Factors associated with health‐related quality of life in heart failure in 23 000 patients from 40 countries: results of the G‐CHF research programme

AIMS: To examine clinical and social correlates of health-related quality of life (HRQL) in patients with heart failure (HF) from high- (HIC), upper middle- (UMIC), lower middle- (LMIC) and low-income (LIC) countries. METHODS AND RESULTS: Between 2017 and 2020, 23 292 patients with HF (32% inpatients, 61% men) from 40 countries were enrolled in the Global Congestive Heart Failure study. HRQL was recorded at baseline using the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12. In a cross-sectional analysis, we compared age- and sex-adjusted mean KCCQ-12 summary scores (SS: 0-100, higher = better) between patients from different country income levels. We used multivariable linear regression examining correlations (estimated coefficients) of KCCQ-12-SS with sociodemographic, comorbidity, treatment and symptom covariates. The adjusted model (37 covariates) was informed by univariable findings, clinical importance and backward selection. Mean age was 63 years and 40% of patients were in New York Heart Association (NYHA) class III-IV. Average HRQL was 55 SD 27. It was 62.5 (95% confidence interval [CI] 62.0-63.1) in HIC, 56.8 (56.1-57.4) in UMIC, 48.6 (48.0-49.3) in LMIC, and 38.5 (37.3-39.7) in LICs (p < 0.0001). Strong correlates (estimated coefficient [95% CI]) of KCCQ-12-SS were NYHA class III versus class I/II (-12.1 [-12.8 to -11.4] and class IV versus class I/II (-16.5 [-17.7 to -15.3]), effort dyspnoea (-9.5 [-10.2 to -8.8]) and living in LIC versus HIC (-5.8 [-7.1 to -4.4]). Symptoms explained most of the KCCQ-12-SS variability (partial R²  = 0.32 of total adjusted R²  = 0.51), followed by sociodemographic factors (R²  = 0.12). Results were consistent in populations across income levels. CONCLUSION: The most important correlates of HRQL in HF patients relate to HF symptom severity, irrespective of country income level.