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

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, we enrolled 23,292 patients with HF (32% inpatients, 61% men) from 40 countries in the Global Congestive Heart Failure Study. We recorded HRQL at baseline using 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% were in NYHA class III-IV. Average HRQL was 55±0.5. It was 62.5 (95% 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 vs class I/II (-12.1 [-12.8 to -11.4] and class IV vs. class I/II (-16.5 [-17.7 to -15.3]), effort dyspnea (-9.5[-10.2 to -8.8]) and living in LIC vs. 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