Isabelle Johansson1,2, Philip Joseph1, Kumar Balasubramanian1, John J V McMurray3, Lars H Lund4,5, Justin A Ezekowitz6, Deepak Kamath7, Khalid Alhabib8, Antoni Bayes-Genis9,10, Andrzej Budaj11, Antonio L L Dans12, Anastase Dzudie13,14,15, Jefferey L Probstfield16, Keith A A Fox17, Kamilu M Karaye18, Abel Makubi19, Bianca Fukakusa1, Koon Teo1, Ahmet Temizhan20, Thomas Wittlinger21, Aldo P Maggioni22, Fernando Lanas23, Patricio Lopez-Jaramillo24,25, José Silva-Cardoso26, Karen Sliwa27, Hisham Dokainish28, Alex Grinvalds1, Tara McCready1, Salim Yusuf1,2. 1. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.). 2. Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Canada (S.Y., I.J.). 3. BHF Cardiovascular Research Centre, University of Glasgow, Scotland (J.J.V.M.). 4. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (L.H.L.). 5. Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.). 6. Faculty of Medicine and Dentistry, University of Alberta Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E.). 7. Division of Clinical Research and Training, St John's Research Institute, India (D.K.). 8. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia (K.A.). 9. Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.B.-G.). 10. Department of Medicine, Universitat Autonoma Barcelona, CIBERCV, Spain (A.B.-G.). 11. Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland (A.B.). 12. Department of Cardiac Sciences, University of Philippines, Manila, Philippines (A.L.L.D.). 13. Douala General Hospital, Cameroon (A.D.). 14. Clinical Research Education, Networking and Consultancy, Douala, Cameroon (A.D.). 15. Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon (A.D.). 16. Division of Cardiology, University of Washington School of Medicine, Seattle (J.L.P.). 17. Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.). 18. Department of Medicine, Aminu Kano Teaching Hospital and Bayero University Kano, Nigeria (K.M.K.). 19. Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania (A.M.). 20. Ankara City Hospital, Department of Cardiology, University of Health Sciences, Turkey (A.T.). 21. Department of Cardiology, Goslar Hospital, Germany (T.W.). 22. ANMCO Research Center, Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy (A.P.M.). 23. Universidad de La Frontera, Temuco, Chile (F.L.). 24. Masira Research Institute, UDES, Bucaramanga, Colombia (P.L.-J.). 25. Facultad de Ciencias de la Salud, UTE, Quito, Ecuador (P.L.-J.). 26. Faculty of Medicine, University of Porto, Sao Joao University Hospital Centre, Porto, Portugal (J.S.-C.). 27. Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.). 28. Echocardiography Laboratory, Circulate Cardiac and Vascular Centre, Burlington, Canada (H.D.).
Abstract
BACKGROUND: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. METHODS: We used the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. RESULTS: The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17-1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03-1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21-1.42]; interaction P<0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14-1.19] and HR, 1.14 [95% CI, 1.12-1.17]; interaction P=0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13-1.17] versus 1.09 [95% CI, [1.07-1.11]; interaction P<0.0001). HR for death was greater in ejection fraction ≥40 versus <40% (HR, 1.23 [95% CI, 1.20-1.26] and HR, 1.15 [95% CI, 1.13-1.17]; interaction P<0.0001). CONCLUSION: HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03078166.
BACKGROUND: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. METHODS: We used the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. RESULTS: The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17-1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03-1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21-1.42]; interaction P<0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14-1.19] and HR, 1.14 [95% CI, 1.12-1.17]; interaction P=0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13-1.17] versus 1.09 [95% CI, [1.07-1.11]; interaction P<0.0001). HR for death was greater in ejection fraction ≥40 versus <40% (HR, 1.23 [95% CI, 1.20-1.26] and HR, 1.15 [95% CI, 1.13-1.17]; interaction P<0.0001). CONCLUSION: HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03078166.
Entities:
Keywords:
health status; heart failure; prognosis; quality of life; ventricular function, left
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