Sociodemographic, Clinical and Behavioural Predictors of Change in Health-Related Quality of Life in Ambulatory Patients With Heart Failure - 14/02/26

Doi : 10.1016/j.hlc.2025.10.007

Bruno Besteiro, MD ^a,^b,^⁎ , Pedro Ribeirinho Soares, MD ^a,^b, Catarina Elias, MD ^a,^b, Catarina Vale, MD ^a,^b, Claudemira Pinto, MD ^a, Joana Tender Vieira, MD ^a, Maria Inês Matos, MD ^a, Maria Teresa Brito, MD ^a, Paula Matias, MD ^a, Filipa Gomes, MD ^a,^b, João Pedro Ferreira, MD ^c,^d, Pedro Marques, MD ^a,^b,^c,^e,^⁎,^{^{1
These authors contributed equally to this work.}} , Fernando Friões, PhD ^a,^b,^c,^{^{1
These authors contributed equally to this work.}}

^a Department of Internal Medicine, Centro Hospitalar e Universitário de São João, Porto, Portugal

^b Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal

^c UnIC@RISE, Department of Surgery and Physiology, Cardiovascular Res and Development Center, University of Porto, Porto, Portugal

^d Heart Failure Clinic, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

^e Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada

^∗ Corresponding authors at: Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal Alameda Prof. Hernâni Monteiro Porto 4200-319 Portugal

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Abstract

Background

Health-related quality of life (HRQoL) is an important clinical measure in heart failure (HF), but little is known about the factors associated with changes in HRQoL.

Method

This is a prospective, single-centre study of patients with HF who completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) to assess HRQoL at baseline and 6-months follow-up. Patients were categorised into baseline KCCQ-Clinical Symptom Score (CSS) tertiles and compared for their baseline to 6-month change. Factors associated with baseline to a 6-month change in KCCQ-CSS were determined by multivariable ordered logistic regression. Other KCCQ domains were studied as secondary outcomes.

Results

We included 246 patients, 32% women, mean age 73±11 years and mean left ventricular ejection fraction of 34±16%. Factors independently associated with worsening KCCQ-CSS at 6 months were higher potassium levels (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.0–2.7 per 1 mmol/L increase in potassium), being retired (OR 2.1; 95% CI 1.2–3.5), a history of stroke (OR 3.2; 95% CI 1.6–6.5), and follow-up duration >1 year (OR 1.7; 95% CI 1.0–2.7). Conversely, smoking cessation was associated with KCCQ-CSS improvement (OR 0.5; 95% CI 0.3–0.8). KCCQ-CSS, total symptom score, and overall summary score was well correlated (Rho≥0.9) with similar results across KCCQ domains.

Conclusions

Factors associated with HRQoL changes included clinical and social aspects. While some factors, such as smoking cessation, can be targeted for intervention, others—like potassium levels, employment status, and stroke—reflect underlying disease progression or demographic characteristics. HRQoL in HF is likely influenced by a multitude of factors, underscoring the importance of a multifactorial management approach.

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Keywords : Heart failure, Health-related quality of life, Predictors, Kansas City Cardiomyopathy Questionnaire, Outcome