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09-04-2021 | Uitgave 5/2021

Quality of Life Research 5/2021

Financial difficulties and patient-reported outcomes among patients with advanced heart failure

Quality of Life Research > Uitgave 5/2021
Chetna Malhotra, Filipinas Bundoc, Felicia Jia Ler Ang, Semra Ozdemir, Irene Teo, David Sim, Fazlur Rehman Jaufeerally, Than Aung, Eric Finkelstein
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Supplementary information

The online version of this article (https://​doi.​org/​10.​1007/​s11136-020-02736-7) contains supplementary material, which is available to authorized users.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s11136-021-02881-7.

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Management of congestive heart failure (CHF) is associated with high health care costs and financial difficulties for patients. We aimed to comprehensively assess the association between financial difficulties and patients’ quality of life (QOL) (physical, emotional, social and spiritual), perceived health care quality, and perception of being a burden to the family among patients with CHF; and to assess whether perceived control over stress moderated these associations.


This was a cross-sectional study of 250 patients using the baseline data of the Singapore Cohort of Patients with Advanced Heart Failure (SCOPAH). Patients had class 3 or 4 CHF symptoms based on the New York Heart Association and were recruited between July 2017 and August 2019. We used a 3-item questionnaire to measure financial difficulties among patients. We used multivariable linear/ordered logistic regressions to test associations between financial difficulties and each dependent variable.


41% of participants reported financial difficulties. A higher financial difficulties score (range: 0–6, higher score indicating greater difficulty) was associated with lower QOL (emotional, social, and spiritual) and perceived health care coordination, and a higher likelihood of patients perceiving themselves to being a burden to family (all p < 0.05)


Patients with financial difficulties are vulnerable to poor outcomes. Heart failure clinics should directly assess patients’ financial difficulties to help guide treatment-related discussions and to identify patients vulnerable to poor QOL.

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