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heart failure, longitudinal studies, quality of life, signs and symptoms



  1. Heo, Seongkum PhD, RN
  2. Moser, Debra K. PhD, RN, FAAN
  3. Lennie, Terry A. PhD, RN
  4. Fischer, Mary MSN, RN
  5. Kim, JinShil PhD, RN
  6. Walsh, Mary N. MD
  7. Ounpraseuth, Songthip PhD
  8. Turrise, Stephanie PhD, RN-BC, APRN, CNE


Background: In patients with heart failure (HF), good health-related quality of life (HRQOL) is as valuable as, or more valuable than, longer survival. However, HRQOL is remarkably poor, and HF symptoms are strongly associated with poor HRQOL. Yet, the multidimensional, modifiable predictors have been rarely examined.


Objective: The aim of this study was to examine the baseline psychosocial, behavioral, and physical predictors of HF symptoms and HRQOL at 12 months and the mediator effect of HF symptoms in the relationship between depressive symptoms and HRQOL.


Methods: We collected data from 94 patients with HF (mean +/- SD age, 58 +/- 14 years). Data included sample characteristics, depressive symptoms, perceived control, social support, New York Heart Association (NYHA) functional class, medication adherence, sodium intake, self-care management, and HF symptoms at baseline, as well as HF symptoms and HRQOL at 12 months. Multiple regression analyses were performed to address the purpose.


Results: Baseline depressive symptoms (P < .001), medication adherence (P = .010), sodium intake (P = .032), and NYHA functional class (P = .040) significantly predicted 12-month HF symptoms, controlling for covariates (F = 7.363, R2 = 47%, P < .001). Baseline medication adherence (P = .001), NYHA functional class (P < .001), and HF symptoms (P = .013) significantly predicted 12-month HRQOL (F = 10.701, R2 = 59%, P < .001). Baseline HF symptoms fully mediated the relationship between baseline depressive symptoms and 12-month HRQOL.


Conclusion: Symptoms of HF and HRQOL could be improved by targeting multidimensional, modifiable predictors, such as self-care, depressive symptoms, and NYHA functional class.