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

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Abstract
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.