A follow-up program in patients after hospitalization for heart failure: long-term health related quality of life and associated factors

Background

The well-being of individuals with chronic heart failure (HF) is significantly influenced by their health-related quality of life (HRQoL), which serves as a crucial measure indicating how HF affects their daily activities. Monitoring programs aimed at reducing the number of hospitalizations and improving functional conditions are currently being offered to patients with chronic HF.

The objective

To examine the long-term health-related quality of life changes in patients with heart failure enrolled in a follow-up program after hospitalization and to evaluate the factors associated with quality of life of patients with heart failure.

Methods

This prospective study was conducted between 2019 and 2020 at the Department of Cardiology of Lithuanian University of Health Sciences. Patients were divided into two groups: Group I consisted of 71 patients (60.2%) where the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score decreased by more than 10 points at 4th visit if compared to the 1st one; and Group II consisted of 47 patients (39.8%) where the MLHFQ score remained unchanged or increased by less than 10 points at the 4th visit if compared to the 1st visit.

Results

Statistically significant differences were observed between groups. In Group II, a history of myocardial infarction was more frequent (p = 0.038), and there was a significantly higher occurrence of significant coronary artery disease (p = 0.006). Laboratory parameters indicating liver function exhibited statistically significant deterioration among patients in Group II. Specifically, AST (p = 0.050), ALT (p = 0.010), and GGT (p = 0.031) levels significantly increased. Upon analyzing the echocardiographic data, a statistically significant difference was found between the groups in relation to the left ventricular ejection fraction (LVEF) (p = 0.043) and TAPSE (p = 0.031). An analysis of changes in dimensions related to QoL was conducted during the long-term follow-up program, which revealed statistically significant differences between groups in overall changes based on the MLHFQ (p < 0.001). This difference was also observed across all dimensions, including the emotional, physical, and social aspects (p < 0.001).

Conclusion

Patients who had a higher LVEF at baseline, as well as those with an etiology of ischemic heart disease (IHD), better liver function, and fewer manifestations of edema, demonstrated a statistically significant improvement in their quality of life throughout the course of the patient monitoring program.

Patients with heart failure education: the effectiveness of interventions

Introduction

According to the data of Lithuanian Hygiene Institute in 2019 the incidence of heart failure (HF) was about 89 300 cases in Lithuania and 1/3 of them had active in-hospital treatment. (1). Sherwood and his colleagues determined that the development of skills improves the quality of life (QoL) for patients with HF; it also affected the decline of the NT-pro BNP significance (2). To prevent worsening of HF and its complications such as severe arrythmias and patients death, it's important not only the prescribtion of optimal medical treatment, but also teaching the patient how to recognize symptoms of worsening HF and adjusting modified risk factors (3,4).

Aim

To determine the impact and effectiveness of a specialized monitoring program for HF patients.

Methods

We have analyzed the data of 82 patients discharged from the Department of Cardiology of Lithuanian University of Health Sciences in 2017–2018 after worsening of HF. All patient participated in the long-term training and monitoring program and had 4 visits at cardiologist and HF nurse in out-patient clinic. Statistical method with IBM SPSS Statistics version of 20.0 program was applied in the analysis. Continuous data are presented as mean ± SD when normally distributed and as median (interquartile range) when not normally distributed. Continuous variables were compared with Student's t-tests or Wilcoxon tests, as appropriate.

Results

The mean age of the study population was 60.63±11.9 years. 72 (87.8%) persons were male. AH was presented in 60 (73.3%), dyslipidemia in 48 (58.5%) patients. 31 (37.8%) patient had history of myocardial infarction, 14 (17.1%) - of diabetes mellitus, 11 (13.25%) of cerebrovascular stroke and atrial fibrillation and/or flutter was presented in 44 (53%) patients. 16 (19.5%) were smokers and 30 (36.6%) - alcohol users. Clinical symptoms did not change statistically significant through the follow-up period, only heartbeat sensing decreased (p&lt;0.001). Evaluating laboratory parameters statistically significant decreased uric acid 417.50 μmol/l [350.50–495.00] v.s. 384.00 μmol/l [350.50–495.00], p&lt;0.051), urea 6.80 mmol/l [5.0–9.9] v.s. 5.9 mmol/l [4.7–7.7], p&lt;0.052) and bilirubin direct 2.8 μmol/l [1.4–3.7] v.s. 2.1 μmol/l [1.3–3.5], p&lt;0.001). NT-pro-BNP decreased from 1242.0 ng/l [582.0–4019.5] to 779.0 ng/l [373.3–2676.8], p&lt;0,001). Left ventricular ejection fraction statistically significant improved (26.53 (±11.63) % v.s. 31.19 (±11.45) %, (p&lt;0.0001). QoL statistically significant improved (58.30±20.92 vs 37.92±22.53) (p&lt;0.0001). Patients after training have improved their physical and psychological status (p&lt;0.0001). QoL assessment is related to the left ventricular ejection fraction r=−0.229, p&lt;0.05 and to NT pro BNP r=−0.3, p&lt;0.05.

Conclusions

Participating in the long-term training and monitoring program following hospital discharge improves HF patient's QoL with a positive impact on NT-pro BNP marker value and LVEF.

Funding Acknowledgement

Type of funding sources: None.