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European Journal of Heart Failure 2002 4(3):337-343; doi:10.1016/S1388-9842(02)00006-5
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© 2002 European Society of Cardiology

Self-rating of quality of life provides additional prognostic information in heart failure. Insights into the EPICAL study

François Allaa,*, Serge Briançona, Francis Guillemina, Yves Juillièreb, Paul-Michel Mertèsb, Jean-Pierre Villemotb, Faiez Zannadb,c and for the EPICAL Investigatorsb,c

a Department of Epidemiology University Hospital, Nancy, France
b Department of Cardiology University Hospital, Nancy, France
c CIC, INSERM-University Hospital Nancy, France

* Corresponding author. Service d'épidémiologie et évaluation cliniques, CHU de Nancy, 54035 Nancy, France. Tel.: +33-3838-52163; fax: +33-3838-51205. E-mail address: f.alla{at}chu-nancy.fr


  Abstract

Background: The relationship between quality of life (QoL) and survival have been poorly investigated. The aim of this study was to determine the value of QoL score as a prognostic factor in a prospective cohort of patients with advanced chronic heart failure (CHF).

Methods: QoL assessment was performed with a generic questionnaire: the Duke Health Profile (DHP) and a disease-specific instrument: the Minnesota Living With Heart Failure Questionnaire (LIhFE), in a sample of 108 patients registered in the EPICAL program (hospitalised patients with severe CHF defined by a NYHA grade III/IV, oedema or hypotension, and LVEF <30%). Prognostic value of general, physical, mental and social dimensions on survival and hospital-free survival were tested in a Cox model.

Results: One-year survival rate was 76%, 1-year hospital-free survival 38%. QoL was significantly associated with outcomes: for both questionnaires, a 10-point decrement in baseline score was associated with a 23–36% increase in the risk of death or hospitalisation for heart failure. For hospital-free survival, this relationship remained significant after adjustment for others prognostic factors.

Conclusion: QoL score is a predictive factor of survival and an independent predictive factor of hospital-free survival in patients with advanced CHF. This assessment may provide additional information for clinical management and therapeutic decisions.

Key Words: Quality of life • Heart failure • Prognosis

Received May 29, 2001; Revised August 29, 2001; Accepted October 23, 2001


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