Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure

Nancy Luo, Tiew Hwa Katherine Teng, Wan Ting Tay, Inder S. Anand, William E. Kraus, Houng Bang Liew, Lieng Hsi Ling, Christopher M. O'Connor, Ileana L. Pina, A. Mark Richards, Wataru Shimizu, David J. Whellan, Jonathan Yap, Carolyn S.P. Lam, Robert J. Mentz

Research output: Contribution to journalArticle

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Abstract

Background: Assessing health-related quality of life (HRQoL) in patients with heart failure (HF) is an important goal of clinical care and HF research. We sought to investigate ethnic differences in perceived HRQoL and its association with mortality among patients with HF and left ventricular ejection fraction ≤35%, controlling for demographic characteristics and HF severity. Methods and results: We compared 5697 chronic HF patients of Indian (26%), white (23%), Chinese (17%), Japanese/Koreans (12%), black (12%), and Malay (10%) ethnicities from the HF-ACTION and ASIAN-HF multinational studies using the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0-100; higher scores reflect better health status). KCCQ scores were lowest in Malay (58. ±. 22) and Chinese (60. ±. 23), intermediate in black (64. ±. 21) and Indian (65. ±. 23), and highest in white (67. ±. 20) and Japanese or Korean patients (67. ±. 22) after adjusting for age, sex, educational status, HF severity, and risk factors. Self-efficacy, which measures confidence in the ability to manage symptoms, was lower in all Asian ethnicities (especially Japanese/Koreans [60. ±. 26], Malay [66. ±. 23], and Chinese [64. ±. 28]) compared to black (80. ±. 21) and white (82. ±. 19) patients, even after multivariable adjustment (P <. .001). In all ethnicities, KCCQ strongly predicted 1-year mortality (HR 0.45, 95% CI 0.30-0.67 for highest vs lowest quintile of KCCQ; P for interaction by ethnicity .101). Conclusions: Overall, HRQoL is inversely and independently related to mortality in chronic HF but is not modified by ethnicity. Nevertheless, ethnic differences exist independent of HF severity and comorbidities. These data may have important implications for future global clinical HF trials that use patient-reported outcomes as endpoints.

Original languageEnglish (US)
JournalAmerican Heart Journal
DOIs
StateAccepted/In press - 2017
Externally publishedYes

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Heart Failure
Quality of Life
Mortality
Social Adjustment
Educational Status
Aptitude
Self Efficacy
Cardiomyopathies
Stroke Volume
Health Status
Comorbidity
Demography
Research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Luo, N., Teng, T. H. K., Tay, W. T., Anand, I. S., Kraus, W. E., Liew, H. B., ... Mentz, R. J. (Accepted/In press). Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure. American Heart Journal. https://doi.org/10.1016/j.ahj.2017.06.016

Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure. / Luo, Nancy; Teng, Tiew Hwa Katherine; Tay, Wan Ting; Anand, Inder S.; Kraus, William E.; Liew, Houng Bang; Ling, Lieng Hsi; O'Connor, Christopher M.; Pina, Ileana L.; Richards, A. Mark; Shimizu, Wataru; Whellan, David J.; Yap, Jonathan; Lam, Carolyn S.P.; Mentz, Robert J.

In: American Heart Journal, 2017.

Research output: Contribution to journalArticle

Luo, N, Teng, THK, Tay, WT, Anand, IS, Kraus, WE, Liew, HB, Ling, LH, O'Connor, CM, Pina, IL, Richards, AM, Shimizu, W, Whellan, DJ, Yap, J, Lam, CSP & Mentz, RJ 2017, 'Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure', American Heart Journal. https://doi.org/10.1016/j.ahj.2017.06.016
Luo, Nancy ; Teng, Tiew Hwa Katherine ; Tay, Wan Ting ; Anand, Inder S. ; Kraus, William E. ; Liew, Houng Bang ; Ling, Lieng Hsi ; O'Connor, Christopher M. ; Pina, Ileana L. ; Richards, A. Mark ; Shimizu, Wataru ; Whellan, David J. ; Yap, Jonathan ; Lam, Carolyn S.P. ; Mentz, Robert J. / Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure. In: American Heart Journal. 2017.
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abstract = "Background: Assessing health-related quality of life (HRQoL) in patients with heart failure (HF) is an important goal of clinical care and HF research. We sought to investigate ethnic differences in perceived HRQoL and its association with mortality among patients with HF and left ventricular ejection fraction ≤35{\%}, controlling for demographic characteristics and HF severity. Methods and results: We compared 5697 chronic HF patients of Indian (26{\%}), white (23{\%}), Chinese (17{\%}), Japanese/Koreans (12{\%}), black (12{\%}), and Malay (10{\%}) ethnicities from the HF-ACTION and ASIAN-HF multinational studies using the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0-100; higher scores reflect better health status). KCCQ scores were lowest in Malay (58. ±. 22) and Chinese (60. ±. 23), intermediate in black (64. ±. 21) and Indian (65. ±. 23), and highest in white (67. ±. 20) and Japanese or Korean patients (67. ±. 22) after adjusting for age, sex, educational status, HF severity, and risk factors. Self-efficacy, which measures confidence in the ability to manage symptoms, was lower in all Asian ethnicities (especially Japanese/Koreans [60. ±. 26], Malay [66. ±. 23], and Chinese [64. ±. 28]) compared to black (80. ±. 21) and white (82. ±. 19) patients, even after multivariable adjustment (P <. .001). In all ethnicities, KCCQ strongly predicted 1-year mortality (HR 0.45, 95{\%} CI 0.30-0.67 for highest vs lowest quintile of KCCQ; P for interaction by ethnicity .101). Conclusions: Overall, HRQoL is inversely and independently related to mortality in chronic HF but is not modified by ethnicity. Nevertheless, ethnic differences exist independent of HF severity and comorbidities. These data may have important implications for future global clinical HF trials that use patient-reported outcomes as endpoints.",
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AU - Luo, Nancy

AU - Teng, Tiew Hwa Katherine

AU - Tay, Wan Ting

AU - Anand, Inder S.

AU - Kraus, William E.

AU - Liew, Houng Bang

AU - Ling, Lieng Hsi

AU - O'Connor, Christopher M.

AU - Pina, Ileana L.

AU - Richards, A. Mark

AU - Shimizu, Wataru

AU - Whellan, David J.

AU - Yap, Jonathan

AU - Lam, Carolyn S.P.

AU - Mentz, Robert J.

PY - 2017

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N2 - Background: Assessing health-related quality of life (HRQoL) in patients with heart failure (HF) is an important goal of clinical care and HF research. We sought to investigate ethnic differences in perceived HRQoL and its association with mortality among patients with HF and left ventricular ejection fraction ≤35%, controlling for demographic characteristics and HF severity. Methods and results: We compared 5697 chronic HF patients of Indian (26%), white (23%), Chinese (17%), Japanese/Koreans (12%), black (12%), and Malay (10%) ethnicities from the HF-ACTION and ASIAN-HF multinational studies using the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0-100; higher scores reflect better health status). KCCQ scores were lowest in Malay (58. ±. 22) and Chinese (60. ±. 23), intermediate in black (64. ±. 21) and Indian (65. ±. 23), and highest in white (67. ±. 20) and Japanese or Korean patients (67. ±. 22) after adjusting for age, sex, educational status, HF severity, and risk factors. Self-efficacy, which measures confidence in the ability to manage symptoms, was lower in all Asian ethnicities (especially Japanese/Koreans [60. ±. 26], Malay [66. ±. 23], and Chinese [64. ±. 28]) compared to black (80. ±. 21) and white (82. ±. 19) patients, even after multivariable adjustment (P <. .001). In all ethnicities, KCCQ strongly predicted 1-year mortality (HR 0.45, 95% CI 0.30-0.67 for highest vs lowest quintile of KCCQ; P for interaction by ethnicity .101). Conclusions: Overall, HRQoL is inversely and independently related to mortality in chronic HF but is not modified by ethnicity. Nevertheless, ethnic differences exist independent of HF severity and comorbidities. These data may have important implications for future global clinical HF trials that use patient-reported outcomes as endpoints.

AB - Background: Assessing health-related quality of life (HRQoL) in patients with heart failure (HF) is an important goal of clinical care and HF research. We sought to investigate ethnic differences in perceived HRQoL and its association with mortality among patients with HF and left ventricular ejection fraction ≤35%, controlling for demographic characteristics and HF severity. Methods and results: We compared 5697 chronic HF patients of Indian (26%), white (23%), Chinese (17%), Japanese/Koreans (12%), black (12%), and Malay (10%) ethnicities from the HF-ACTION and ASIAN-HF multinational studies using the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0-100; higher scores reflect better health status). KCCQ scores were lowest in Malay (58. ±. 22) and Chinese (60. ±. 23), intermediate in black (64. ±. 21) and Indian (65. ±. 23), and highest in white (67. ±. 20) and Japanese or Korean patients (67. ±. 22) after adjusting for age, sex, educational status, HF severity, and risk factors. Self-efficacy, which measures confidence in the ability to manage symptoms, was lower in all Asian ethnicities (especially Japanese/Koreans [60. ±. 26], Malay [66. ±. 23], and Chinese [64. ±. 28]) compared to black (80. ±. 21) and white (82. ±. 19) patients, even after multivariable adjustment (P <. .001). In all ethnicities, KCCQ strongly predicted 1-year mortality (HR 0.45, 95% CI 0.30-0.67 for highest vs lowest quintile of KCCQ; P for interaction by ethnicity .101). Conclusions: Overall, HRQoL is inversely and independently related to mortality in chronic HF but is not modified by ethnicity. Nevertheless, ethnic differences exist independent of HF severity and comorbidities. These data may have important implications for future global clinical HF trials that use patient-reported outcomes as endpoints.

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