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Quality of Life, Resource Use, and Survival

Priit Jaagosild, MD; Neal V. Dawson, MD; Charles Thomas, BA; Neil S. Wenger, MD; Joel Tsevat, MD, MPH; William A. Knaus, MD; Robert M. Califf, MD; Lee Goldman, MD; Humberto Vidaillet, MD; Alfred F. Connors, Jr, MD; for the SUPPORT Investigators

Arch Intern Med. 1998;158:1081-1089.

Background  Congestive heart failure (CHF) is a common disease with high health care costs and high mortality rates. Knowledge of the health-related quality of life outcomes of CHF may guide decision making and be useful in assessing new therapies for this population.

Methods  A prospective cohort study was conducted involving 1390 adult patients hospitalized with an acute exacerbation of severe CHF (New York Heart Association class III-IV). Demographic data and health-related quality of life were determined by interview; physiologic status and cost and intensity of care were determined from hospital charts.

Results  The median (25th, 75th percentiles) age of patients was 68.0 (58.2, 76.9) years; 61.7% were male. Survival was 93.4% at discharge from the index hospitalization, 72.9% at 180 days, and 61.5% at 1 year. Of patients interviewed at 180 days, the median health rating on a scale of 0 to 100 (0 indicates death; 100, excellent health) was 60 (interquartile range, 50-80), and 59.7% were independent in their activities of daily living. Overall quality of life was reported to be good, very good, or excellent in 58.2% at 180 days. Patients with worse functional capacity were more likely to die. Health perceptions among the patients with available interview data improved at 60 and 180 days after acute exacerbation of severe CHF.

Conclusions  Patients hospitalized for acute exacerbation of severe CHF have a generally poor 6-month survival, but survivors retain relatively good functional status and have good health perceptions. Furthermore, health perceptions improve after the acute exacerbation.

From the Departments of Medicine at the following institutions: MetroHealth Medical Center, Case Western Reserve University, Cleveland (Drs Jaagosild and Dawson, and Mr Thomas) and the University of Cincinnati Medical Center, Cincinnati (Dr Tsevat), Ohio; University of California Medical Center, Los Angeles (Dr Wenger); University of Virginia School of Medicine, Charlottesville (Drs Knaus and Connors); Duke University Medical Center, Durham, NC (Dr Califf); University of California, San Franciscov (Dr Goldman); and Marshfield Medical Research Foundation, Marshfield Clinic, Marshfield, Wis (Dr Vidaillet).

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