Changes over time in patient-reported outcomes in patients with heart failure.

AIM: This paper describes the trajectory during 1 year of four patient-reported outcomes (PROs), namely, sleep, depressive symptoms, health-related quality of life (HrQoL), and well-being, in patients with heart failure (HF), their relationship and the patient characteristics associated with changes in these PROs. METHODS AND RESULTS: Data analyses of PROs from 603 patients (mean age 67 years; 29% female, 60% NYHA II) enrolled in the HF-Wii study. On short term, between baseline and 3 months, 16% of the patients experienced continuing poor sleep, 11% had sustained depressive symptoms, 13% had consistent poor HrQoL, and 13% consistent poor well-being. Across the entire 1-year period only 21% of the patients had good PRO scores at all timepoints (baseline, 3, 6, and 12 months). All others had at least one low score in any of the PROs at some timepoint during the study. Over the 12 months, 17% had consistently poor sleep, 17% had sustained symptoms of depression, 15% consistently rated a poor HrQoL, and 13% poor well-being. Different patient characteristics per PRO were associated with a poor outcomes across the 12 months. Age, education, New York Heart Association, and length of disease were related to two PRO domains and submaximal exercise capacity (6 min test), co-morbidity, and poor physical activity to one. CONCLUSION: In total, 79% of the patients with HF encountered problems related to sleep, depressive symptoms, HrQoL, and well-being at least once during a 1-year period. This underscores the need for continuous monitoring and follow-up of patients with HF and the need for dynamic adjustments in treatment and care regularly throughout the HF trajectory.

Multivariate and multidimensional analysis of cardiovascular oscillations in patients with heart failure.

Within 5 years of first diagnosis, nearly 60% of patients with heart failure (HF) suffer from cardiac death. Early diagnosis of HF and reliable risk prediction are still required. Therefore, the objective of this study was to develop a parameter set for enhanced risk stratification in HF patients. In 43 patients suffering from HF (NYHA class > or =II, ejection fraction <45%) and 10 healthy subjects (REF), heart rate and blood pressure variability (HRV and BPV), interactions between heart rate and blood pressure (joint symbolic dynamics, JSD) and blood pressure morphology (BPM) were analysed. BPV, BPM and JSD measures revealed high significance (p<0.0001) in discriminating REF and HF. A set of three parameters from BPV, JSD and BPM was developed for risk stratification (sensitivity 76.5%, specificity 84.2%, area under the receiver operating characteristic curve 81.4%) in patients with HF.