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229]

Review Article

Quality of life in heart failure: A review

Saheed O Adebayo, Taiwo O Olunuga, Amina Durodola, Okechukwu S Ogah1
Department of Internal Medicine, Cardiology Unit, Federal Medical Centre, Abeokuta, 1Department of Medicine,
Division of Cardiology, University College Hospital, Ibadan, Nigeria

Abstract Heart failure (HF) is a major cause of morbidity and mortality worldwide. HF severity and mortality can be
predicted by measurement of quality of life (QOL). Generic and disease‑specific instruments for measurement
of QOL have been shown to be effective in clinical settings and in research. QOL compares favorably with
traditional calibrators of HF severity such as New York Heart Association (NYHA) class, left ventricular ejection
fraction (LVEF), 6‑min walk test (6MWT), and B‑type natriuretic peptide levels. QOL measurement using
domains such as social interaction, emotion, environmental interaction, sexual activity, and demographic
characteristics, among others, can be used effectively in resource‑limited environments, as well as adjunct
to echocardiography and BNP. Lower QOL predicts early and more frequent HF hospitalization, depression,
higher NYHA class, poor 6MWT, lower estimated glomerular filtration rate, and lower LVEF. Older age,
lower socioeconomic status, longer duration of HF, and comorbidities correspond to lower QOL scores.
Clinical trials incorporating QOL as primary and/or secondary end‑point show improved QOL with the use
of angiotensin receptor blockers, angiotensin‑converting enzyme inhibitors, beta blockers, device therapies,
such as implantable cardiac defibrillator, and exercise‑based rehabilitation. The aim of this paper is to
review information on QOL in HF.

Keywords: Health outcome, heart failure, quality of life

Address for correspondence: Dr. Okechukwu S Ogah, Department of Medicine, Division of Cardiology, University College Hospital, PMB 5116, Ibadan,
Nigeria. E‑mail: osogah56156@yahoo.com

INTRODUCTION traditional functional status assessment (New York Heart

Since the 1980s when the concept of quality of life (QOL)
in health was introduced, it has received tremendous
acceptance to the extent that clinical trials include it as
part of outcome measures.[1‑3] It is now routinely assessed
for clinical, research, and health policy decisions. It has
effectively predicted the severity of heart failure (HF),
morbidity and mortality as well as the cost of management.[1‑7]
Because of psychological, social, emotional, and mental
dimensions involved in health‑related QOL (HRQOL),
its assessment provided additional advantages over the
Association [NYHA], 6‑min walk test [6MWT], and left
ventricular ejection fraction [LVEF]).
QOL is viewed in a broad sense as all factors relating
directly or indirectly to health status. It is a reflection of a
person’s mental and physical well‑being in their everyday
life. Because the functional status of HF patients tends to
affect the domains of the QOL (physical, psychological,
social, emotional, sexual, and mental well‑being), it is
prudent to probe into the relationship between the QOL
and functional status of the patients.

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DOI:
10.4103/0189-7969.201914 How to cite this article: Adebayo SO, Olunuga TO, Durodola A, Ogah OS.
Quality of life in heart failure: A review. Nig J Cardiol 2017;14:1-8.

© 2017 Nigerian Journal of Cardiology | Published by Wolters Kluwer - Medknow 1

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Adebayo, et al.: Quality of life in heart failure
The goals of treatment in patients with HF are to
relieve symptoms, prevent hospital re‑admission, and
improve survival.[8] Therefore, clinical trials have focused on
mortality and hospital readmission as primary end‑points and
changes in functional status (NYHA class, 6MWT), cardiac
biomarkers, left ventricular function, serum creatinine, blood
urea nitrogen, and estimated glomerular filtration rate (GFR)
as secondary end‑points.[9]
Recently, QOL was introduced as an outcome measure
as well as a prognostic variable as many patients prefer
improvement in QOL at the expense of prolonged
survival.[1] Meaningful survival indicates satisfactory QOL
to the patient.[10]
QOL reflects the way a person’s physical and mental well‑being
is evident in their life. It measures the effect of an illness or
its treatment from patients’ perspective.[11] Measurement
of HRQOL promotes patient’s active participation in his
or her care. Determination of HRQOL is likened to blood
pressure measurement in the sense that both require formal
assessment are reproducible and independently predict
adverse outcome.[12]
The aim of this paper is to review information on QOL
in individuals with HF with special reference to available
data from Nigeria.
DEFINITIONS OF QUALITY OF LIFE
In 1948, the World Health Organization (WHO) defined
health as “a state of complete physical, mental and social
well‑being and not merely the absence of disease and
infirmity.”[13] Since then, QOL issues have steadily become
more important in health‑care practice and research.
Although there is no universally agreed definition of QOL,
the WHO has defined QOL as “an individual’s perception
of their position in life in the context of the culture and
value systems in which they live and in relation to their
goals, expectations, standards, and concerns.”[14]
QOL is viewed in a broad sense as all factors relating
directly and indirectly to health status. It is a reflection of
a person’s mental and physical well‑being in their everyday
life.[15]
According to Schipper et al., HRQOL measures the effects
of an illness or treatment from the patient’s perspectives.[16]
The ranges of manifestation of disease in a given patient
include symptoms, functional limitations, and QOL, in
which QOL is the discrepancy between actual and desired
functions.[12]
2 Nigerian Journal of Cardiology
Calman defined QOL as the gap between the patient’s
expectations and achievements.[17] The smaller the gap,
the higher the QOL.[17] Conversely, the less the patient
can realize his expectations, the poorer his QOL. It has
also been shown that the gap between expectations and
achievement may vary over time as the patient’s health
improves or regresses in relation to the effectiveness of
treatment or progress of disease.[17]
A related term to the QOL is health status, which means
the impact of disease on patient’s function as reported by
the patient.[12]
While discussing the social dimension of QOL, Siegrist
and Junge defined social health as “the dimension of an
individual’s well‑being that concerns how the individual
gets along with others, how other people react to him or
her, and how the person interacts with social institutions
and norms.”[18]
The three constructs QOL, HQOL, and Health Status are
frequently used interchangeably in medical literature.[19]
QUALITY OF LIFE INSTRUMENTS
Central to the concept of the QOL is the measurement
which makes use of certain tools referred to as instruments.
These instruments are basically into two categories: generic
instrument and disease‑specific instrument.[20]
In general, instruments used in measuring QOL must possess
the following psychometric properties‑validity (if it is really
measuring what it is supposed to measure), reliability (if it gives the
same measurement after repeated administration in stable
patients), sensitivity (if it can detect clinically meaningful
differences in QOL across the broad spectrum of the clinical
conditions), and responsiveness (if it detects changes when
the patients’ conditions change).[21]
Generic instruments
These are general health measures applicable to a wide
range of groups, age, diseases, and cover a wide range
of QOL domains.[22,23] Examples are shown in Table 1.
Among all of these, Short Form 36 (SF‑36) is the most
frequently used.[24]
Disease‑specific instruments
These instr uments are specifically designed for
cardiovascular diseases (CVDs). They focus on the area
of the health status specific to the cardiac disorders. They
are disease, symptom, or domain specific.[24] Examples are
shown in Table 1.
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Adebayo, et al.: Quality of life in heart failure
Table 1: Types and examples of instruments used for the
assessment of quality of life
Type of Examples
instrument
Generic Medical outcomes study item SF‑36 and
instruments SF‑12
Ladder of life
Scale of life satisfaction
PGWB
SIP
Nottingham health profile
The functional status questionnaire
WHO health‑related QOL questionnaire etc.
Disease‑specific Chronic HF questionnaire
instruments MLHF questionnaire
KCCQ
HF functional status inventory
The Yale scale
Signs and symptoms of HF questionnaire
scales
QOL: Quality of life; PGWB: Psychological general well‑being index;
SIP: Sickness impact profile; WHO: World Health Organization;
HF: Heart failure; MLHF: Minnesota living with health failure;
KCCQ: Kansas City Cardiomyopathy Questionnaire; SF: Short form
The Minnesota Living with Health Failure (MLHF)
Questionnaire is the most frequently used disease‑specific
instrument.[22,24]
In QOL research, it is recommended that both a generic
and a disease‑specific instrument be combined so as
to synergize the advantages inherent in each of the
instruments.[22,25]
Domains of quality of life
These are aspects of behavior that are measured. These
vary depending on the type of instrument used.[19] They
range from physical activity, social interaction, sexual
activity, work, emotion, psychological, environmental,
symptom stability, symptom burden, self‑efficacy, clinical
summary, gender, age, mental health, body pain, role
limitations, etc.[17,19]
Medical Outcomes Study (Item Short Form 36)
The SF 36 was developed by Stewart, Hayes, and
Ware in 1988 for a health insurance study by RAND
Corporation.[24] It is the most widely and extensively used
generic instrument.[22] It is used to gather information
about the individual’s multidimensional health concepts. It
also measures a full range of domains including well‑being
and personal evaluations. SF‑36 is suitable for use in HF
trials and can be used in conjunction with disease‑specific
questionnaires. It has been found to be more sensitive to
small degree of impairment in QOL.[22]
SF‑36 consists of eight scaled scores, which are the
weighted sums of the questions in their section. Each scale
Nigerian Journal of Cardiology | Volume 14 | Issue 1 | January-June 2017 3
is directly transformed into a 0–100 scale on the assumption
that each question carries equal weight.[26]
The eight sections are vitality, physical functioning, bodily
pain, and general health perceptions. Others include
physical role functioning, emotional role functioning, social
role functioning, and mental health.
Two summary scores can be generated from the above
which are the physical component and the mental
component summaries.[26]
Minnesota Living with Health Failure Questionnaire
The questionnaire was developed in 1984 by Rector et al.
in the USA.[27,28]
The objective is to systematically and comprehensively
assess the patient’s perceptions of the effects of HF and
its treatment on his or her daily life.[29,30] It is a 21‑item
questionnaire using a six‑point Likert scale (0–5) with score
0 (no impairment) and score 105 (maximum impairment)
as a result of HF. It is the most frequently and extensively
studied disease‑specific instrument.[24] MLHF assesses the
patient’s perception of the effects of HF on the physical,
socioeconomic, and psychological aspects of life. It is,
short, easy to understand, and easy to administer. It can be
self‑ or interviewer‑administered and could be completed
within 5–10 min. [31] It has high internal consistency
reliability with Cronbach’s alpha of 0.86.[28,32]
Quality of life and demographic profile of heart failure
patients
The relationship between QOL and demographic profiles
of HF patients, especially age, gender, and race are
inconsistent. While some studies reported that older age is
associated with higher QOL, others reported no correlation
or that older age is associated with lower QOL.[23,33‑35]
However, recent study by Hoekstra et al. revealed that
low QOL is related to older age, female gender, duration
of HF, and comorbidities.[36] Contrary to this, Mbakwem
et al. found that gender did not correlate with QOL in an
HF cohort in Lagos.[37]
In a review of QOL studies in Iran between the year 2000
and 2012, men were found to have better QOL compared
to women, especially in physical and mental function while
increasing age was associated with significant decrease in
QOL in most of the studies.[38]
In addition, higher educational status being married and
being employed had positive correlation with QOL in the
majority of the studies.[38] In contrast, longer duration
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Adebayo, et al.: Quality of life in heart failure
of cardiac disease, frequent hospitalizations, background
medical disorders (such as hypertension, diabetes, and
hyperlipidemia), and family history of cardiac diseases
had a significant decremental relationship to QOL.[38]
In a recent scientific statement by the American Heart
Association on measurement of patient‑reported health
status, it was concluded that women with CVDs had poorer
QOL status. Likewise, lower socioeconomic status (SES)
is also associated with worse health status.[25]
Findings on race and ethnicity were dependent on specific
disease conditions.[25] For coronary heart disease, Blacks
and Hispanic had significantly worse QOL than whites.
No relationship was found between ethnicity and QOL in
patients with advanced HF.[25]
Quality of life and socioeconomic status
SES is usually assessed using the educational level,
occupation, and income.[39,40] Studies in the USA have
shown that low SES is associated with high prevalence
of risk factors, poor health education and knowledge
of risk factors, late/severe presentation of CVDs, poor
health‑seeking behavior, and poor access to the health
care. In addition, it is associated with inability to afford
the medication, poor adherence to the treatment, poor
follow‑up, and high rehospitalization rate and mortality.[41‑44]
Results from Atherosclerosis Risk in Communities Study
indicate that people with lower SES had a 50% greater
risk of developing heart disease. Therefore, being poor or
having low level of education can be considered as extra
risk factors for developing CVDs.
Similarly, a study from Iran showed that lower SES
independently and strongly increased the risk of
readmission for HF with a hazard ratio of 2.66, after
controlling for the confounders.[41]
Spertus et al. investigated the effect of the difficulty
affording health care on health status.[45] The authors
found that QOL (using the Seattle Angina Questionnaire)
was significantly affected at the time of coronary
revascularization which persisted 6 months after the
percutaneous coronary intervention in subjects who had
difficulty in financing their health care.[45] Similarly, using
level of employment grade as an indicator for SES, lower
grade was associated with poor physical function on SF‑36
QOL questionnaire.[46]
Heavy economic burden of HF has recently been shown
from the Abeokuta HF registry, in which total cost of care
4 Nigerian Journal of Cardiology
was estimated to be ₦76 million translating to ₦319,000
per patient per year.[47,48] In developed countries, QOL
assessment had been used to predict cost of treatment over
the 12 months period thereby guiding the allocation of the
scarce resources in the management of cardiac diseases.[5,49]
In QOL substudy of the Eplerenone Post‑Acute myocardial
Infarction HF Efficacy and Survival Study (EPHESUS),
health status assessment using Kansas City Cardiomyopathy
Questionnaire (KCCQ) was used to predict the cost of
treatment over the next 12 months with more than 300%
additional cost incurred by the subjects with worst health
status.[5]
Quality of life and depression
The prevalence of depression is high among CHF patients
contributing to the low QOL.[50] A study found that the
incidence of depression in an outpatient HF population
was 48%, with higher rates among females (compared with
males) and Whites (compared with Blacks).[34] In addition,
when compared with nondepressed individuals, depressed
individuals were more likely to receive higher QOL scores
on both the SF‑36 and the MLHF.[34]
Depressed individuals were also more likely to receive
lower QOL scores on the KCCQ and depression remains
a strong predictor of short‑term decreases in QOL even
after controlling for other patients’ variables.[23,51] This could
be partially explained by poor motivation.[23,51,52]
Likewise, lower QOL as measured on the KCCQ was
associated with decreased medication adherence in HF
outpatients and that concomitant depression seems to
partially explain this correlation.[53]
Ola et al. in Ile‑Ife evaluated the relationship between
depression and QOL in HF patients and found that
the QOL was worse in subjects with major depressive
disorder than those without depression.[50] The factors
that independently correlated with poor QOL were
disability due to illness, younger age, duration of illness,
and presence of major depressive disorder.[50] The authors
concluded that programs designed to improve QOL
should also incorporate early detection and treatment of
depression.[50]
Quality of life and severity of heart failure
Low QOL correlates with higher NYHA functional
class, poor 6MWT, and low estimated GFRs.[35] Juenger
et al. found that QOL decreases as NYHA functional
class worsens (P < 0.001).[35] Jefferson and Brofman
found that QOL correlated significantly with the distance
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Adebayo, et al.: Quality of life in heart failure
covered (r = −0.62, P  = 0.004). The longer the distance
covered in the 6MWT, the better the QOL.[54]
However, the relationship with ejection fraction (EF) is
inconsistent. Parajón et al. found no correlation between
LVEF and QOL while Quittan et al. reported weak
correlation with LVEF (p ꞊ 0.01).[55,56]
Quality of life and interventions
Pharmacologic and nonpharmacologic trials are now
incorporating QOL as primary and/or secondary
end‑points. There are interventions that have been
found to improve QOL in HF patients. Use of
angiotensin II receptor blocker (candesartan), angiotensin
converting enzyme inhibitor, beta blockers, device‑based
therapy‑(Pacing, Cardiac, and Resynchronization Therapy),
and exercise‑based rehabilitation are known to improve
QOL.[57‑61] Furthermore, the increase in peak oxygen
uptake achieved by exercise training had been associated
with an improvement in QOL[28] Hoekstra et al. also found
that patients with low QOL are less likely to be using beta
blockers.[36]
However, in the assessment of long‑term effects of
irbesartan on HF with preserved EF (I‑PRESERVE
trial) as measured by the MLHF questionnaire, irbesartan
did not substantially improve the MLHF scores after
6 months of follow‑up. [62] A controlled clinical trial
also demonstrated that digoxin did not significantly
improve MLHF scores compared to placebo. [63]
However, withdrawing digoxin from those already on it
was associated with worsened MLHF scores compared
to those who continued on the drug.[63] Similarly, there
was no significant improvement in QOL measured
by MLHF in several clinical trials of calcium channel
blockers in HF.[64,66]
Accordingly, interventions that improve QOL are now
forming an integral component of the HF management.
Quality of life as an independent predictor of mortality
Baseline QOL is a predictor of adverse clinical outcomes
such as short‑term mortality, risk of early hospital
readmission, and duration of hospital stay.[67]
Konstam et al. found that the baseline QOL independently
predicted mortality and HF‑related hospitalizations in
symptomatic and asymptomatic patients randomized
to enalapril or placebo treatment in the studies of the
left ventricular dysfunction.[1] In this study, domains of
activities of daily living and general health were found to
predict mortality and HF‑related hospitalizations in both
Nigerian Journal of Cardiology | Volume 14 | Issue 1 | January-June 2017 5
univariate and multivariate analysis.[1] EPidémiologie de
l’Insuffisance Cardiaque Avancée en Lorraine study also
found that 10‑point decrease in MLHF scores assessed
4 weeks after discharge from hospital admission for HF
was associated with unadjusted 23% increased risk of
death and 33% increased risk of rehospitalization or
death during follow‑up.[68]
Mbakwem et al. in Lagos found a negative correlation
between QOL and number of hospital admissions (r ꞊ −0.167,
P ꞊ 0.02).[37] Recent work by Hoekstra et al. also found
that QOL independent of BNP values predicted 3 years
mortality in patients with HF.[36] These findings indicate that
QOL assessment provides additional predictive values with
respect to both mortality and HF‑related hospitalizations,
superior to the predictive power of variables, such as EF,
age, treatment, and the NYHA class.[69]
STUDIES OF QUALITY OF LIFE IN HEART
FAILURE PATIENTS IN NIGERIA
There are few studies on the QOL in Nigerian HF
population. [37,50] Ola et al . in 2006 investigated the
relationship between depression and QOL in Nigerian
outpatients with HF.[37] One hundred HF subjects were
studied. Subjects completed the WHO QOL scales brief
version (WHO QOL BREF) to assess their QOL, and
depression was diagnosed according to Diagnostic and
Statistical Manual of Mental Health Disorders, fourth
edition. The result of this study revealed the factors
independently associated with poor QOL. These include
disability from the illness, presence of major depressive
illness, younger age, and longer duration of illness. Patients
with major depressive illness were noted to have worse
QOL than those without major depressive illness on
dimension of physical health, psychological health, and
environment.[37]
In another study, Mbakwem et al. did a comparative analysis
of the QOL of HF patients in Lagos using a generic
questionnaire (WHO QOL BREF and a disease‑specific
questionnaire, KCCQ).[50] The authors reported that 25%
of the participants had poor QOL. There was positive
correlation between the KCCQ QOL and WHO‑BREF
QOL score (P < 0.001), and the four domains assessed,
namely, physical health, psychological, social relationship,
and environment.[50]
Furthermore, Iseko in Ibadan recently investigated the
relationship between functional status and HRQOL in
patients with HF.[70] The authors concluded that 41.6% of the
subjects had suboptimal QOL and that the disease‑specific
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Adebayo, et al.: Quality of life in heart failure
instrument used, MLHF demonstrated high reliability with
Cronbach’s alpha score  (reliability coefficient) of 0.928.
There were statistically significant relationship between
the MLHF and the NYHA class (r ‑ 0.776, P < 0.001) and
6MWT (r ‑ 0.3986, P < 0.001). There was also significant
relationship between LV systolic function and global
QOL (r ‑ −0.235, P < 0.005).
From the above, it is obvious that the QOL in Nigerian HF
patients is significantly impaired. None of the mentioned
studies has objectively compared the QOL findings in HF
patients with that of healthy controls and also evaluated
the correlation with the laboratory features in HF subjects.
Therefore, there is great need to further document the
QOL and its correlates in HF patients in our environment.
CONCLUSION
QOL has been used successfully as a predictor of adverse
outcome in HF. Its reliability in HF assessment and
prognostication is comparable to traditional HF assessment
tools such as LVEF, 6MWT, B‑type natriuretic peptide,
and NYHA class. Various generic and disease‑specific
measurement instruments have proved effective in QOL
measurement in HF. Hence, its application as a tool in
routine clinical assessment for HF patients at baseline and
as a tool for assessing the impact of pharmacologic as well
as nonpharmacologic care of HF patient is important.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 REFERENCES
1. Konstam V, Salem D, Pouleur H, Kostis J, Gorkin L, Shumaker S, et al.
Baseline quality of life as a predictor of mortality and hospitalization
in 5,025 patients with congestive heart failure. SOLVD Investigations.
Studies of Left Ventricular Dysfunction Investigators. Am J Cardiol
1996;78:890‑5.
2. Rodríguez‑Artalejo  F, Guallar‑Castillón P, Pascual  CR, Otero  CM,
Montes AO, García AN, et al. Health‑related quality of life as a predictor
of hospital readmission and death among patients with heart failure.
Arch Intern Med 2005;165:1274‑9.
3. Zuluaga  MC, Guallar‑Castillón P, López‑García E, Banegas  JR,
Conde‑Herrera M, Olcoz‑Chiva M, et al. Generic and disease‑specific
quality of life as a predictor of long‑term mortality in heart failure.
Eur J Heart Fail 2010;12:1372‑8.
4. Holland R, Rechel B, Stepien K, Harvey I, Brooksby I. Patients’
self‑assessed functional status in heart failure by New York Heart
Association class: A prognostic predictor of hospitalizations, quality
of life and death. J Card Fail 2010;16:150‑6.
5. Chan PS, Soto G, Jones PG, Nallamothu BK, Zhang Z, Weintraub WS,
et al. Patient health status and costs in heart failure: Insights from the
6 Nigerian Journal of Cardiology
eplerenone post‑acute myocardial infarction heart failure efficacy and
survival study (EPHESUS). Circulation 2009;119:398‑407.
6. DeSalvo KB, Jones TM, Peabody J, McDonald J, Fihn S, Fan V, et al.
Health care expenditure prediction with a single item, self‑rated health
measure. Med Care 2009;47:440‑7.
7. Carels RA. The association between disease severity, functional status,
depression and daily quality of life in congestive heart failure patients.
Qual Life Res 2004;13:63‑72.
8. Francis GS, Tang WH, Richard A. Pathophysiology of Heart Failure.
In: Fuster V, Waish RA, Harrington RA, editors. Hurst's the heart.
13th ed. USA: The Mcgraw-Hill Companies; 2011:719-738.
9. Dunderdale  K, Thompson  DR, Miles  JN, Beer  SF, Furze  G.
Quality‑of‑life measurement in chronic heart failure: Do we take
account of the patient perspective? Eur J Heart Fail 2005;7:572‑82.
10. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Drazner MH,
et al. 2013 ACCF/AHA guideline for the management of heart
failure: A report of the American College of Cardiology Foundation/
American Heart Association Task Force on Practice Guidelines. J Am
Coll Cardiol 2013;62:e147‑239.
11. Heo S, Lennie TA, Okoli C, Moser DK. Quality of life in patients with
heart failure: Ask the patients. Heart Lung 2009;38:100‑8.
12. Rumsfeld JS. Health status and clinical practice: When will they meet?
Circulation 2002;106:5‑7.
13. Callahan D. The WHO definition of 'health'. Hastings Center Studies
1973:77-87.
14. Study protocol for the World Health Organization project to develop
a quality of life assessment instrument (WHOQOL). Qual Life Res
1993;2:153‑9.
15. Guyatt GH. Measurement of health‑related quality of life in heart
failure. J Am Coll Cardiol 1993;22 4 Suppl A: 185A‑91A.
16. Schipper H, Clinch J, McMurray A, Levitt M. Measuring the quality
of life of cancer patients: The Functional Living Index‑Cancer:
Development and validation. J Clin Oncol 1984;2:472‑83.
17. Calman KC. Quality of life in cancer patients – An hypothesis. J Med
Ethics 1984;10:124‑7.
18. Siegrist J, Junge A. Measuring the social dimension of subjective health
in chronic illness. Psychother Psychosom 1990;54:90‑8.
19. Coelho R, Ramos S, Prata J, Bettencourt P, Fer reira A,
Cerqueira‑Gomes M. Heart failure and health related quality of life.
Clin Pract Epidemiol Ment Health 2005;1:19.
20. Patrick DL, Deyo RA. Generic and disease‑specific measures in assessing
health status and quality of life. Med Care 1989;27 3 Suppl: S217‑32.
21. Lunneborg CE. Book Review: Psychometric Theory: Second Edition
Jum C. Nunnally New York: Mcgraw-Hill; 1978.
22. Morgan K, McGee H, Shelley E. Quality of life assessment in heart
failure interventions: A 10‑year (1996‑2005) review. Eur J Cardiovasc
Prev Rehabil 2007;14:589‑607.
23. Gott M, Barnes S, Parker C, Payne S, Seamark D, Gariballa S, et al.
Predictors of the quality of life of older people with heart failure
recruited from primary care. Age Ageing 2006;35:172‑7.
24. Garin  O, Ferrer  M, Pont  A, Rué M, Kotzeva  A, Wiklund  I, et al.
Disease‑specific health‑related quality of life questionnaires for
heart failure: A systematic review with meta‑analyses. Qual Life Res
2009;18:71‑85.
25. Rumsfeld  JS, Alexander  KP, Goff DC Jr., Graham  MM, Ho  PM,
Masoudi FA, et al. Cardiovascular health: The importance of measuring
patient‑reported health status: A scientific statement from the
American Heart Association. Circulation 2013;127:2233‑49.
26. Vilagut G, Valderas JM, Ferrer M, Garin O, López‑García E, Alonso J.
Interpretation of SF‑36 and SF‑12 questionnaires in Spain: Physical
and mental components. Med Clin (Barc) 2008;130:726‑35.
27. Rector T, Cohn J. Minnesota living with heart failure questionnaire.
Minnesota: University of Minnesota; 2004.
28. Rector T, Kubo S, Cohn J. Patients’ self-assessment of their congestive
heart failure. Part 2: content, reliability and validity of a new measure,
| Volume 14 | Issue 1 | January-June 2017
[Downloaded free from http://www.nigjcardiol.org on Saturday, April 20, 2019, IP: 182.1.60.229]
Adebayo, et al.: Quality of life in heart failure
the Minnesota Living with Heart Failure Questionnaire. Heart failure
1987;3:198-209.
29. Rector TS, Anand IS, Cohn JN. Relationships between clinical
assessments and patients’ perceptions of the effects of heart failure
on their quality of life. J Card Fail 2006;12:87‑92.
30. Rector  TS, Tschumperlin  LK, Kubo  SH, Bank  AJ, Francis  GS,
McDonald KM, et al. Use of the living with heart failure questionnaire
to ascertain patients’ perspectives on improvement in quality of life
versus risk of drug‑induced death. J Card Fail 1995;1:201‑6.
31. Rector T, Cohn J. Minnesota Living with Heart Failure Questionnaire;
2004. Available from: http://www.licenseumnedu/Products/
M i n n e s o t a ‑ L iv i n g ‑ W i t h ‑ H e a r t ‑ Fa i l u r e ‑ Q u e s t i o n n a i r e _ _
Z94019aspx. [Last accessed on 2011 Aug 08].
32. Rector TS, Cohn JN. Assessment of patient outcome with the
Minnesota living with heart failure questionnaire: Reliability and
validity during a randomized, double‑blind, placebo‑controlled trial of
pimobendan. Pimobendan Multicenter Research Group. Am Heart J
1992;124:1017‑25.
33. Clark DO, Tu W, Weiner M, Murray MD. Correlates of health‑related
quality of life among lower‑income, urban adults with congestive heart
failure. Heart Lung 2003;32:391‑401.
34. Gottlieb SS, Khatta M, Friedmann E, Einbinder L, Katzen S, Baker B,
et al. The influence of age, gender, and race on the prevalence of
depression in heart failure patients. J Am Coll Cardiol 2004;43:1542‑9.
35. Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W,
et al. Health related quality of life in patients with congestive heart
failure: Comparison with other chronic diseases and relation to
functional variables. Heart 2002;87:235‑41.
36. Hoekstra T, Jaarsma T, van Veldhuisen DJ, Hillege HL, Sanderman R,
Lesman‑Leegte I. Quality of life and survival in patients with heart
failure. Eur J Heart Fail 2013;15:94‑102.
37. Mbakwem A, Aina F, Amadi C, Akinbode A, Mokwunyei J.
Comparative analysis of the quality of life of heart failure patients
in South Western Nigeria. World Journal of Cardiovascular Diseases
2013:146-53.
38. Yaghoubi A, Tabrizi JS, Mirinazhad MM, Azami S, Naghavi‑Behzad M,
Ghojazadeh M. Quality of life in cardiovascular patients in iran and
factors affecting it: A systematic review. J Cardiovasc Thorac Res
2012;4:95‑101.
39. Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status
and health: How education, income, and occupation contribute to risk
factors for cardiovascular disease. Am J Public Health 1992;82:816‑20.
40. Chukwuonye II, Chuku A, Okpechi IG, Onyeonoro UU, Madukwe OO,
Okafor GO, et al. Socioeconomic status and obesity in Abia State, South
East Nigeria. Diabetes Metab Syndr Obes 2013;6:371‑8.
41. Noori A, Shokoohi M, Baneshi MR, Naderi N, Bakhshandeh H,
Haghdoost AA. Impact of socio‑economic status on the hospital
readmission of congestive heart failure patients: A prospective cohort
study. Int J Health Policy Manag 2014;3:251‑7.
42. Rathore SS, Masoudi FA, Wang Y, Curtis JP, Foody JM, Havranek EP,
et al. Socioeconomic status, treatment, and outcomes among elderly
patients hospitalized with heart failure: Findings from the national
heart failure Project. Am Heart J 2006;152:371‑8.
43. Philbin EF, Dec GW, Jenkins PL, DiSalvo TG. Socioeconomic status
as an independent risk factor for hospital readmission for heart failure.
Am J Cardiol 2001;87:1367‑71.
44. Burstin HR, Lipsitz SR, Brennan TA. Socioeconomic status and risk
for substandard medical care. JAMA 1992;268:2383‑7.
45. Spertus J, Decker C, Woodman C, House J, Jones P, O’Keefe J, et al.
Effect of difficulty affording health care on health status after coronary
revascularization. Circulation 2005;111:2572‑8.
46. Hemingway H, Nicholson A, Stafford M, Roberts R, Marmot M. The
impact of socioeconomic status on health functioning as assessed by
the SF‑36 questionnaire: The Whitehall II Study. Am J Public Health
1997;87:1484‑90.
47. Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA,
Nigerian Journal of Cardiology | Volume 14 | Issue 1 | January-June 2017 7
et al. Contemporary profile of acute heart failure in Southern Nigeria:
Data from the Abeokuta Heart Failure Clinical Registry. JACC Heart
Fail 2014;2:250‑9.
48. Ogah OS, Stewart S, Onwujekwe OE, Falase AO, Adebayo SO,
Olunuga T, et al. Economic burden of heart failure: Investigating
outpatient and inpatient costs in Abeokuta, Southwest Nigeria. PLoS
One 2014;9:e113032.
49. Spertus JA, Tooley J, Jones P, Poston C, Mahoney E, Deedwania P,
et al. Expanding the outcomes in clinical trials of heart failure: The
quality of life and economic components of EPHESUS (EPlerenone’s
neuroHormonal Efficacy and SUrvival Study). Am Heart J
2002;143:636‑42.
50. Ola BA, Adewuya AO, Ajayi OE, Akintomide AO, Oginni OO,
Ologun YA. Relationship between depression and quality of
life in Nigerian outpatients with heart failure. J Psychosom Res
2006;61:797‑800.
51. Rumsfeld JS, Magid DJ, Plomondon ME, Sales AE, Grunwald GK,
Every NR, et al. History of depression, angina, and quality of life after
acute coronary syndromes. Am Heart J 2003;145:493‑9.
52. Rumsfeld  JS, Jones  PG, Whooley  MA, Sullivan  MD, Pitt  B,
Weintraub WS, et al. Depression predicts mortality and hospitalization
in patients with myocardial infarction complicated by heart failure. Am
Heart J 2005;150:961‑7.
53. Morgan  AL, Masoudi  FA, Havranek  EP, Jones  PG, Peterson  PN,
Krumholz HM, et al. Difficulty taking medications, depression, and
health status in heart failure patients. J Card Fail 2006;12:54‑60.
54. Santos JJ, Brofman PR. Six-minute walk test and quality-of-life in
heart failure A correlative study with a Brazilian sample. Insuficiencia
cardíaca 2008;3:72-75.
55. Parajón T, Lupón J, González B, Urrutia A, Altimir S, Coll R, et al. Use
of the Minnesota living with heart failure quality of life questionnaire
in Spain. Rev Esp Cardiol 2004;57:155‑60.
56. Quittan  M, Wiesinger  GF, Crevenna  R, Nuhr  MJ, Posch  M,
Hülsmann M, et al. Cross‑cultural adaptation of the Minnesota
living with heart failure questionnaire for German‑speaking patients.
J Rehabil Med 2001;33:182‑6.
57. Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S, et al.
Exercise based rehabilitation for heart failure. Cochrane Database Syst
Rev 2010;(4):CD003331.
58. Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, et al.
Long‑term benefits of biventricular pacing in congestive heart failure:
Results from the MUltisite STimulation in cardiomyopathy (MUSTIC)
study. J Am Coll Cardiol 2002;40:111‑8.
59. Curiati JA, Bocchi E, Freire JO, Arantes AC, Braga M, Garcia Y, et al.
Meditation reduces sympathetic activation and improves the quality of
life in elderly patients with optimally treated heart failure: A prospective
randomized study. J Altern Complement Med 2005;11:465‑72.
60. Wolfel EE. Effects of ACE inhibitor therapy on quality of life in
patients with heart failure. Pharmacotherapy 1998;18:1323‑34.
61. Maciver J, Rao V, Ross HJ. Quality of life for patients supported on a
left ventricular assist device. Expert Rev Med Devices 2011;8:325‑37.
62. Rector TS, Carson PE, Anand IS, McMurray JJ, Zile MR, McKelvie RS,
et al. Assessment of long‑term effects of irbesartan on heart failure
with preserved ejection fraction as measured by the minnesota living
with heart failure questionnaire in the irbesartan in heart failure with
preserved systolic function (I‑PRESERVE) trial. Circ Heart Fail
2012;5:217‑25.
63. Lader E, Egan D, Hunsberger S, Garg R, Czajkowski S, McSherry F.
The effect of digoxin on the quality of life in patients with heart failure.
J Card Fail 2003;9:4‑12.
64. Packer M, Carson P, Elkayam U, Konstam MA, Moe G, O’Connor C,
et al. Effect of amlodipine on the survival of patients with severe
chronic heart failure due to a nonischemic cardiomyopathy: Results
of the PRAISE‑2 study (prospective randomized amlodipine survival
evaluation 2). JACC Heart Fail 2013;1:308‑14.
65. Udelson JE, DeAbate CA, Berk M, Neuberg G, Packer M, Vijay NK,
[Downloaded free from http://www.nigjcardiol.org on Saturday, April 20, 2019, IP: 182.1.60.229]

Adebayo, et al.: Quality of life in heart failure

et al. Effects of amlodipine on exercise tolerance, quality of life, and left
ventricular function in patients with heart failure from left ventricular
systolic dysfunction. Am Heart J 2000;139:503‑10.
66. Levine  TB, Bernink  PJ, Caspi  A, Elkayam  U, Geltman  EM,
Greenberg  B, et al. Effect of mibefradil, a T‑type calcium channel
blocker, on morbidity and mortality in moderate to severe congestive
heart failure: The MACH‑1 study. Mortality Assessment in Congestive
Heart Failure Trial. Circulation 2000;101:758‑64.
67. Faller H, Störk S, Schowalter M, Steinbüchel T, Wollner V, Ertl G, et al.
Is health‑related quality of life an independent predictor of survival in
patients with chronic heart failure? J Psychosom Res 2007;63:533‑8.
68. Alla F, Briançon S, Guillemin F, Juillière Y, Mertès PM, Villemot JP,
et al. Self‑rating of quality of life provides additional prognostic
information in heart failure. Insights into the EPICAL study. Eur J
Heart Fail 2002;4:337‑43.
69. Rector TS, Kubo SH, Cohn JN. Validity of the Minnesota living with
heart failure questionnaire as a measure of therapeutic response to
enalapril or placebo. Am J Cardiol 1993;71:1106‑7.
70. Iseko II. Relationship Between Functional Status And Health Related
Quality of Life in Patients With Heart Failure. Faculty of Internal
Medicine. Lagos: National Postgraduate Medical College of Nigeria,
2015.

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