Skip to main content
Log in

Evaluating Health-Related Quality-of-Life Outcomes in Patients with Congestive Heart Failure

A Review of Recent Randomised Controlled Trials

  • Review Article
  • Evaluating HR-QOL in Patients with CHF
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Congestive heart failure (CHF) is a chronic disorder characterised by fatigue, shortness of breath and congestion. Treatment is designed to relieve symptoms, halt or delay progression of the disease, prolong life and, ultimately, improve quality of life. The purpose of this paper is to identify recent trends in the assessment of health-related quality-of-life (HR-QOL) outcomes in randomised, controlled trials evaluating treatment effectiveness in patients with CHF. 41 studies using HR-QOL as an explicit outcome and published in English between 1990 and September 1998 were reviewed. Trends in the measurement of HR-QOL and evidence of treatment effectiveness are presented followed by a discussion of the implications for future research.

Results suggest that pharmacological and nonpharmacological treatment regimens can have a positive impact on HR-QOL. However, treatment-related improvement in exercise capacity in patients with CHF was not consistently associated with improvement in all domains of HR-QOL. The primary HR-QOL domain affected by treatment appears to be the performance of daily activities, which may or may not be accompanied by enhanced well-being. This suggests that functional status should be considered a primary HR-QOL end-point in clinical intervention trials. Preference-based or utility assessment, ethnic group differences in treatment effectiveness, caregiver burden and cost effectiveness are understudied outcomes in CHF research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Cohn JN. The management of chronic heart failure. N Engl J Med 1996; 335 (7): 490–8

    Article  PubMed  CAS  Google Scholar 

  2. Andrews F, Withey S. Developing measures of perceived life quality: results from several national surveys. Soc Indic Res 1974; 1: 1–26

    Article  Google Scholar 

  3. Dupuy HJ. The psychological general well-being (PGWB) index. In: Wenger NK, Mattson ME, Furberg CD, editors. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq, 1984: 170–84

    Google Scholar 

  4. Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care 1989; 27 (3 Suppl.): S217–32

    Article  Google Scholar 

  5. Gorkin L, Norvell NK, Rosen RC, et al. Assessment of quality of life as observed from the baseline data of the Studies of Left Ventricular Dysfunction (SOLVD) trial quality-of-life substudy. Am J Cardiol 1993; 71 (12): 1069–73

    Article  PubMed  CAS  Google Scholar 

  6. Rogers WJ, Johnstone DE, Yusuf S, et al. Quality of life among 5,025 patients with left ventricular dysfunction randomized between placebo and enalapril: the Studies of Left Ventricular Dysfunction. The SOLVD Investigators. J Am Coll Cardiol 1994; 23 (2): 393–400

    Article  PubMed  CAS  Google Scholar 

  7. Rector TS, Johnson G, Dunkman WB, The V-HeFT VA Cooperative Studies Group, et al. Evaluation by patients with heart failure of the effects of enalapril compared with hydralazine plus isosorbide dinitrate on quality of life: Circulation 1993; 87 (6 Suppl.): VI71–7

    Google Scholar 

  8. Cohn JN, Ziesche S, Smith R, et al. Effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patients with chronic heart failure treated with enalapril: V-HeFT III. Circulation 1997; 96 (3): 856–63

    Article  PubMed  CAS  Google Scholar 

  9. Bristow MR, Gilbert EM, Abraham WT, et al. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. Circulation 1996; 94 (11): 2807–16

    Article  PubMed  CAS  Google Scholar 

  10. Cohn JN, Fowler MB, Bristow MR, et al. Safety and efficacy of carvedilol in severe heart failure. J Card Fail 1997; 3 (3): 173–9

    Article  PubMed  CAS  Google Scholar 

  11. Colucci WS, Packer M, Bristow MR, et al. Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure. Circulation 1996; 94 (11): 2800–6

    Article  PubMed  CAS  Google Scholar 

  12. Guyatt GH, Sullivan MJJ, Fallen E, et al. A controlled trial of digoxin in congestive heart failure. Am J Cardiol 1988; 61: 371–5

    Article  PubMed  CAS  Google Scholar 

  13. Guyatt GH, Nogradi S, Halcrow S, et al. Development and testing of a new measure of health status for clinical trials in heart failure. J Gen Intern Med 1989; 4: 101–7

    Article  PubMed  CAS  Google Scholar 

  14. Guyatt GH. Measurement of health-related quality of life in heart failure. J Am Coll Cardiol 1993; 22 (4 Suppl. A): 185A–91A

    Article  PubMed  CAS  Google Scholar 

  15. Wiklund I, Lindvall K, Swedberg K, et al. Self-assessment of quality of life in severe heart failure. Scand J Psychol 1987; 28: 220–5

    Article  PubMed  CAS  Google Scholar 

  16. de Vries RJ, Quere M, Lok DJ, et al. Comparison of effects on peak oxygen consumption, quality of life, and neurohormones of felodipine and enalapril in patients with congestive heart failure. Am J Cardiol 1995; 76 (17): 1253–8

    Article  PubMed  Google Scholar 

  17. Sasayama S, Asanoi H, Ishizaka S, et al. Evaluation of functional capacity of patients with congestive heart failure. In: Yasuda H, Morgan HE, editors. New aspect in the treatment of failing heart. New York: Springer, 1992: 113–7

    Chapter  Google Scholar 

  18. McNair D, Lorr M, Droppleman L. POMS: profile of mood states. San Diego (CA): EdITS/Educational and Industrial Testing Service, 1992

    Google Scholar 

  19. Jenkins CD, Stanton BA, Savageau JA, et al. Coronary artery bypass surgery; physical, psychological, social and economic outcomes six months later. JAMA 1983; 250: 782–8

    Article  PubMed  CAS  Google Scholar 

  20. Stewart AL, Ware JE, Sherbourne CD, et al. Psychological distress/well-being and cognitive functioning measures. In: Stewart AL, Ware JE, editors. Measuring functioning and well being. Durham (NC): Duke University, 1992: 102–42

    Google Scholar 

  21. Kaplan RM, Atkins CJ, Timms R. Validity of a quality of wellbeing scale as an outcome measure in chronic obstructive pulmonary disease. J Chronic Dis 1984; 37 (2): 85–95

    Article  PubMed  CAS  Google Scholar 

  22. Kaplan RM, Anderson JP, Wu AW, et al. The quality of well-being scale: applications in AIDS, cystic fibrosis, and arthritis. Med Care 1989; 27 Suppl. 3: S27–43

    Article  Google Scholar 

  23. Ganiats TG, Palinkas LA, Kaplan RM. Comparison of quality of well-being scale and functional status index in patients with atrial fibrillation. Med Care 1992; 30 (10): 958–64

    Article  PubMed  CAS  Google Scholar 

  24. Torrance GW, Boyle MH, Horwood SP. Application of multiattribute utility theory to measure social preferences for health states. Oper Res 1982; 30: 1043–69

    Article  PubMed  CAS  Google Scholar 

  25. Torrance GW, Furlong W, Feeny D, et al. Multi-attribute preference functions: health utilities index. Pharmacoeconomics 1995; 7: 503–20

    Article  PubMed  CAS  Google Scholar 

  26. EuroQoL Group. EuroQoL: a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208

    Article  Google Scholar 

  27. Ekeberg O, Klemsdal TO, Kjeldsen SE. Quality of life on enalapril after acute myocardial infarction. Eur Heart J 1994; 15 (8): 1135–9

    PubMed  CAS  Google Scholar 

  28. Weintraub WS, Mauldin PD, Becker E, et al. A comparison of the costs and quality of life after coronary angioplasty or coronary surgery for multivessel coronary artery disease: results from the Emory Angioplasty Versus Surgery Trial (EAST). Circulation 1995; 92: 2831–40

    Article  PubMed  CAS  Google Scholar 

  29. Boden WE, Ziesche S, Carson PE, V-HeFT investigators, et al. Rationale and design of the third vasodilator-heart failure trial (V-HeFT III): felodipine as adjunctive therapy to enalapril and loop diuretics with or without digoxin in chronic congestive heart failure. Am J Cardiol 1996; 77: 1078–82

    Article  PubMed  CAS  Google Scholar 

  30. Sasayama S, Asanoi H, Kihara Y, et al. Clinical effects of longterm administration of pimobendan in patients with moderate congestive heart failure. Heart Vessels 1994; 9 (3): 113–20

    Article  PubMed  CAS  Google Scholar 

  31. Califf RM, Adams KF, McKenna WJ, et al. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: The Flolan International Randomized Survival Trial (FIRST). Am Heart J 1997; 134 (1): 44–54

    Article  PubMed  CAS  Google Scholar 

  32. Just H, Drexler H, Taylor SH, The Captopril and Digoxin Study (CADS) Group, et al. Captopril versus digoxin in patients with coronary artery disease and mild heart failure: a prospective, double-blind, placebo-controlled multicenter study. Herz 1993; 18 Suppl. 1: 436–43

    PubMed  Google Scholar 

  33. Kostis JB, Rosen RC, Cosgrove NM, et al. Nonpharmacologic therapy improves functional and emotional status in congestive heart failure. Chest 1994; 106: 996–1001

    Article  PubMed  CAS  Google Scholar 

  34. Naughton MT, Liu PP, Benard DC, et al. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure. Am J Respir Crit Care Med 1995; 151 (1): 92–7

    PubMed  CAS  Google Scholar 

  35. OPC-8212 Multicenter Research Group. A placebo-controlled, randomized, double-blind study of OPC-8212 in patients with mild chronic heart failure. Cardiovasc Drugs Ther 1990; 4 (2): 419–26

    Article  Google Scholar 

  36. Cowley AJ, Skene AM, Enoximone Investigators. Treatment of severe heart failure: quantity or quality of life? A trial of enoximone. Br Heart J 1994; 72 (3): 226–30

    Article  PubMed  CAS  Google Scholar 

  37. Koch M, Douard J, Broustet J-P. The benefit of graded physical exercise in chronic heart failure. Chest 1992; 191 (5 Suppl.): 231S–5S

    Google Scholar 

  38. Barabino A, Galbariggi G, Pizzorni C, et al. Comparative effects of long-term therapy with captopril and obopamine in chronic congestive heart failure in old patients. Cardiology 1991; 78: 243–56

    Article  PubMed  CAS  Google Scholar 

  39. Rucinska EJ. Enalapril in the treatment of congestive heart failure: effects on signs, symptoms and mortality. Acta Cardiol 1991; 46 (2): 231–46

    PubMed  CAS  Google Scholar 

  40. Gundersen T, Wiklund I, Swedberg K, Ramipril Study Group, et al. Effects of 12 weeks of ramipril treatment on the quality of life in patients with moderate congestive heart failure: results of a placebo-controlled trial. Cardiovasc Drugs Ther 1995; 9 (4): 589–94

    Article  PubMed  CAS  Google Scholar 

  41. Massie BM, Berk MR, Brozena SC, et al. Can further benefit be achieved by adding flosequinan to patients with congestive heart failure who remain symptomatic on diuretic, digoxin, and an angiotensin converting enzyme inhibitor? Results of the flosequinan-ACE inhibitor trial (FACET). Circulation 1993; 88 (2): 492–501

    Article  PubMed  CAS  Google Scholar 

  42. Kubo SH, Gollub S, Bourge R, The Pimobendan Multicenter Research Group, et al. Beneficial effects of pimobendan on exercise tolerance and quality of life in patients with heart failure: results of a multicenter trial. Circulation 1992; 85 (3): 942–9

    Article  PubMed  CAS  Google Scholar 

  43. Wiklund I, Waagstein F, Swedberg K, et al. Quality of life on treatment with metoprolol in dilated cardiomyopathy: results from the MDC trial. Cardiovasc Drugs Ther 1996; 10: 361–8

    PubMed  CAS  Google Scholar 

  44. Wiklund I, Swedberg K. Some methodological problems in analyzing quality of life data in severe congestive heart failure patients. Clin Res Pharmacoepidemiol 1991; 5 (3): 265–73

    Google Scholar 

  45. Acanfora D, Lanzillo T, Papa A, et al. Congestive heart failure in elderly patients: controlled study of delapril versus captopril. Am J Cardiol 1995; 75 (18): 37F–43F

    Article  PubMed  CAS  Google Scholar 

  46. Feldman AM, Baughman KL, Lee WK, et al. Usefulness of OPC-8212, a quinolinone derivative, for chronic congestive heart failure in patients with ischemic heart disease or idiopathic dilated cardiomyopathy. Am J Cardiol 1991; 68: 1203–10

    Article  PubMed  CAS  Google Scholar 

  47. Feldman AM, Bristow MR, Parmley WW, Vesnarinone Study Group, et al. Effects of vesnarinone on morbidity and mortality in patients with heart failure. N Engl J Med 1993; 329 (3): 149–55

    Article  PubMed  CAS  Google Scholar 

  48. DiBianco R, Parker JO, Chakko S, et al. Doxazosin for the treatment of chronic congestive heart failure: results of a randomized double-blind and placebo-controlled study. Am Heart J 1991; 121 (1 Pt 2): 372–80

    Article  PubMed  CAS  Google Scholar 

  49. Tyni-Lenne R, Gordon A, Sylven C. Improved quality of life in chronic heart failure patients following local endurance training with leg muscles. J Card Fail 1996; 2 (2): 111–7

    Article  PubMed  CAS  Google Scholar 

  50. Kavanagh T, Myers MG, Baigrie RS, et al. Quality of life and cardiorespiratory function in chronic heart failure: effects of 12 months’ aerobic training. Heart 1996; 76: 42–9

    Article  PubMed  CAS  Google Scholar 

  51. Rich MW, Beckham V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 1995; 333 (18): 1190–5

    Article  PubMed  CAS  Google Scholar 

  52. Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions? N Engl J Med 1996; 334 (22): 1441–7

    Article  PubMed  CAS  Google Scholar 

  53. Schulman KA, Buxton MJ, Glick H, et al. Prospective economic evaluation of the first study. Annu Meet Int Soc Technol Assess Health Care 1995; 11: Abstract no. 2

    Google Scholar 

  54. Blackwood R, Mayou RA, Garnham JC, et al. Exercise capacity and quality of life in the treatment of heart failure. Clin Pharmacol Ther 1990; 48 (3): 325–32

    Article  PubMed  CAS  Google Scholar 

  55. Hawthorne MH, Hixon ME. Functional status, mood disturbance and quality of life in patients with heart failure. Prog Cardiovasc Nurs 1994; 9 (1): 22–32

    PubMed  CAS  Google Scholar 

  56. Northridge DB, Rose E, Raftery ED, et al. A multicentre, double-blind, placebo-controlled trial of quinapril in mild, chronic heart failure. Eur Heart J 1993; 14 (3): 403–9

    Article  PubMed  CAS  Google Scholar 

  57. Dorszewski A, Göhmann E, Dorszewski B, et al. Vasodilation by urapidil in the treatment of chronic congestive heart failure in addition to angiotensin-converting enzyme inhibitors is not beneficial: results of a placebo-controlled, double-blind study. J Card Fail 1997; 3 (2): 91–6

    Article  PubMed  CAS  Google Scholar 

  58. Tyni-Lenne R, Gordon A, Jansson E, et al. Skeletal muscle endurance training improves peripheral oxidative capacity, exercise tolerance, and health-related quality of life in women with chronic congestive heart failure secondary to either ischemic cardiomyopathy or idiopathic dilated cardiomyopathy. Am J Cardiol 1997; 80: 1025–9

    Article  PubMed  CAS  Google Scholar 

  59. Brignole M, Menozzi C, Gianfranchi L, et al. Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation: a randomized, controlled study. Circulation 1998; 98: 953–60

    Article  PubMed  CAS  Google Scholar 

  60. Baligadoo SJ, Subratty H, Manraz M, et al. Effects of enoximone on quality of life. Int J Cardiol 1990; 28 Suppl. 1: S29–32

    Article  Google Scholar 

  61. Dubourg O, Delorme G, Hardy A, et al. Placebo-controlled trial of oral enoximone in end-stage congestive heart failure refractory to optimal treatment. Int J Cardiol 1990; 28 Suppl. 1: S33–42

    Article  Google Scholar 

  62. The Italian Xamoterol Multicenter Research Group. Comparative effects of xamoterol and digoxin in patients with mild to moderate heart failure. Eur Heart J 1990; 11 Suppl. A: 50–1

    Article  Google Scholar 

  63. Parker JO, The Ibopamine Study Group. The effects of oral ibopamine in patients with mild heart failure: a double blind placebo controlled comparison to furosemide. Int J Cardiol 1993; 40 (3): 221–7

    Article  PubMed  CAS  Google Scholar 

  64. McNair DM, Lorr M, Dropplemann LF. Manual of the profile of moods states. San Diego (CA): Educational and Industrial Testing Service, 1971

    Google Scholar 

  65. Mayou R, Bryant B. Quality of life after coronary artery surgery. Q J Med 1987; 239: 239–48

    Google Scholar 

  66. Meenan RF, Gertman PM, Mason JH. Measuring health status in arthritis. Arthritis Rheum 1980; 23: 146–52

    Article  PubMed  CAS  Google Scholar 

  67. Bergner M. The sickness impact profile (SIP). In: Wenger NK, Mattson ME, Furberg CD, et al., editors. Assessment of quality of life in clinical trials of cardiovascular therapies. New York (NY): Le Jacq, 1984: 152–9

    Google Scholar 

  68. Rector TS, Kubo SH, Cohn JN. Patients’ self-assessment of their congestive heart failure. Part 2: content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure 1987; 3: 198–209

    Google Scholar 

  69. Hunt SM, McKenna SP. The Nottingham health profile user manual. Manchester: Galen Research, 1991

    Google Scholar 

  70. Vigholt-Sorensen E, Faergeman O, Snow HM. Effects of xamoterol, a beta-adrenoceptor partial agonist, in patients with ischemic dysfunction of the left ventricle. Br Heart J 1989; 62: 335–41

    Article  PubMed  CAS  Google Scholar 

  71. Guyatt GH, Sullivan MJ, Thompson PJ, et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 1985; 132: 919–23

    PubMed  CAS  Google Scholar 

  72. Sparrow J, Parameshwar J, Poole-Wilson PA. Assessment of functional capacity in chronic heart failure: time-limited exercise on a self-powered treadmill. Br Heart J 1996; 71: 391–4

    Article  Google Scholar 

  73. Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebocontrolled trial of pimobendan. Am Heart J 1992; 124: 1017–25

    Article  PubMed  CAS  Google Scholar 

  74. Rosser R, Sintonen H. The EuroQol quality of life project. In: Walker SR, Rosser RM, editors. Quality of life assessment:key issues in the 1990s. Dordrecht: Kluwer Academic Publishers, 1993: 197–9

    Chapter  Google Scholar 

  75. Hunt SM, McKenna SP, McEwen J, et al. The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med 1981; 15: 221–9

    Article  CAS  Google Scholar 

  76. Rector TS, Kubo SH, Cohn JN. Validity of the Minnesota Living with Heart Failure Questionnaire as a measure of therapeutic response: effects of enalapril and placebo. Am J Cardiol 1993; 71: 1106–7

    Article  PubMed  CAS  Google Scholar 

  77. McNair DM, Lorr M. An analysis of moods and neurotics. J Abnorm Soc Psychol 1964; 69: 620–7

    Article  CAS  Google Scholar 

  78. Mishel MH. The Mishel uncertainty in illness manual. Chapel Hill (NC): University of North Carolina, 1990

    Google Scholar 

  79. Ferrans CE, Powers MJ. Psychometric assessment of the quality of life index. Res Nurs Health 1992; 15: 29–38

    Article  PubMed  CAS  Google Scholar 

  80. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–71

    Article  PubMed  CAS  Google Scholar 

  81. Bergner M, Bobbitt RA, Carter W, et al. The sickness impact profile: development and final revision of a health status measure. Med Care 1981; 19: 787–806

    Article  PubMed  CAS  Google Scholar 

  82. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-item shortform health survey (SF-36). II: psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993; 31: 247–63

    Article  PubMed  CAS  Google Scholar 

  83. Ware JE Jr, Snyder MK, Wright WR, et al. Defining and measuring patient satisfaction with medical care. Eval Program Plann 1983; 6: 247–63

    Article  PubMed  Google Scholar 

  84. Goldman L, Hashimoto B, Cook F, et al. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation 1981; 64: 1227–34

    Article  PubMed  CAS  Google Scholar 

  85. Dracup K, Walden JA, Stevenson LW, et al. Quality of life in patients with advanced heart failure. J Heart Lung Transplant 1992; 11 (2 Pt 1): 273–9

    PubMed  CAS  Google Scholar 

  86. Bharani A, Ganguly A, Bhargava KD. Salutary effect of Terminalia Arjuna in patients with severe refractory heart failure. Int J Cardiol 1995; 49 (3): 191–9

    Article  PubMed  CAS  Google Scholar 

  87. Antonovsky A. The structure and properties of the sense of coherence scale. Soc Sci Med 1993; 36: 725–33

    Article  PubMed  CAS  Google Scholar 

  88. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I: conceptual framework and item selection. Med Care 1992; 30: 473–83

    Article  PubMed  Google Scholar 

  89. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 32: 50–5

    Google Scholar 

  90. Buxton M, Acheson RM, Caine N, et al. Costs and benefits of the heart transplant programmes at Harefield and Papworth Hospitals, London. London: HMSO, 1985

    Google Scholar 

  91. Bulpitt CJ, Fletcher AE. Effect of treatment on the quality of life in hypertension and congestive heart failure. Cardiology 1988; 75 Suppl. 1: 53–60

    Article  PubMed  Google Scholar 

  92. Fletcher AE, Hunt BM, Bulpitt CJ. Evaluation of quality of life in clinical trials of cardiovascular disease. J Chronic Dis 1987; 40 (6): 557–69

    Article  PubMed  CAS  Google Scholar 

  93. Wallwork J, Caine N. A comparison of the quality of life of cardiac transplant patients and coronary artery bypass graft patients before and after surgery. Qual Life Cardiovasc Care 1985; 1: 317–31

    Google Scholar 

  94. Bulpitt CJ, Fletcher AE. Measurement of the quality of life in congestive heart failure: influence of drug therapy. Cardiovasc Drugs Ther 1988; 2 Suppl. 1: 419–24

    Article  PubMed  Google Scholar 

  95. Fletcher AE, Bulpitt CJ. Measurement of quality of life in clinical trials of therapy. Cardiology 1988; 75 Suppl. 1: 41–52

    Article  PubMed  Google Scholar 

  96. Tandon PK, Stander H, Schwartz RP. Analysis of quality of life data from a randomized, placebo-controlled heart-failure trial. J Clin Epidemiol 1989; 42: 955–62

    Article  PubMed  CAS  Google Scholar 

  97. Vermeer F, Simoons ML, de Zwaan C, et al. Cost benefit analysis of early thrombolytic treatment with intracoronary streptokinase: twelve month follow up report of the randomised multicentre trial conducted by the Interuniversity Cardiology Institute of The Netherlands. BMJ 1988; 59 (5): 527–34

    CAS  Google Scholar 

  98. Wong JB, Sonnenberg FA, Salem DN, et al. Myocardial revascularization for chronic stable angina. Ann Intern Med 1990; 113: 852–71

    PubMed  CAS  Google Scholar 

  99. Leidy, NK. Using functional status to assess treatment outcomes. Chest 1994; 106 (6): 1645–6

    Article  PubMed  CAS  Google Scholar 

  100. Kinney MR, Burfitt SN, Stullenbarger E, et al. Quality of life in cardiac patient research: a meta-analysis. Nurs Res 1996; 45: 173–80

    Article  PubMed  CAS  Google Scholar 

  101. Hlatky MA, Boineau RE, Higginbotham MB, et al. A brief selfadministered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol 1989; 64 (10): 651–4

    Article  PubMed  CAS  Google Scholar 

  102. Karmilovich SE. Burden and stress associated with spousal caregiving for individuals with heart failure. Prog Cardiovasc Nurs 1994; 9 (1): 33–8

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nancy Leidy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leidy, N., Rentz, A.M. & Zyczynski, T.M. Evaluating Health-Related Quality-of-Life Outcomes in Patients with Congestive Heart Failure. Pharmaeconomics 15, 19–46 (1999). https://doi.org/10.2165/00019053-199915010-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199915010-00003

Keywords

Navigation