Clinical Investigation
Educational Level and the Quality of Life of Heart Failure Patients: A Longitudinal Study

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Abstract

Background

Lower education in heart failure (HF) patients is associated with high levels of anxiety, limited physical functioning, and an increased risk of hospitalization. We examined whether educational level is related to longitudinal differences in quality of life (QoL) in HF patients.

Methods and Results

This research is a substudy of the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure (COACH). QoL of 553 HF patients (mean age 69, 38% female, mean left ventricular ejection fraction 33%) was assessed during their hospitalization and at 4 follow-up measurements after discharge. In total 32% of the patients had very low, 24% low, 32% medium, and 12% high education. Patients with low educational levels reported the worst QoL. Significant differences between educational groups (P < .05) were only reported in physical functioning, social functioning, energy/fatigue, pain, and limitations in role functioning related to emotional problems. Longitudinal results show that a significantly higher proportion of high-educated patients improved in functional limitations related to emotional problems over time compared with lower-educated patients (P < .05).

Conclusions

Patients with low educational levels reported the worst physical and functional condition. High-educated patients improved more than the other patients in functional limitations related to emotional problems over time. Low-educated patients may require different levels of intervention to improve their physical and functional condition.

Section snippets

Methods

We performed secondary analyses using data from the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure (COACH). COACH is a multicenter study involving 17 hospitals in the Netherlands aimed at studying the effect of education and counseling in HF patients.13, 14 For the present research, we focused on educational disparities.

Results

The sample included 62% men, a small number (12%) of high-educated patients and the average age was 69 years (Table 1). Mean LVEF was 33%, and the average number of other chronic conditions was 1.4. The high-educated patients were younger (mean age 66 ± 13), more often male (81%), and had fewer comorbid conditions (mean 1.1 ± 1.1), especially when compared with the very low-educated patients. About 70% of the participants in the whole group, as well as in each educational group, have received

Discussion

This study examined whether cross-sectional and longitudinal differences in QoL of HF patients were attributable to educational level, independently of other clinical and sociodemographic factors. We found better QoL for high-educated patients in physical and functional domains, specifically in physical functioning, energy/fatigue, social functioning, and limitations in role functioning related to emotional problems.

The greatest inequalities were found when the high-educated patients were

Acknowledgments

We thank Dr. Tim Fawcett for his comments on the text. We would like to thank the patients who participated in the study.

Disclosures

None.

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    The COACH study is supported by a program grant of the Netherlands Heart Foundation [2000Z003].

    See page 53 for disclosure information.

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