Abstract 12250: Physical and Psychological Symptom Profiles Predict Poor Quality-of-Life in Advanced Heart Failure
Introduction: Many adults with heart failure (HF) have refractory symptoms. We hypothesized that symptom profiling would identify advanced HF patients at greater risk for poor quality-of-life (QOL).
Methods: We analyzed data on 98 participants in a study of physical and psychological symptoms in advanced HF. Physical symptoms were measured with the HF Somatic Perception Scale (HFSPS; range 0-90), sleepiness was measured with the Epworth Sleepiness Scale (ESS; range 0-24), depression was measured with the Patient Health Questionnaire (PHQ9; range 0-27, ≥10 = moderate depression), and hostility and anxiety were measured with the Brief Symptom Inventory (BSI; range 0-4). QOL was measured with the European QOL 5 Dimensions (EQ5D) visual analogue scale (0-100) and health index (0-1). Latent class mixture modeling was used to identify distinct profiles among HFSPS, ESS, PHQ9 categories, and BSI scores. Generalized linear modeling was used to quantify differences in QOL by symptom profile.
Results: The mean age was 57±13 years, 64% were male, 40% had NYHA class II and 60% had class III/IV HF; the average LVEF was 27±11%. Three symptom profiles were identified. Adults with a severe symptom profile (21.4%) had the worst symptoms in all domains (HFSPS 41±27, ESS 11±6, BSI anxiety 1.2±0.6 and hostility 1.1±0.8) and at least moderate depression. Those with a moderate profile (33.7%) had average symptoms in all domains (HFSPS 25±20, ESS 8±4, BSI anxiety 0.6±0.5 and hostility 0.5±0.4) and mild depression. Those with a mild profile (44.9%) had mild symptoms in all domains (HFSPS 18±13, ESS 6±3, BSI anxiety 0.1±0.2 and hostility 0.1±0.2) and less than mild depression (P<.001 for all comparisons). Controlling for age, gender, NYHA, and LVEF, adults with the severe symptom profile (21.8±6.7 lower visual analogue scores, P=.001; 0.58±0.10 lower health index scores, P<.001), and those with the moderate profile (13.7±6.5 lower visual analogue scores, P=.001; 0.12±0.05 lower health index scores, P<.001) had worse health-related QOL compared with adults with the mild profile.
Conclusions: Profiling physical and psychological symptoms identifies patient subgroups with markedly worse QOL, and would be useful in personalizing monitoring and management strategies in advanced HF.
- © 2011 by American Heart Association, Inc.