Michael M. Givertz

QUALITY OF LIFE 60 DAYS AFTER AN ACUTE HEART FAILURE EVENT: INSIGHTS FROM THE PROTECT TRIAL

Background: Acute heart failure (AHF) causes disabling symptoms and is associated with an adverse prognosis. Treatment improves symptoms acutely but little is known about what proportion of patients makes a good symptomatic recovery during follow-up or survives but with debilitating symptoms. Methods: Data on quality of life (QoL) was collected using the EQ5D instrument at 14 and 60 days after enrolment in a randomised controlled trial comparing rolofylline to placebo in patients with AHF (PROTECT) and plasma BNP >500pg/ml or NT-proBNP >2,000pg/ml. A QoL of 1.0 is the highest attainable. A poor QoL can receive a value below zero. Results: Of 2,033 patients, the median [IQR] age was 72 [62-79] years and 33% were women. By day 14, 72 (4%) patients had died and 1835 completed an EQ5D. By day 60, 173 patients (9%) had died and 1764 completed an EQ5D. On days 14 and 60, 336 (18%) and 388 (22%) of survivors reported no impairment in any EQ5D dimension. At day 60, extreme problems were reported by 4% for mobility, 5% for self-care, 12% for activity, 4% for pain and 5% for mood, whilst 57%, 36%, 49%, 43% and 32% reported moderate problems and 38%, 59%, 40%, 54% and 63% reported no problems in these categories. The median [IQR] EQ5D summary score (UK TTO weights) on Day 14 was 0.71 [0.52 to 0.85] and on Day 60 was 0.73 [0.52 to 0.88], with younger (60-69 years; 0.74 [0.62 - 0.88]) having higher scores than older (70-79 years; 0.71 [0.52 - 0.88) patients. For comparison, median scores for general populations in these age groups are 0.80 and 0.73 and in similarly aged patients with chronic heart failure (CARE-HF) who declared themselves in NYHA class I/II was 0.78 (0.69-0.85) and in class III/IV was 0.62 (0.38-0.76). Conclusion: Although AHF is associated with a high mortality, few survivors report very poor QoL and a substantial minority report QoL similar to the general population at 60 days. Mobility and activity are the EQ5D dimensions most likely to show persistent impairment.