EuroQol 5-Dimension Questionnaire in Heart Failure With Reduced, Mildly Reduced, and Preserved Ejection Fraction A Patient-Level Analysis of DAPA-HF and DELIVER

被引:0
作者
Yang, Mingming [1 ,2 ]
Kondo, Toru [2 ,3 ]
Talebi, Atefeh [2 ]
Jhund, Pardeep S. [2 ]
Docherty, Kieran F. [2 ]
Claggett, Brian L. [4 ,5 ]
Vaduganathan, Muthiah [4 ,5 ]
Bachus, Erasmus [6 ]
Hernandez, Adrian F. [7 ]
Lam, Carolyn S. P. [8 ,9 ]
Martinez, Felipe A. [10 ]
de Boer, Rudolf A. [11 ]
Kosiborod, Mikhail N. [12 ,13 ]
Desai, Akshay S.
Kober, Lars [14 ]
Ponikowski, Piotr [15 ]
Sabatine, Marc S. [5 ,16 ]
Solomon, Scott D. [4 ,5 ]
Mcmurray, John J. V. [2 ]
机构
[1] Southeast Univ, Zhongda Hosp, Sch Med, Dept Cardiol, Nanjing, Peoples R China
[2] Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, 126 Univ Pl, Glasgow G12 8TA, Scotland
[3] Nagoya Univ, Grad Sch Med, Dept Cardiol, Nagoya, Japan
[4] Brigham & Womens Hosp, Cardiovasc Div, Boston, MA USA
[5] Harvard Med Sch, Boston, MA USA
[6] AstraZeneca, Late Stage Dev Cardiovasc Renal & Metab, Biopharmaceut R&D, Gothenburg, Sweden
[7] Duke Univ, Duke Clin Res Inst, Med Ctr, Durham, NC USA
[8] Natl Heart Ctr Singapore, Singapore, Singapore
[9] Duke Natl Univ Singapore, Singapore, Singapore
[10] Univ Nacl Cordoba, Cordoba, Argentina
[11] Erasmus MC, Dept Cardiol, Rotterdam, Netherlands
[12] St Lukes Mid Amer Heart Inst, Kansas City, MO USA
[13] Univ Missouri, Kansas City, MO USA
[14] Rigshosp, Dept Cardiol, Copenhagen Univ Hosp, Copenhagen, Denmark
[15] Med Univ, Clin Mil Hosp, Wroclaw, Poland
[16] Brigham & Womens Hosp, Cardiovasc Div, TIMI Study Grp, Boston, MA USA
基金
美国国家卫生研究院;
关键词
dapagliflozin; EQ-5D; heart failure; quality of life; symptoms; QUALITY-OF-LIFE; CITY CARDIOMYOPATHY QUESTIONNAIRE;
D O I
10.1016/j.jchf.2024.10.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND The value of generic quality of life (QoL) instruments in heart failure (HF) is uncertain. OBJECTIVES In this study, the authors sought to quantify individual dimension scores and the EuroQol 5-Dimension questionnaire (EQ-5D) Level Sum Score (LSS) in patients with HF with reduced, mildly reduced, or preserved ejection fraction, the association between those scores and outcomes, and the impact of treatment with dapagliflozin on the scores. METHODS Analyses were conducted using patient-level data from DAPA-HF and DELIVER trials. Cox proportional hazards regression models were used to assess the association between EQ-5D scores (each dimension and LSS) and clinical outcomes. Sankey diagrams were used to illustrate changes in individual patient EQ-5D dimensions from baseline to 8 months' follow-up. RESULTS Of the 11,007 patients randomized in DAPA-HF and DELIVER, 10,135 (92.1%) completed the instrument at baseline. Scores varied markedly by question with 37%, 30%, and 33% of patients reporting no, slight, or moderate or greater problem, respectively for mobility; 67%, 20%, and 13% for self-care; 40%, 33%, and 27% for usual activities; 45%, 32%, and 23% for pain/discomfort; and 57%, 27%, and 16% for anxiety/depression. Patients with higher (worse) EQ-5DLSS were more frequently female, had more comorbidities, and had worse HF status. Compared with patients free from any problem across all dimensions (ie, an EQ-5D-LSS of 5), the HRs for the composite outcome of time to first cardiovascular death or worsening HF were 1.27 (95% CI: 1.10-1.47), 1.70 (95% CI: 1.46-1.98), and 2.31(95% CI: 1.88-2.85) in patients with EQ-5D-LSS of 6-10, 11-15, and 16-25 points, respectively. Dapagliflozin led to greater improvement and less worsening in mobility (OR: 1.13 [95% CI: 1.04-1.23]; P = 0.004), self-care (OR: 1.13 [95% CI: 1.02-1.24]; P = 0.016), usual activities (OR: 1.11 [95% CI: 1.02-1.21]; P = 0.015), and anxiety/depression (OR: 1.10 [95% CI: 1.01-1.21]; P = 0.034) after 8 months. The number needed to treat for 1 patient to report improvement in EQ-5D-LSS was 31(95% CI: 20-72). CONCLUSIONS The EQ-5D revealed problems not often associated (eg, pain) with HF or commonly quantified in HF (eg, anxiety/depression). Dapagliflozin improved multiple QoL dimensions, and possibly anxiety/depression. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124; Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213) (JACC Heart Fail. 2025;13:277-292) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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收藏
页码:277 / 292
页数:16
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