Does heart failure-specific health status identify patients with bothersome symptoms, depression, anxiety and/or poorer spiritual well-being?

Aims: Patients with HF often have underrecognized symptoms, depression, anxiety and poorer spiritual well-being ("QoL domains"). Ideally all patients should have HF-specific health status and QoL domains routinely evaluated; however, lack of time and resources are limiting in most clinical settings. Therefore, we aimed to evaluate whether HF-specific health status was associated with QoL domains and to identify a score warranting further evaluation of QoL domain deficits.

Methods and results: Participants (N = 314) enrolled in the Collaborative Care to Alleviate Symptoms and Adjust to Illness trial completed measures of HF-specific health status (KCCQ (score 0-100, 0=worst health status)), additional symptoms (Memorial Symptom Assessment Scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder -7), and spiritual well-being (Facit-Sp) at baseline. Mean±SD KCCQ score was 46.9±19.3, mean age was 65.5±11.4, and 79% were male. Prevalence of QoL domain deficits ranged from 11% (nausea) to 47% (depression). Sensitivity/specificity of KCCQ for each QoL domain ranged from 20-40%/80-96% for KCCQ≤25, 61-84%/48-62% for KCCQ≤50, 84-97%/26-40% for KCCQ≤60, and 96-100%/8-13% for KCCQ≤75. Patients with KCCQ≤60 had mean±SD 4.5±2.5 QoL domain deficits (maximum 12), vs. 1.6±1.6 for KCCQ>60 (p < 0.001). Similar results were seen for KCCQ ≤25 (6.6±2.4 vs. 3.3±2.4), KCCQ≤50 (4.8±2.6 vs. 2.5±2) and KCCQ≤75 (4.0±2.6 vs. 1.0±1.2) (all p < 00001). Conclusions KCCQ≤60 had good sensitivity for each QoL domain deficit and for patients with at least one QoL domain deficit. Screening for QoL domain deficits should target patients with lower KCCQ scores based on a clinic's KCCQ score distribution and clinical resources for addressing QoL domain deficits.