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.

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.

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.

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.