Determinants and associations of health-related quality of life with mortality in acute and chronic heart failure: findings from the ESC HF III Registry

Aims: To assess the demographic, clinical, behavioural, and treatment factors associated with health-related quality of life (HRQoL) in heart failure (HF), examine the association between HRQoL and mortality, and evaluate changes in HRQoL over 1-year. Methods: We analysed the ESC EORP Heart Failure III Registry, including patients hospitalised with acute HF or outpatient HF visits. HRQoL was assessed using the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaire. Generalised linear models examined associations between demographic, clinical, behavioural, and treatment characteristics with baseline HRQoL. Cox proportional hazards models assessed the relationship between baseline HRQoL and 1-year mortality. Changes in HRQoL were classified as improvement, deterioration, or mixed change across EQ-5D dimensions, and determinants of change were assessed using fixed-effects models. Results: Among 10,130 patients (acute HF: 38.6%; outpatient HF: 61.4%), those with acute HF had worse baseline HRQoL than outpatients. Older age, female sex, eGFR≤29, NYHA class III/IV, and dyspnoea at rest were strongly associated with lower HRQoL in both acute and outpatient HF. Lower baseline HRQoL was associated with a higher risk of death at one year, with a 0.1-unit decrease in HRQoL on a scale of -0.59 to 1.00 (equivalent to 37 days of full health lost annually) associated with a 9% higher risk of death; a finding consistent across ejection fraction categories and sex. At 1-year, 45% of patients reported improved HRQoL, and improvements were more common in those with acute HF, mildly reduced ejection fraction, and women. Use of ACEi/ARBs/ARNIs was associated with a modest improvement in HRQoL at 1 year. Conclusions: HRQoL provides important clinical information and may provide additional insight into patients’ health status and disease progression beyond conventional clinical measures.