Comorbid Conditions and Health-related Quality of Life in Ambulatory Heart Failure Patients: A Report from REVIVAL

BACKGROUND: Patients with heart failure (HF) often have multiple chronic conditions that may impact health-related quality of life (HRQOL) despite HF therapy. We sought to determine the association between noncardiac comorbidities and HRQOL in ambulatory patients with advanced HF. METHODS: Baseline data from 373 subjects in Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life were analyzed using multivariable general linear models to evaluate the relationship between comorbidities and HRQOL (EuroQol-visual analogue scale [EQ-VAS], EQ-5D-3L Index Score, and Kansas City Cardiomyopathy Questionnaire [KCCQ]). The primary independent variables were a comorbidity index (sum of 14 noncardiac conditions), a residual comorbidity index (without depression), and depression alone. The median (25(th)-75(th) percentile) number of comorbidities was 3 (2–4). RESULTS: Increasing comorbidity burden was associated with a reduction in generic (EQ-5D Index, p=0.005) and HF-specific (KCCQ, p=0.001) HRQOL. The residual comorbidity index was not associated with HRQOL when depression included in the model independently, while depression was associated with HRQOL across all measures. Participants with depression (vs. without) scored on average 13 points (95% confidence interval 8–17) lower on the EQ-VAS, 0.15 points (0.12–0.18) lower on the EQ-5D Index, and 24.9 points (21.2–28.5) lower on the KCCQ-overall summary score. CONCLUSIONS: While noncardiac comorbidities were prevalent in ambulatory advanced HF patients, only depression was associated with decreased generic and HF-specific HRQOL. Other than depression, the presence of noncardiac comorbidities should not impact expected gains in HRQOL following VAD, provided the conditions are not a contraindication to implant. REGISTRATION: Clinicaltrials.gov; Unique identifier: NCT01369407.