Objective: Individuals with heart failure (HF) have impaired health-related quality of life (QoL). We examined whether self-rated QoL predicts long-term mortality and explored factors related to low quality of life in a HF population.

Methods: Associations between QoL and all-cause mortality were examined in the MyoVasc study (NCT04064450; N=3,289), a prospective cohort study on chronic HF. QoL was assessed with EQ-5D-3L Questionnaire as a known valid tool for assessing the quality of life in chronic diseases including HF. In linear regression models we analyzed independent predictors of EQ-5D-3L on visual analog scale (VAS) as well on the sum score and each dimension of EQ-5D-3L in HF. In a multivariable cox regression model including the clinical profile, CVRF, comorbidities and medication, association between QoL and mortality were analyzed.

Results: The analysis sample comprised a total of 2,690 participants (mean age: 64.2 ± 11.1 years) with complete data on QoL. The mean score for the QoL based on the EQ-5D-VAS scale (0-100) was 69.88. In subjects with symptomatic stage C/D HF (n=1366) mean EQ-5D-VAS score was 64.20. Moderate and severe problems were found in the mobility dimension in 18,3%, in Self-care dimension in 3.2%, in usual activities in 18.5%, in pain/discomfort in 58.6% and in anxiety/depression dimensions in 22.6% of the individuals. In linear regression model, the strongest independent clinical predictors of poor QoL were depressiveness (PHQ-9), Age, SES, Obesity and pain medication in the full sample. During the follow-up period of 6 years 22.1% (n=302) died. In Cox regression with adjustment for clinical profile, CVRF, comorbidities and medication EQ-5D-VAS remained an independent predictor for all-cause death in the analysis sample (HR per SD 1.54, 95% CI: 1.35-1.75, p<0.0001) as well as in  (HR per SD 1.40, 95% CI: 1.21-1.62, p<0.0001). The EQ-5D-3L sum score showed comparable association to all-cause death in the full sample and in the subsample of individuals with symptomatic HF. 

Conclusions: Worse QoL is associated with increased risk of all-cause mortality in individuals with HF. Both somatic and psychosomatic factors impact on QoL in HF underlying the relevance for consideration for future preventive strategies. Data indicate the need to monitor health–related QoL in HF.