Synergistic Effect of Disease Severity, Anxiety Symptoms and Elderly Age on the Quality of Life of Outpatients with Heart Failure

• Published in: Arquivos brasileiros de cardiologia Vol. 114; no. 1; pp. 25 - 32
• Main Authors: Figueiredo, José Henrique Cunha, Oliveira, Gláucia Maria Moraes de, Pereira, Basílio Bragança, Figueiredo, Ana Elisa Bastos, Nascimento, Emília Matos, Garcia, Marcelo Iorio, Xavier, Sergio Salles
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Cardiologia - SBC 01.01.2020; Sociedade Brasileira de Cardiologia (SBC)
• Subjects: Aged; Ansiedade/diagnóstico; Anxiety Disorders - psychology; CARDIAC & CARDIOVASCULAR SYSTEMS; Cross-Sectional Studies; Female; Heart Failure - psychology; Hospitalização; Humans; Idade; Insuficiência Cardíaca; Male; Middle Aged; Original; Outpatients; Qualidade de Vida; Quality of Life - psychology; Severity of Illness Index; Socioeconomic Factors; Surveys and Questionnaires; Volume Sistólico; Volume Sistólico; Anxiety/diagnosis; Idade; Qualidade de Vida; Insuficiência Cardíaca; Ansiedade/diagnóstico; Heart Failure; Quality of Life; Systolic Volume; Hospitalização; Hospitalization; Age
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.5935/abc.20190174

Heart failure (HF) is a multifactorial syndrome with repercussions on quality of life (QoL). To investigate the main interacting factors responsible to worsen quality of life of outpatients with HF. Cross-sectional observational study with 99 patients of both genders, attending a HF outpatient clinic at a university hospital, all with a reduced ejection fraction (<40%) by echocardiography. They were evaluated using sociodemographic and clinical questionnaires, the Minnesota Living with Heart Failure (MLwHF), and the Hospital Anxiety and Depression scale (HADS). QoL was the outcome variable. Two multivariate models were used: the parametric beta regression analysis, and the non-parametric regression tree, considering p < 0.05 and 0.05 < p < 0.10 for statistical and clinical significance, respectively. Beta regression showed that depression and anxiety symptoms worsened the QoL of HF patients, as well as male sex, age younger than 60 years old, lower education level, lower monthly family income, recurrent hospitalizations and comorbidities such as ischemic heart diseases and arterial hypertension. The regression tree confirmed that NYHA functional class III and IV worsen all dimensions of MLwHF by interacting with anxiety symptoms, which influenced directly or indirectly the presence of poorer total score and emotional dimension of MLwHF. Previous hospitalization in the emotional dimension and age younger than 60 years in general dimension were associated with anxiety and NYHA functional class, also worsening the QoL of HF patients. HF with reduced ejection fraction was associated with poorer MLwHF. Anxiety symptoms, previous hospitalization and younger age were also associated with worsened MLwHF. Knowledge of these risk factors can therefore guide assessment and treatment of HF patients.