Settergren Camilla, Benson Lina, Dahlström Ulf, Thorvaldsen Tonje, Savarese Gianluigi, Lund Lars H, Shahim Bahira
Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
ESC Heart Fail. 2025 Jun;12(3):1977-1991. doi: 10.1002/ehf2.15206. Epub 2025 Jan 27.
The study aims to examine characteristics and outcomes associated with health-related quality of life (HRQoL) in patients with heart failure (HF) with preserved, mildly reduced and reduced ejection fraction (EF) (HFpEF, HFmrEF and HFrEF).
Data on HRQoL were collected in the Swedish Heart Failure Registry (SwedeHF; 2000-2021) using the EuroQoL 5-dimensional visual analogue scale (EQ 5D-vas). Baseline EQ 5D-vas scores were categorized as 'best' (76-100), 'good' (51-75), 'bad' (26-50) and 'worst' (0-25). Independent associations between patients' characteristics and EQ 5D-vas, as well as between EQ 5D-vas and outcomes were assessed. Of 40 809 patients (median age 74 years; 32% female), 29% were in the 'best', 41% in the 'good', 25% in the 'bad' and 5% in the 'worst' EQ 5D-vas categories, similarly distributed across all EF categories. Higher New York Heart Association (NYHA) class was strongly associated with lower EQ 5D-vas regardless of EF categories, followed by chronic obstructive pulmonary disease, smoking, body mass index, higher heart rate, anaemia, previous stroke, ischaemic heart disease, use of diuretics and living alone, whereas higher income, male sex, outpatient status and higher systolic blood pressure were inversely associated with lower EQ 5D-vas categories. Patients in the 'worst' EQ 5D-vas category as compared with the 'best' had the highest risk of all-cause death [adjusted hazard ratios 1.97, 95% confidence interval (CI) 1.64-2.37 in HFrEF, 1.77, 95% CI 1.30-2.40 in HFmrEF and 1.43 95% CI 1.02-2.00 in HFpEF].
Most patients were in the two highest EQ 5D-vas categories. Higher NYHA class had the strongest association with lower EQ 5D-vas categories, across all EF categories. Patients in the worst EQ 5D-vas category were at the highest risk of mortality.
本研究旨在探讨射血分数保留、轻度降低和降低的心力衰竭（HF）患者（HFpEF、HFmrEF和HFrEF）与健康相关生活质量（HRQoL）相关的特征和结局。
使用欧洲五维视觉模拟量表（EQ 5D-vas）在瑞典心力衰竭登记处（SwedeHF；2000-2021年）收集HRQoL数据。基线EQ 5D-vas评分分为“最佳”（76-100）、“良好”（51-75）、“较差”（26-50）和“最差”（0-25）。评估患者特征与EQ 5D-vas之间以及EQ 5D-vas与结局之间的独立关联。在40809例患者（中位年龄74岁；32%为女性）中，29%处于EQ 5D-vas“最佳”类别，41%处于“良好”类别，25%处于“较差”类别，5%处于“最差”类别，在所有射血分数类别中分布相似。无论射血分数类别如何，纽约心脏协会（NYHA）分级越高与EQ 5D-vas越低密切相关，其次是慢性阻塞性肺疾病、吸烟、体重指数、心率加快、贫血、既往中风、缺血性心脏病、使用利尿剂和独居，而较高收入、男性、门诊状态和较高收缩压与较低EQ 5D-vas类别呈负相关。与“最佳”类别相比，处于EQ 5D-vas“最差”类别的患者全因死亡风险最高[HFrEF患者调整后风险比为1.97，95%置信区间（CI）为1.64-2.37；HFmrEF患者为1.77，95%CI为1.30-2.40；HFpEF患者为1.43，95%CI为1.02-2.00]。
大多数患者处于EQ 5D-vas的两个最高类别。在所有射血分数类别中，较高的NYHA分级与较低的EQ 5D-vas类别关联最强。处于EQ 5D-vas最差类别的患者死亡风险最高。
