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

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. (C) 2002 European Society of Cardiology. Published by Elsevier Science B.V. All rights reserved.