Quality of life in a diverse population of patients with heart failure: BASELINE FINDINGS FROM THE HEART FAILURE ADHERENCE AND RETENTION TRIAL (HART).

Heart failure (HF) is a common, debilitating, and costly syndrome. Approximately 5 million patients in the U.S. have HF and more than 550,000 new cases are identified each year.1 HF has a substantial adverse impact on quality of life (QOL). HF patients generally report significantly poorer QOL than patients with other common cardiac conditions or other chronic medical conditions.2-4 The impact of HF on QOL is related to stage of disease, although disease symptoms and functional capacity tend to have a greater adverse effect on QOL than clinical indicators of disease severity, such as ejection fraction or abnormal wall motion.5-9 QOL in HF may also be affected by the psychosocial status of the patient. Psychosocial characteristics of particular interest include depression and social support, as these characteristics have been found to predict long-term prognosis in HF.10-14 Although several studies have focused on these characteristics in relation to QOL in HF patients,5,6,9,15-17 their exact role in HF-related QOL remains poorly specified. With few exceptions,9 most studies have been conducted in small samples with limited data on disease aspects that may affect QOL, in particular well-validated measures of disease symptoms or functional capacity. In addition, previous studies generally have been limited to patients with systolic dysfunction, rather than the full spectrum of HF, and have lacked sufficient representation of minority patients. Patients with diastolic dysfunction and from minority backgrounds tend to account for substantial portions of the total HF patient population.18-20 Thus, our understanding of how depression and social support affect various aspects of QOL across a sociodemographically and clinically broad range of HF patients remains limited. This study was aimed at investigating the cross-sectional association of depression and social support with QOL in HF patients, using baseline data from a large behavioral clinical trial. Two QOL domains are the focus of analysis. The first domain emphasizes satisfaction with health, daily functioning, and psychological and spiritual aspects of life, or satisfaction with QOL (S-QOL). The second domain emphasizes limitations in the ability to perform basic activities due to poor health, or physical functioning QOL (PF-QOL). Both domains fall under the general definition of QOL as “the functional effect of an illness and its consequent therapy upon a patient as perceived by the patient”.21 Based on Wilson and Cleary’s conceptual framework of QOL in chronic disease populations,22 we hypothesize that depression and social support account for a greater portion of the impact of HF on satisfaction with QOL (S-QOL) than on perceived limitations in basic activities (PF-QOL).