Abstract 3146: The Relation of Quality of Life Score to Outcome in Heart Failure With Preserved Ejection Fraction: Findings From the Irbesartan in Heart Failure With Preserved Ejection Fraction Trial (I-PRESERVE)
Background: In heart failure, health related quality of life (HRQOL) assessments have been felt to measure unique aspects of patient centered experience not obtainable by other clinical measurements. The relation of HRQOL scores to prognosis has been noted in heart failure with reduced ejection fraction (HF-REF). In heart failure with preserved ejection fraction (HF-PEF), data from Irbesartan in Heart Failure with Preserved Ejection Fraction Trial (I-PRESERVE) showed that HRQOL scores, using the Minnesota Living with Heart Failure Questionnaire (MLwHFQ), were an independent predictor of clinical outcomes. To better understand the role of these scores on prognosis, we further examined baseline scores in relation to clinical outcomes.
Methods: 3181 patients were grouped by quartiles of baseline MLwHFQ score (28, 28 – 41, 42–57, >/=58). For these quartiles, baseline characteristics were compared between groups. Further the following outcomes were examined using Cox proportional hazard models: (i) the I-PRESERVE primary outcome of all-cause mortality or cardiovascular hospitalization (primary M/M); (ii) a secondary outcome of all cause mortality (ACM); (iii) a secondary outcome of heart failure (HF) mortality or HF hospitalization (HF M/M).
Results: Using the adjusted models, there was a progressive increase in risk for each 5 unit increase in MLwHFQ score (HR(95%CI) p value) : primary M/M (1.033 (1.02–1.05)p<0.001), ACM (1.027 (1.01–1.05) p<0.01), HF M/M (1.041 (1.02–1.06)p<0.001). Analysis by quartiles demonstrated that the increase in risk was confined to those with scores >/− 58 for all three outcomes: primary M/M (1.37 (1.15–1.63) p<0.001), ACM (1.28 (1.01–1.62) p<0.038), HF M/M (1.50 (1.16 –1.94) p<0.002), although it was also present in the 42–57 quartile (1.41 (1.08 –1.83) p=0.01)for HF M/M.
Conclusions: In I-PRESERVE, a cohort of HF-PEF patients, worse QOL scores were associated with higher risk for cardiovascular events and death in a multivariable analysis. However, this risk appears confined to those with marked QOL impairment, a group in which these scores provided independent prognostic information.