• Hillary D Lum, Evan P Carey, Diane Fairclough, Mary E Plomondon, Evelyn Hutt, John S Rumsfeld, and David B Bekelman.
• Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA. Electronic address: Hillary.lum@ucdenver.edu.
• J Pain Symptom Manage. 2016 Jun 1; 51 (6): 963-70.

ContextHeart failure (HF)-specific health status (symptom burden, functional status, and health-related quality of life) is an important patient-reported outcome that is associated with palliative care needs, hospitalizations, and death.ObjectivesTo identify potentially modifiable patient-reported factors that predict HF-specific health status over one year.MethodsThis was a prospective cohort study using data from the Patient-Centered Disease Management trial. Participants were identified using population-based sampling of all patients with an HF diagnosis at four VA Medical Centers. Patients were enrolled with reduced HF-specific health status (i.e., significant HF symptoms, limited functional status, and poor quality of life, defined by a Kansas City Cardiomyopathy Questionnaire [KCCQ] score <60). Patient-reported factors at baseline were chest pain, other noncardiac pain, dry mouth, numbness/tingling, constipation, nausea, cough, dizziness, depressive symptoms (Patient Health Questionnaire-9), and spiritual well-being (validated, single-item measure). Patients reported HF-specific health status (KCCQ) at 3, 6, and 12 months.ResultsOf 384 U.S. veterans, 42% screened positive for depression and 76% described burdensome physical symptoms at baseline. In bivariate analyses, all patient-reported factors were correlated with KCCQ score over one year. Multivariable mixed-effect modeling showed that baseline chest pain, numbness/tingling, depressive symptoms, and higher comorbidity count predicted HF-specific health status over the following year.ConclusionBurdensome physical and depressive symptoms independently predicted subsequent HF-specific health status in patients with symptomatic HF. Whether addressing these aspects of the patient experience can improve health status and well-being in symptomatic HF should be studied further.Published by Elsevier Inc.

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