The clinical course of health status and association with outcomes in patients hospitalized for heart failure: Insights from ASCEND-HF

Andrew P. Ambrosy, Adrian F. Hernandez, Paul W. Armstrong, Javed Butler, Allison Dunning, Justin A. Ezekowitz, G. Michael Felker, Stephen J. Greene, Padma Kaul, John J. McMurray, Marco Metra, Christopher M. O'Connor, Shelby D. Reed, Phillip Schulte, Randall C. Starling, W. H. Wilson Tang, Adriaan A. Voors, Robert J. Mentz

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Aims A longitudinal and comprehensive analysis of health-related quality of life (HRQOL) was performed during hospitalization for heart failure (HF) or soon after discharge. Methods and results A post-hoc analysis was performed of the ASCEND-HF trial. The EuroQOL five dimensions questionnaire (EQ-5D) was administered to study participants at baseline, 24 h, discharge/day 10, and day 30. EQ-5D includes functional dimensions mapped to corresponding utility scores (i.e. 0 = death and 1 = perfect health), and a visual analogue scale (VAS) ranging from 0 (i.e. 'worst imaginable health state') to 100 (i.e. 'best imaginable health state'). The association between baseline and discharge EQ-5D measurements and subsequent clinical outcomes including death and rehospitalization were assessed using multivariable logistic regression and Cox proportional hazards regression. A total of 6943 patients (97%) had complete EQ-5D data at baseline. Mapped utility and VAS scores (mean ± SD) increased over time, respectively, from 0.56 ± 0.23 and 45 ± 22 at baseline to 0.67 ± 0.26 and 58 ± 22 at 24 h and to 0.79 ± 0.20 and 68 ± 22 at discharge, and remained stable at day 30. Lower mapped utility scores at baseline [odds ratio (OR) per 0.1 decrease in utility score 1.03, 95% confidence interval (CI) 1.00-1.06] and discharge (OR 1.10, 95% CI 1.05-1.15) and VAS scores at baseline (OR per 10 point decrease 1.05, 95% CI 1.01-1.09) were significantly associated with increased risk of 30-day all-cause death or HF rehospitalization. Conclusions Patients hospitalized for HF had severely impaired health status at baseline and, although this improved substantially during admission, health status remained abnormal at discharge.

Original languageEnglish (US)
Pages (from-to)306-313
Number of pages8
JournalEuropean Journal of Heart Failure
Volume18
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Keywords

  • Heart failure
  • Hospitalization
  • Morbidity
  • Mortality
  • Quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Ambrosy, A. P., Hernandez, A. F., Armstrong, P. W., Butler, J., Dunning, A., Ezekowitz, J. A., Felker, G. M., Greene, S. J., Kaul, P., McMurray, J. J., Metra, M., O'Connor, C. M., Reed, S. D., Schulte, P., Starling, R. C., Wilson Tang, W. H., Voors, A. A., & Mentz, R. J. (2016). The clinical course of health status and association with outcomes in patients hospitalized for heart failure: Insights from ASCEND-HF. European Journal of Heart Failure, 18(3), 306-313. https://doi.org/10.1002/ejhf.420