLT2i), 4. Group of 30 patients (ARNI) with SGLT2i. Their quality of life assessment was done using validated questionnaire MLHFQ (Minnesota Living with Heart Failure Questionnaire) as face to face interviews and data were collected from hospital records. Statistical software IBM SPSS package version 27.0, a one-way ANOVA test was conducted to compare the difference between 4 groups normally distributed quantitative variables. Post hoc pairwise multiple comparisons were executed using the Tukey HSD test. A multiple linear regression analysis was conducted to assess the ability of the independent variables (Platelets count, Ejection Fraction EF%, Hemoglobin, S.Cr, Gender, WBCs and Urea) to predict the value of MLHFQ score. Significance was judged at the 5% level. Results There was a statistically significant difference In MLHFQ Score for the four groups: F (3, 114) = 8.135, P = 0.000. The actual difference in mean scores was relatively high and this was approved by a large effect size, calculated using eta squared (0.176). Post hoc comparisons indicated that the mean score for Conventional regimen group (M = 68.06, SD = 19.77, CI95% 11.92–38.67, P &amp;lt; 0.05) and SGLT2i containing regimen group (M = 56.88, SD = 22.21, CI95% 0.74–27.48, P = 0.034) both were significantly different from that of ARNI + SGLT2i combination containing regimen group (M = 42.77, SD = 19.04). By comparing the EF% between the 4 groups, There was a statistically significant difference: F (3, 114) = 2.725, P = 0.047. Post hoc comparisons indicated that the mean score for Conventional containing regimen (M = 33, SD = 8.746, CI95% 0.1–10.43, P = 0.044) was significantly different from that of ARNI + SGLT2i combination regimen (M = 27.73, SD = 7.497). The linear regression analysis for variables showed statistical significance (F Change (7,110) = 5.234, P = .000).The statistically significant affected predicted variables are (S.Cr, P = 0.01), (B.urea, P = 0.003), (Hb, P = 0.011), while R2 = 0.25 explained only 25% of the variance in the dependent variable (MLHFQ score). Conclusions The early beginning of ARNI + SGLT2i with B-blocker + MRA may improve the QOL beside the approved reduction in heart failure hospitalizations. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Comparison of Effect of Conventional Medical Management and Ivabradine with Conventional Medical Management on Quality of Life in Patients with Chronic Heart Failure

Background: The study aimed to see the effectiveness and role of ivabradine on the quality of life in chronic heart failure suffering patients. This open-label Randomized controlled Trial was conducted to assess the effect of ivabradine plus conventional medical management over conventional medical management on quality-of-life parameters among 100 patients of chronic heart failure from January 2021 to December 2021 in the Department of Pharmacology &amp; Therapeutics in collaboration with the Department of Cardiology &amp; Medicine, Rajshahi Medical College Hospital, Rajshahi.&#x0D; Materials and methods: According to the drug allocation study population was divided into a control group (50 patients) and an experimental group (50 patients). Minnesota Living with Heart Failure questionnaire (MLWHFQ) was used to assess the quality of life, and the resting heart rate was measured by 12-lead electrocardiography. Baseline demographic and clinical characteristics were recorded, and patients were followed up at four weeks and 12 weeks of treatment.&#x0D; Results: The comparison of mean differences of MLWHFQ score at first and second follow-up visits between the two study groups was statistically significant [t (100) = 2.43 p &lt; 0.05 &amp; t (100) = 6.60 p &lt; 0.001 respectively]. According to the MLWHFQ cut-point score, it was also observed that poor baseline quality of life gradually shifted to good quality after four weeks and 12 weeks of treatment, and it was proportionately higher in the experimental group. Relations between the respondents of both study groups and their different qualities of life during the first follow-up visit (x2 = 13.69, df = 2, p &lt; 0.05) and second follow-up visit (x2 = 22.79, df = 2, p &lt; 0.001) were statistically significant.The comparison of the mean (±SD) heart rate between the two study groups was statistically significant (p &lt;0.001) only during the second follow-up visit.&#x0D; Conclusion: This study concluded that adding ivabradine to conventional medical management in treating patients with chronic heart failure improves their symptoms, quality of life, and heart rate and ultimately reduces the morbidity and mortality of such patients.&#x0D; TAJ 2022; 36: No-1: 1-8

Functional capacity and quality of life in advanced heart failure patients assessment

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) is characterized by functional limitation and consequent loss of quality of life. These parameters can be measured through self-evaluated instruments, namely Duke activity status index (DASI) and Minnesota living with heart failure questionnaire (MLHFQ). In parallel, HF is also characterized by objective parameters measured by complementary diagnostic tests, namely NT-proBNP and left ventricular ejection fraction by echocardiogram. Patients with higher NT-proBNP value and worse ejection fraction may present with more symptoms and consequently functional impairment and worse quality of life. Aim To analyze if self-reported parameters present significant correlation with objective measured parameters and to understand if there are differences between gender in out-patients followed in advanced heart failure assessment. Methods During the year of 2022, a cohort of out-patients was analyzed. Data was collected regarding DASI, MLHFQ and disease stratification based on NT-proBNP and left ventricular ejection fraction by echocardiogram. Pearson's correlation was made between these parameters, trying to understand whether they were related to them and whether this relationship is in line with the patient's clinical presentation. An independent sample T-test was performed in order to understand any differences regarding the gender. Results A sample of 122 patients were evaluated; 97 (80%) were male, with a mean age of 63 years. New York Heart association functional class was between II and III and all patients had reduced left ventricular ejection fraction, with an average of 35% (min: 10% and max: 48%). NT-proBNP scores are quite high, presenting an average score of 1349.7±1482.5. Average score of MLHFQ was 13±15, meaning that patients present a good quality of life and DASI average score was 33.9±16.1, meaning a very acceptable functional capacity level. The DASI score correlates negatively with MLHFQ (r = -0.566, p = 0.003) and with NT-proBNP value (r = -0.783, p = 0.000); MLHFQ score is positively correlated with NT-proBNP value (r = 0.018, p = 0.000). A high DASI score corresponds to good functional capacity and, as such, better quality of life and lower physiological impact of the disease. Surprisingly, despite the lower MLHFQ and high DASI, patients present a quite increase level of NT-proBNP. There were no gender differences in relation to the DASI score (p = 0.077) and MLHFQ (p = 0.422). Conclusion The self-evaluated parameters correlate with the physiological parameters objectively measured. The perception of patients regarding their quality of life and functional capacity may not allow to infer about their physiological parameters, since a high NT-proBNP a low left ventricular ejection fraction normally indicates a worse functional level, which is not observed in this cohort of patients. Gender seems to have no impact on the level of quality of life or self-reported functional capacity.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure.

With the intensification of social aging, the susceptibility of the elderly population to diseases has attracted increasing attention, especially chronic heart failure (CHF) that accounts for a large proportion of the elderly. To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF. This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received. The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group (SG; n = 62), and those who underwent routine detailed behavioral nursing intervention were included as a control group (CG; n = 54). Patients' negative emotions (NEs), quality of life (QoL), and nutritional status were assessed using the self-rating anxiety/ depression scale (SAS/SDS), the Minnesota Living with Heart Failure Ques-tionnaire (MLHFQ), and the Modified Quantitative Subjective Global Assessment (MQSGA) of nutrition, respectively. Differences in rehabilitation efficiency, NEs, cardiac function (CF) indexes, nutritional status, QoL, and nursing satisfaction were comparatively analyzed. A higher response rate was recorded in the SG vs the CG after intervention (P < 0.05). After care, the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG (P < 0.05). The post-intervention SAS and SDS scores, as well as MQSGA and MLHFQ scores, were also lower in the SG (P < 0.05). The SG was also superior to the CG in the overall nursing satisfaction rate (P < 0.05). Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients, and it can not only effectively enhance rehabilitation efficiency, but also mitigate patients' NEs and improve their CF and QoL.

Modeling the clinical profile of patients with hypertension and atrial fibrillation by serum NTpro-BNP levels

Background. Hypertension and atrial fibrillation are a fairly common combination of heart pathology that occurs in the daily practice of a cardiologist. Associations of clinical laboratory and instrumental indicators with the levels of various biomarkers, in particular serum N-terminal fragment of brain natriuretic propeptide (NT-proBNP), are interesting and promising for scientific research and practical application. The aim of the study was to simulate the clinical profiles of patients with hypertension and atrial fibrillation depending on the serum levels of NTpro-BNP. Materials &amp; Methods. 89 patients with stage II hypertension and various clinical forms of atrial fibrillation were included in the study. All patients underwent a general clinical examination, additional determination of NT-proBNP serum levels, and assessment of quality of life according to the Minnesota Living with Heart Failure Questionnaire (MLHFQ) for 2–3 days of hospital stay at against the background of selection of optimal therapy. Sequential statistical processing of the obtained data using Spearman’s rank correlation analysis and multiple linear regression made it possible to create two clinical profiles of patients. Results &amp; conclusions. Thus, with a relatively high serum level of NTpro-BNP (≥810 ng/l), the following will be characteristic: hypertensive history &gt;12 years; the presence of signs of left ventricular hypertrophy on the ECG according to the Sokolov-Lyon criteria; increase in the right atrium &gt;36 mm and systolic pressure in the pulmonary artery &gt;38 mm Hg according to Echocardiography; an increase in the average daily heart rate &gt;110 per 1 min with Holter ECG monitoring; a decrease in the glomerular filtration rate &lt;56 ml/min/1.73m2 and an increase in the total MLHFQ score &gt;27. The dominant markers of a relatively high level of NTpro-BNP were a decrease in quality of life, instrumental signs of hemodynamic overload of the right heart and clinically significant cardiorenal disorders. With a relatively low serum level of NTpro-BNP (≤220 ng/l), the following will be characteristic: hypertensive history anamnesis &lt;8 years; lack of signs of the left ventricle hypertrophy on the ECG according to the Sokolov-Lyon criteria; the size of the right atrium &lt;34 mm and/or the value of systolic pressure in the pulmonary artery &lt;33 mm Hg according to Echocardiography; average daily heart rate with Holter ECG monitoring &lt;92 per 1 minute; glomerular filtration rate &gt;68 ml/min/1.73m2 and the total MLHFQ score &lt;21. The dominant markers of a relatively low level of NTpro-BNP were the absence of signs of left ventricular hypertrophy on the ECG and a balanced state of sympatho-adrenal activity by the nature of circadian regulation of heart rate. Keywords: atrial fibrillation; N-terminal fragment of brain natriuretic propeptide; clinical profile of patients.

The effect of a standardized capsule of Aloe vera gel on the quality of life in patients with systolic heart failure: A randomized double-blind placebo-controlled clinical trial.

This trial was designed to evaluate the effect of a standardized capsule of Aloe vera gel (AVG) on the quality of life (QOL) in patients with systolic heart failure (HF). Forty-two patients were randomly divided into two groups to receive either AVG 150 mg or harmonized placebo capsules twice a day for 8 weeks. The patients were evaluated before and after the intervention using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), New York Heart Association (NYHA) functional class, six-minute walk test (6MWT), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and STOP-BANG questionnaires. Post-intervention, AVG group indicated a significant reduction in the total score of MLHFQ (p< 0.001). The changes in MLHFQ and NYHA class were statistically significant after taking medication (p< 0.001 and p= 0.004, respectively). The change of 6MWT in the AVG group was more advanced; however, it was not statistically significant (p= 0.353). Moreover, in the AVG group, the severity of insomnia and obstructive sleep apnea decreased (p< 0.001, p= 0.01 respectively) and the sleep quality improved as well (p< 0.001). There were significantly fewer adverse events reported in the AVG group (p= 0.047). Therefore, AVG combined with standard medical therapy could provide more clinical benefits for patients with systolic HF.

Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction

Patients with heart failure with preserved ejection fraction (HFpEF) with a pacemaker may benefit from a higher, more physiologic backup heart rate than the nominal 60 beats per minute (bpm) setting. To assess the effects of a moderately accelerated personalized backup heart rate compared with 60 bpm (usual care) in patients with preexisting pacemaker systems that limit pacemaker-mediated dyssynchrony. This blinded randomized clinical trial enrolled patients with stage B and C HFpEF from the University of Vermont Medical Center pacemaker clinic between June 2019 and November 2020. Analysis was modified intention to treat. Participants were randomly assigned to personalized accelerated pacing or usual care and were followed up for 1 year. The personalized accelerated pacing heart rate was calculated using a resting heart rate algorithm based on height and modified by ejection fraction. The primary outcome was the serial change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score. Secondary end points were changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, pacemaker-detected physical activity, atrial fibrillation from baseline, and adverse clinical events. Overall, 107 participants were randomly assigned to the personalized accelerated pacing (n = 50) or usual care (n = 57) groups. The median (IQR) age was 75 (69-81) years, and 48 (48%) were female. Over 1-year follow-up, the median (IQR) pacemaker-detected heart rate was 75 (75-80) bpm in the personalized accelerated pacing arm and 65 (63-68) bpm in usual care. MLHFQ scores improved in the personalized accelerated pacing group (median [IQR] baseline MLHFQ score, 26 [8-45]; at 1 month, 15 [2-25]; at 1 year, 9 [4-21]; P < .001) and worsened with usual care (median [IQR] baseline MLHFQ score, 19 [6-42]; at 1 month, 23 [5-39]; at 1 year, 27 [7-52]; P = .03). In addition, personalized accelerated pacing led to improved changes in NT-proBNP levels (mean [SD] decrease of 109 [498] pg/dL vs increase of 128 [537] pg/dL with usual care; P = .02), activity levels (mean [SD], +47 [67] minutes per day vs -22 [35] minutes per day with usual care; P < .001), and device-detected atrial fibrillation (27% relative risk reduction compared with usual care; P = .04) over 1-year of follow-up. Adverse clinical events occurred in 4 patients in the personalized accelerated pacing group and 11 patients in usual care. In this study, among patients with HFpEF and pacemakers, treatment with a moderately accelerated, personalized pacing rate was safe and improved quality of life, NT-proBNP levels, physical activity, and atrial fibrillation compared with the usual 60 bpm setting. ClinicalTrials.gov Identifier: NCT04721314.

Sex Differences in Quality of Life and Clinical Outcomes in Patients with Heart Failure

Background: Heart failure (HF) is generally associated with poor quality of life (QoL). Limited data are available characterizing health-related QoL (HRQL) in Chinese patients with HF. Methods: We used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to record QoL in 4082 patients with HF from China who were followed up over 12 months in the Heart Failure Registry of Patient Outcomes (HERO) study. Baseline HRQL and differences in QoL between women and men with heart failure were compared. We used multivariable Cox regression with adjustment for variables to assess the association between MLHFQ summary scores and a composite of all-cause mortality and HF hospitalization. Result: At baseline, the mean MLHFQ in the overall population was 42.9 ± 19.57; the scores for physical and emotional domains were 22.0 ± 8.69 and 8.66 ± 6.08, respectively. Women had a higher (poorer) MLHFQ summary score (44.27 ± 19.13) than men (41.63 ± 19.90) (P&lt;0.001). Female patients also had higher MLHFQ physical and emotional scores than male patients (P&lt;0.001). The specific scores of the questionnaire were higher in women than men. NYHA class was the strongest independent predictor of MLHFQ score (β=6.12 unit increment; P&lt;0.001). Sex was not independently associated with higher MLHFQ scores after multivariable adjustments. The 12-month mortality in the overall cohort was 19.6%, the hospitalization rate was 24.4%, and the composite endpoint was 40.15%. A 10-point increase in MLHFQ score was associated with higher risk of mortality (female and male HRs=1.19 [95% CI 1.12–1.26]; P&lt;0.001 and 1.18 [95% CI 1.12–1.24]; P&lt;0.001, respectively) and composite outcomes (HRs=1.08 [95% CI 1.04–1.13]; P&lt;0.001 and 1.11 [95% CI 1.07–1.14]; P&lt;0.001, respectively). Females did not show a significant association between HRQL and hospitalization (HR=1.04 [95% CI 0.99–1.09]; P=0.107). Conclusion: Quality of life was largely poorer in women than men, but was similar between sexes in terms of physical burden and emotional limitation. HRQL is an independent predictor of all-cause death and HF hospitalization in patients with HF.

Abstract 13620: Different Outcomes Influenced by Physical Frailty: A Comparison Between Women and Men With Heart Failure

Introduction: Physical frailty is strongly related to adverse outcomes in heart failure (HF), including greater adverse clinical event risk and poor quality-of-life. In HF, women are more likely to be physically frail than men, but little is known about how this sex difference affects outcomes. The purpose of this study was to quantify sex differences in the associations between physical frailty and clinical and quality-of-life outcomes in HF. Methods: This was a prospective study of adults with NYHA Functional Class I-IV HF. A formal assessment of physical frailty was performed using the Frailty Phenotype Criteria; scores range from 0-5. Clinical characteristic data specific to the Seattle HF Model score (SHFM) were collected to account for the severity and treatment of HF. Clinical events (all-cause death, emergency room visit, or hospitalization for cardiovascular cause) over 12 months were adjudicated. Health-related quality-of-life was assessed using the Minnesota Living with HF Questionnaire (MLHFQ). Sex-stratified Cox regression analysis was used to examine associations between physical frailty and clinical events. Sex-stratified generalized linear modeling was used to examine associations between physical frailty and MLHFQ scores. Results: The sample (n = 115) was 63.5±15.7 years old, 49% women, and 29% had HF with preserved EF. After adjusting for SHFM scores, continuous physical frailty scores were significantly associated with time to first clinical event among men but not women. Specifically, for every one point increase in physical frailty score, there was a 46% higher risk of experiencing an event among men (HR = 1.46 [1.00, 2.11], p = 0.047) but not women (HR = 1.21 [0.81, 1.81], p = 0.36). After adjusting for SHFM scores, physical frailty was associated with 89% worse MLHFQ scores among women (p = 0.005) but was not significantly associated with MLHFQ scores among men (p = 0.14). Conclusions: This study demonstrates that physical frailty in HF may be predominantly associated with worse clinical event risk among men and worse quality-of-life among women.