Aplicación en España del cuestionario sobre calidad de vida «Minnesota Living With Heart Failure» para la insuficiencia cardíaca

doi:10.1016/S0300-8932(04)77078-5

Revista Española de Cardiología

Volume 57, Issue 2, 2004, Pages 155-160

https://doi.org/10.1016/S0300-8932(04)77078-5 Get rights and content

Introducción y objetivos

La calidad de vida es, junto con la mortalidad y las hospitalizaciones, un objetivo importante en los estudios sobre insuficiencia cardíaca. El cuestionario «Minnesota Living With Heart Failure» es el instrumento más extensamente utilizado para valorarla en los trabajos de investigación. Nuestro objetivo ha sido conocer la calidad de vida mediante este cuestionario en una población general atendida en una unidad de insuficiencia cardíaca.

Pacientes y método

Se evaluó a 326 pacientes en la primera visita. Hemos analizado la correlación entre la puntuación obtenida y diversos factores clínicos y demográficos.

Resultados

La puntuación global fue relativamente baja (28). Encontramos una fuerte correlación (p < 0,001) con la clase funcional, el sexo (puntuaciones más altas en mujeres) y la diabetes. Hallamos también correlación con el número de ingresos durante el año previo (p < 0,001), la anemia (p < 0,001) y la etiología (p = 0,01), y una débil tendencia a aumentar con la edad (p = 0,04). Las puntuaciones más altas se observaron en pacientes valvulares (43) y las más bajas en pacientes con cardiopatía alcohólica (20) e isquémica (24). No hallamos correlación con el tiempo de evolución ni con la fracción de eyección de ventrículo izquierdo.

Conclusiones

La aplicación del «Minnesota Living With Heart Failure» a una población general con insuficiencia cardíaca ha mostrado puntuaciones relativamente bajas. A pesar de ello, hemos encontrado una correlación importante de la puntuación obtenida con la clase funcional y con el número de ingresos en el año previo, lo que sugiere que el cuestionario refleja correctamente el grado de severidad de la enfermedad.

Introduction and objectives

Quality of life is an important end-point in heart failure studies, as well as mortality and hospitalization rates. The Minnesota Living With Heart Failure Questionnaire is the instrument used most widely to evaluate quality of life in research studies. We used this questionnaire to evaluate quality of life in a general population attended by a heart failure unit in Spain.

Patients and method

326 patients seen for the first time at the unit were evaluated. We analyzed the relationship between the questionnaire score and different clinical and demographic factors.

Results

The median global score on the Minnesota Living With Heart Failure Questionnaire was relatively low (28). We found a strong correlation (P<.001) between the score and functional class, sex (women had higher scores), and diabetes. We also found a correlation between the score and number of hospital admissions in the previous year (P< .001), anemia (P<.001) and etiology (P=.01), and a weak trend toward higher scores with increasing age (P=.04). The highest scores were observed in patients with valve disease disorders (43), and the lowest were seen in patients with alcoholic cardiomyopathy (20) and ischemic heart disease (24). We found no correlation with time of evolution of heart failure or with left ventricular ejection fraction.

Conclusions

The scores on the Minnesota Living With Heart Failure Questionnaire in a general population attended by a heart failure unit in Spain were relatively low. However, we found a strong correlation between this score and functional class, and also between this score and number of admissions in the previous year. These results suggest that the questionnaire adequately reflects the severity of the disease.

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Cited by (53)

Study of the factors contributing to poor quality of life in chronic heart failure with reduced ejection fraction
2021, Annales de Cardiologie et d'Angeiologie
La prévalence de l'insuffisance cardiaque ne cesse d'augmenter. L'amélioration de la qualité de vie chez les patients porteurs de cette maladie est l'un des objectifs incontournables dans son traitement. La qualité de vie des patients insuffisants cardiaque reste peu étudiée en Tunisie. L'objectif de notre étude était de mesurer la qualité de vie et de déterminer les facteurs auxquels elle est liée.
Dans cette étude prospective, nous avons inclus les patients en insuffisance cardiaque suivis dans le service de cardiologie de l'hôpital Habib Thameur sur une période de quatre mois, avec comme critère de sélection majeur, une fraction d’éjection systolique gauche (FEVG) inférieure ou égale à 45 %. L’étude a porté sur l’évaluation de la qualité de vie au moyen du questionnaire spécifique de Minnesota. La relation entre la qualité de vie et les différents paramètres recueillis a été étudiée en analyse univariée puis en régression logistique binaire.
Dans un échantillon total de 100 patients, l’âge moyen était de 62,7±12,8 ans. Nos patients étaient majoritairement de sexe masculin (77 %), de classe fonctionnelle NYHA III à IV (61 %), avec en moyenne 2,5±1,5 comorbidités et une FEVG de 36 %. En matière de qualité de vie, nous avons eu autant de patients avec une qualité de vie altérée que de patients avec une bonne qualité de vie selon le score de Minnesota. Avec des moyennes de 45 ± 28,3 pour le score total (médiane 41,5), pour le sous-score physique (médiane 17,5) et pour le sous-score émotionnel (médiane 11,25). Les facteurs dépendant de la mauvaise qualité de vie en analyse univariée étaient l'inactivité professionnelle, l'hypertension artérielle, l'insuffisance rénale, l'anémie, le régime hyposodé, l'inactivité physique, la classe fonctionnelle NYHA avancée et les QRS large. En régression logistique binaire, les facteurs associés à une mauvaise qualité de vie étaient: les classes fonctionnelles NYHA avancées et l'insuffisance rénale.
Cette étude a montré que les classes avancées NYHA et l'insuffisance rénale sont des facteurs de mauvaise qualité de vie indépendamment de la sévérité de la maladie chez les insuffisants cardiaques chroniques.
The increasing prevalence and poor prognosis associated with chronic heart failure (CHF) have made the improvement of quality of life (QoL) one of the main goals in the treatment of CHF patients. Since little is known about the QoL in Tunisian patients with heart failure (HF), the current study was performed to assess QoL in a sample of Tunisian patients hospitalized with HF and to identify factors related to QoL.
In this prospective study, we evaluated patients with CHF attending the cardiology department of Habib Thameur University Hospital in a four-month period. Echocardiography was performed and patients with left ventricular ejection fraction of 45% or less were selected. QoL assessment was performed with a disease-specific instrument: the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in a sample of 100 selected patients. Relationships between health-related QoL and the studied variables were examined with bivariate correlations and binary logistic regression analysis.
In the total sample (n = 100), mean age was 62.7 years. The majority were male (77%), married (76%), with a mean of 2.5 comorbidities, and in a New York Heart Association (NYHA) functional class III to IV (61%). Mean LVEF was 36%. Half of the patients had poor QoL on the total MLHFQ scale (median = 41.5) as well as on its physical (median = 17.5) and emotional (median = 11.25) domains. In univariate analysis, the following variables were related to poor QoL with p < 0.005: not being employed, suffering from hypertension, renal failure, anemia, being under a low-salt diet, having no regular physical activity, having the physical symptoms of HF, higher NYHA class and longer QRS duration. In multiple regression analysis, the main independent predictors of poor QoL on the total scale were higher NYHA functional class and renal dysfunction,. The data provided no evidence of an association between LVEF and QoL.
This study has found that higher NHYA functional class and chronic kidney disease are risk factors for impaired QoL, independently of disease severity among patients with heart failure.
Mini nutritional assessment is a better predictor of mortality than subjective global assessment in heart failure out-patients
2019, Clinical Nutrition
Citation Excerpt :
QoL was assessed with a HF-specific QoL questionnaire, known as the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) [21,22]. We used the Spanish version, which has been widely used and was prospectively validated [23–26]. Consisting of 21 questions, the MLWHFQ evaluates the impact of HF on the physical, psychological, and social aspects of patients' lives.
There is no consensus on the best method for nutritional screening and assessment in patients with heart failure (HF). This study aimed to determine which nutritional assessment method had the highest prognostic significance for patients with HF treated in outpatient clinics. We also aimed to identify a fast, reliable screening method for detecting malnutrition in these patients.
This prospective study included 151 subjects that attended an outpatient HF clinic at a university hospital. All patients completed three nutritional screening tools: the Malnutrition Universal Screening Tool (MUST), the MNA-short form (MNA-SF), and the Malnutrition Screening Tool (MST), and then, two nutritional assessment questionnaires: the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment®(MNA). Patients were followed-up for 2 years. The primary endpoint was all-cause mortality.
Malnutrition or nutritional risk was identified in 15.9% of patients with the SGA and in 25.1% of patients with the MNA. Age, New York Heart Association (NYHA) functional class, and MNA were the only independent all-cause death predictors after adjusting for age, gender, NYHA functional class, body mass index, Barthel index, 25-hydroxyvitamin D concentrations, treatment with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, and treatment with beta-blockers. The SGA could not independently predict all-cause mortality in a multivariate analysis that included the same covariates. The MNA-SF had the best sensitivity, specificity, and kappa coefficient for screening malnutrition, based on the MNA and the SGA as references, compared to the other screening methods.
In our cohort, malnutrition assessed by MNA, but not by SGA, was an independent predictor of mortality. MNA-SF showed remarkable sensitivity and specificity; thus, it might be a valuable tool for rapidly identifying malnutrition risk in outpatients with HF.
The level of anxiety, depression and quality of life among patients with heart failure in Greece
2017, Applied Nursing Research
Citation Excerpt :
The inclusion criteria for participants were the following: (1) at least 40 years old; (2) ejection fraction (EF) ≤ 35%; (3) presence of typical symptoms of HF (breathlessness, ankle swelling, and fatigue); (4) presence of typical signs of HF (elevated jugular venous pressure, pulmonary crackles, and displaced apex beat); (5) knowledge of the Greek language; (6) ability of verbal communication; (7) written informed consent and (8) patients should not conduct any diagnostic procedure two hours before their enrolment in the study. ( Grady et al., 2001) (Parajon et al., 2004) (Hunt et al., 2001) (Lloyd-Jones et al., 2002) (Bleumink et al., 2001) (Morales, Cunningham, Brown, Liu, & Hays, 1999) The exclusion criteria of the study were (Χριστοδούλου, 2004): (1) existence of depression before the diagnosis of HF; (2) existence of schizophrenia before the diagnosis of HF; (3) existence of chronic respiratory failure; (4) existence of musculoskeletal disease, which affects patients' ability to conduct any physical activity; (5) existence of chronic renal failure at end stage; (6) diagnosis of cancer during the last 5 years. The data collection was taken place from September 2010 to January 2012 in a General Hospital of Athens in Greece.
The assessment of the level of anxiety, depression and quality of life among patients with heart failure.
It was an observational study. The populations were 231 patients with heart failure who were hospitalized in cardiology departments of 2 general hospitals in Athens, from September 1, 2010 through January 31, 2012. We used the “Minnesota Living with Heart Failure Questionnaire - MLHFQ” to evaluate patients' quality of life and the “ State-Trait Anxiety Inventory - STAI” and the “Maastricht Questionnaire - MQ” to evaluate the level of stress and depression, respectively.
The mean age of patients was 66.1 ± 10.1 years. The quality of life was poor, since the average score in MLHFQ was 65.4 ± 20.6. Also, patients revealed high levels of both trait and state anxiety (mean score in STAI was 54.5 ± 9.4 and 52.8 ± 8.5 respectively) and depression (mean score in MQ was 34.3 ± 8.4). Factors associated with poor quality of life and high levels of anxiety and depression were older age, low level of education, unemployment, poor economic situation, multiple hospitalizations (> 4 times) and heart failure stages III and IV in NYHA (p < 0.001 in all cases).
Patients with heart failure present severe symptoms of anxiety and depression and poor quality of life. Assessing those patients for these symptoms and providing holistic health care by a multidisciplinary team, will lead to the prevention and early treatment not only of physical but also of the psychosocial manifestations of the disease.
Assessment of the knowledge and perception of support of patients with heart failure SOPICA study in Spain
2016, Revista Clinica Espanola
Conocer la percepción de los pacientes con insuficiencia cardiaca (IC) sobre su enfermedad, tratamiento y soporte, así como los especialistas que intervienen tras una descompensación, y si existe relación entre el tipo de especialista involucrado en el seguimiento y el pronóstico a medio plazo.
Estudio de cohortes multicéntrico, prospectivo, con inclusión consecutiva en urgencias de pacientes con IC aguda. Se entrevistaron telefónicamente los pacientes a los 91-180 días tras la consulta en urgencias. Se investigó la relación entre el tipo de especialista que hacía el seguimiento y las visitas a urgencias u hospitalizaciones mediante modelos de regresión de Cox con ajuste progresivo por grupos de potenciales confusores de la relación de interés.
Se entrevistaron 785 pacientes: un 33% (IC 95%: 30-36%) consideraron su enfermedad leve, un 64% (60-67%) necesitaban ayuda de terceras personas para sus actividades diarias, un 65% (61-68%) no habían percibido cambios terapéuticos recientemente y un 69% (67-72%) perciben el mismo tratamiento en las agudizaciones. El soporte percibido varió significativamente dependiendo del factor considerado (de mayor a menor: familia, hospital, urgencias, centro de salud, religión y asociaciones de pacientes; p < 0,05 en todas las comparaciones). El 39% (36-43%) de pacientes con descompensaciones consultaron directamente a urgencias sin modificaciones previas del tratamiento y, al alta, el médico de cabecera (74%, 71-77%) y el cardiólogo (74%, 70-77%) fueron los más involucrados en el seguimiento, aunque la especialidad no se relacionó con el pronóstico.
Existen diversos aspectos de percepción del paciente con IC respecto a su enfermedad susceptibles de futuras intervenciones. El seguimiento del paciente involucra a diferentes especialidades, pero todas consiguen resultados similares a medio plazo.
To understand the perceptions of patients with heart failure (HF) concerning their disease, treatment and support, as well as the specialists who provide care after a decompensation, and to determine whether there is a relationship between the type of specialist involved in the follow-up and the medium-term prognosis.
A multicentre, prospective cohort study consecutively included patients with acute HF in the emergency department. The patients were interviewed by telephone 91-180 days after their emergency department visit. We investigated the relationship between the type of specialist who performed the follow-up and the emergency department visits or hospitalisations using Cox regression models, with progressive adjustment by groups of potential confounders of these relationships.
We interviewed 785 patients. Thirty-three percent (95% CI: 30%-36%) considered their disease mild, 64% (60%-67%) required help from third parties for daily activities, 65% (61%-68%) had no recent therapeutic changes, and 69% (67%-72%) received the same treatment in the exacerbations. The perceived support varied significantly depending on the factor under consideration (from greater to lesser: family, hospital, emergency department, health centre, religion and patient associations; p < .05 in all comparisons). Thirty-nine percent (36%-43%) of the patients with decompensations consulted directly with the emergency department, with no prior changes in treatment. At discharge, general practitioners (74%, 71%-77%) and cardiologists (74%, 70%-77%) were the most involved in the follow-up, although the specialty was not related to the prognosis.
There are various aspects of the perception of patients with HF concerning their disease that are susceptible to future interventions. Patient follow-up involves various specialties, but all achieve similar results in the medium term.
Health-related quality of life in symptomatic postmyocardial infarction patients with left ventricular dysfunction
2015, Asian Nursing Research
Citation Excerpt :
Perceptions of overall HRQoL among post-MI patients were moderately low, considering a cut-off score between 24 and 45 on the MLHFQ [25]. The HRQoL of symptomatic post-MI patients in this study was worse than that (31.6 ± 23.0) of outpatients with stable HF (N = 114, NYHA class I/II 83.1%, LVEF 52.9%) [26] and outpatients with ischemic heart disease (MLHFQ = 24) and alcoholic cardiomyopathy (MLHFQ = 20) [19]. However, the HRQoL of participants in this study was better than the HRQoL in hospitalized elderly patients with chronic HF (MLHFQ = 50.4 ± 19.3) [27].
Symptoms of postmyocardial infarction (post-MI) patients at risk for progression to heart failure are often ignored, and lack of symptom recognition or misinterpretation may diminish health-related quality of life (HRQoL). This study was conducted to evaluate the differences in HRQoL by symptom experience and determine factors that predict diminished HRQoL in post-MI patients.
Using a descriptive correlational study design, post-MI patients with left ventricular dysfunction (ejection fraction < 50%) completed face-to-face interviews for symptoms, HRQoL, covariates including self-care compliance, New York Heart Association class, and demographic and clinical questionnaires.
A total of 105 post-MI patients participated (mean age 65 years, 79.0% male, mean ejection fraction 43.6%, New York Heart Association class III/IV 33.3%). Mean length of time after the cardiac event was 48 months. Patients reported four or more symptoms, with fatigue being the most common symptom (63.8%), followed by shortness of breath (56.2%), weakness (54.3%), and dizziness (51.4%). HRQoL was moderately poor, with a mean score of 44.38 ± 27.66. There was no significant relationship between self-care compliance and HRQoL. Patients who were female, with low monthly income, and had lower functional capacity and more symptoms had worse HRQoL, after controlling for age and length of time after the event (adjusted R² = 0.53, p < .001).
A need for transitional care that assists post-MI patients take an active involvement in symptom monitoring arises so that they can get into the system earlier and benefit from treatment, and eventually achieve desirable HRQoL.
Effect of fragility on quality of life in patients with heart failure
2013, American Journal of Cardiology
Citation Excerpt :
The investigation conforms to the principles outlined in the Declaration of Helsinki. QoL was assessed with an HF-specific QoL questionnaire, the Minnesota Living with Heart Failure Questionnaire (MLWHFQ)7 in its Spanish version, which has been widely used8 and prospectively validated.9,10 Consisting of 21 questions, the MLWHFQ evaluates the impact of HF on the physical, psychological, and social aspects of patients' lives.
Heart failure (HF) is a chronic disease that frequently causes quality of life (QoL) impairment. We aimed to evaluate whether fragility affects QoL perception in outpatients with HF across age strata. The Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used to assess QoL, and fragility was defined according to basic standardized geriatric scales. Predefined criteria for such scales were scores of Barthel index <90, Older Americans' Resources and Services scale <10 in women and <6 in men, and Pfeiffer test >3 (±1 depending on educational grade) and ≥1 positive depression response on the abbreviated Geriatric Depression Scale. We evaluated 1,405 consecutive outpatients with HF (27.8% women, median age 69 years [twenty-fifth to seventy-fifth percentiles: 59 to 76 years]). Fragility, defined as at least 1 abnormal evaluation, was detected in 621 patients (44.2%). A positive depression response on the abbreviated Geriatric Depression Scale was the most prevalent (31.2%) component of fragility. We found a strong correlation between MLWHFQ score and the presence of fragility and all fragility components (all p <0.001). These associations prevailed in both younger (<75 years) and older patients (≥75 years; all p values <0.001 except for Pfeiffer test in younger patients [p = 0.007]). In multivariate regression analysis, QoL remained significantly associated with fragility after adjustment for age, gender, etiology of HF, left ventricular ejection fraction, New York Heart Association functional class, co-morbidities, and HF treatment, in both younger and older patients (p <0.001). In conclusion, MLWHFQ, a specific HF QoL questionnaire, is significantly influenced by fragility regardless of age.

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Aplicación en España del cuestionario sobre calidad de vida «Minnesota Living With Heart Failure» para la insuficiencia cardíacaUse of the «Minnesota Living With Heart Failure» Quality of Life Questionnaire in Spain

Introducción y objetivos

Pacientes y método

Resultados

Conclusiones

Introduction and objectives

Patients and method

Results

Conclusions

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am Heart J

J Card Failure

J Heart Lung Transplant

J Am Coll Cardiol

Am J Cardiol

Heart Lung

J Cardiac Failure

J Cardiac Failure

Epidemiology, aetiology, and prognosis of heart failure

Heart

Clinical epidemiology of heart failure: public and private health burden

Eur Heart J

Prediction of outcome by neurohumoral activation, the six-minute walk test and the Minnesota Living with Heart Failure Questionnaire in an outpatient cohort with congestive heart failure

Eur Heart J

for the EPICAL investigators. Self-rating of quality of live provides additional prognostic information in heart failure. Insights into the EPICAL study

Eur J Heart Failure