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Aims: We sought to analyse quality of life (QoL) measures derived from two questionnaires widely used in clinical trials, the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL 5 dimensions (EQ-5D), and to compare their prognostic value in men and women with heart failure and reduced ejection fraction (HFrEF).
Methods and Results: From the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) we compared KCCQ and EQ-5D at baseline and after nine months in 1276 men and 373 women with new-onset or worsening symptoms of HFrEF, who were sub-optimally treated and in whom there was an anticipated up-titration of guidelines-derived medical therapies. Women had significantly worse baseline QoL (median) as compared with men, both when assessed with KCCQ overall score (KCCQ-OS, 44 vs 53, p<0.001) and EQ-5D utility score (0.62 vs 0.73, p<0.001). QoL improved equally in women and men at follow-up. All summary measures of QoL were independently associated with all-cause mortality, with KCCQ-OS showing the most remarkable association with mortality up to one year compared to the EQ-5D scores (C-statistic 0.650 for KCCQ-OS vs 0.633 and 0.599 for EQ-5D US and EQ-5D VAS respectively). QoL was associated with all outcomes analysed, both in men and in women (all p for interaction with sex >0.2).
Conclusion: Amongst patients with HFrEF, women reported significantly worse QoL than men. QoL was independently associated with subsequent outcome, similarly in men and in women. The KCCQ in general, and KCCQ-OS in particular, showed the strongest independent association with outcome.
- Heart failure
- Quality of life