Abstract
Purpose: Although mortality related to heart failure (HF) is high, the number of patients living with HF increases annually. Therefore, health status is an increasingly important concept in the management of HF. In fact, most symptomatic patients are more concerned about their everyday health status than the length of their life. Yet, most investigators conduct intervention studies that are designed to reduce mortality. As a result, health status is poorly understood for patients with HF. Thus, the purpose of this study was to identify predictors of health status.
Method: In this correlational study, we interviewed 87 patients (age 73±11 years; 48% female; ejection fraction [EF] 38±15%; New York Heart Association [NYHA] class III/IV 53%) immediately prior to discharge from a hospitalization for HF. Health status was conceptualized as health-related quality of life [HRQL] (measured using the Minnesota Living with Heart Failure Questionnaire), actual physical activity level (measured over 24 h using the Mini Mitter actigraph), and level of symptom burden (measured using the Dyspnea-Fatigue Index). Hierarchical multiple regression techniques were used to determine sociodemographic (sex, age, living alone), clinical (comorbidities, NYHA class, EF), health perception, and emotional (anxiety, depression, and hostility measured using the Brief Symptom Inventory) variables associated with health status.
Results: Worse NYHA class, higher anxiety, and higher depression predicted worse HRQL, explaining 37% of the variance. Better NYHA class and higher anxiety predicted higher levels of physical activity and explained 17% of the variance. Worse NYHA class and higher depression predicted greater symptom burden, explaining 52% of the variance. Based on the standardized beta coefficients, the three strongest predictors of health status were anxiety, NYHA class, and depression.
Conclusion: Although emotional variables are not routinely assessed clinically, clearly they have a major impact on health status. Data from this study demonstrate that most traditional demographic and clinical variables assessed by clinicians are not associated with health status. Interventions to improve health status should target not only physical, but also emotional well-being.