Clinical InvestigationSymptoms, Depression, and Quality of Life in Patients With Heart Failure
Section snippets
Study Population
Participants were recruited from outpatient cardiology clinics at an academic-affiliated community hospital and a tertiary care academic referral hospital in Baltimore, Maryland, between August 2004 and April 2005. Eligible study participants (1) had a cardiologist's diagnosis of heart failure, (2) had a cardiologist's assigned NYHA functional class II, III, or IV, and (3) were age 60 years or older. Patients were excluded if they were (1) diagnosed with dementia, (2) unable to understand the
Results
The study population is described in Table 1. The median age of participants was 75 years, and a minority were female (37%) and African-American (12%). The median health status (KCCQ) score was 71, which has been associated with NYHA class II.18 Thirty-two percent had current probable depression according to a standard cutoff score on the GDS-SF. Although there were only seven African-Americans enrolled in the study, they were more likely to have a greater number of symptoms (median of 16
Discussion
We found that patients with heart failure reported a large number of distressing symptoms that were associated with depression and worse quality of life. Many of the symptoms reported are not generally thought of as being caused by heart failure. Some of these symptoms may be associated with medications used to treat heart failure, such as dry mouth (reported by 50% of patients in our sample) or constipation (reported by 30%). Others may be associated with comorbid illnesses, and yet others may
Conclusions
Depression in patients with heart failure is associated with a greater number of symptoms, which in turn is responsible for a major portion of the decrease in quality of life associated with heart failure. The substantial decrease in quality of life attributed to symptoms has several implications for clinicians. First, strategies to improve the quality of life in patients with heart failure may require that clinicians ask about and address patients' symptoms beyond those generally associated
References (34)
- et al.
Epidemiology of heart failure
Cardiol Clin
(2001) - et al.
Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure
J Am Coll Cardiol
(2000) A conceptual model of quality of life in relation to heart failure
J Card Fail
(2005)- et al.
Testing a published model of health-related quality of life in heart failure
J Card Fail
(2005) - et al.
Symptoms in patients with heart failure are prognostic predictors: insights from COMET
J Card Fail
(2005) - et al.
Correlates of psychological distress in elderly patients with congestive heart failure
J Psychosom Res
(2004) - et al.
Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the memorial symptom assessment scale
J Pain Symptom Manage
(2003) - et al.
Health status identifies heart failure outpatients at risk for hospitalization or death
J Am Coll Cardiol
(2006) - et al.
The symptom of pain with heart failure: a systematic review
J Card Fail
(2006) - et al.
Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes
J Am Coll Cardiol
(2006)
A double-blind placebo-controlled pilot study of controlled-release paroxetine on depression and quality of life in chronic heart failure
Am Heart J
Symptom distress and quality-of-life assessment at the end of life: the role of proxy response
J Pain Symptom Manage
Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes
JAMA
National Ambulatory Medical Care Survey: 2004 summary
Adv Data
The prevalence of symptoms in medical outpatients and the adequacy of therapy
Arch Intern Med
Reasons for seeking acute care in chronic heart failure
Eur J Heart Fail
Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure
Eur J Cardiovasc Nurs
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The study was funded by the Johns Hopkins Center for Complementary and Alternative Medicine; Johns Hopkins General Clinical Research Center; and National Center for Complementary and Alternative Medicine, National Institutes of Health.