Symptom Burden and Health-Related Quality of Life Among Patients with Heart Failure in Indonesia

ABSTRACT

Background: Heart Failure (HF) is a complex syndrome that can cause a variety of symptoms and multiple organ dysfunctions, leading to a greater symptom burden than other chronic diseases. Symptom burden in patients with HF may affect functional status, survival, and economic outcomes, and contribute to poor health-related quality of life (HRQOL) of the patients.
Purpose: This cross-sectional study examine of the relationship between symptom burden and HRQOL among patients with HF in Indonesia.
Method: A convenience sample of 164 heart failure patients was recruited from a cardiology outpatient department, inpatients cardiac ward, and echocardiography room at a public hospital in Indonesia. A set of self-reported questionnaires was used to including the demographic questionnaire, the Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF), the World Health Organization Quality of Life (WHOQOL)-BREF and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Descriptive statistics, bivariate analyses (independent t-tests, one-way ANOVA, and Pearson correlation), and hierarchical regression analysis were utilized to analyse the data.
Results: The mean age of the participants was 58.37 years old, the mean duration of HF diagnosis was 42.59 months, and the mean frequency of admission was 2.18 times. All participants experienced a mean of 9.72 ± 5.44 symptoms, while chest pain and lack of energy were the most prevalent. The most burdensome symptoms were chest pain, lack of energy, difficulty sleeping, numbness/tingling in hands/feet and cough. A hierarchical multiple regression analysis showed that after controlling for demographic factors and illness-related factors, higher NYHA classes, psychological symptoms and heart failure symptoms predicted 55.1% of the variance in HRQOL by MLHFQ measurement. In terms of predictors of WHOQOL-BREF domains, participants who had CAD and DM type 2 comorbidity, higher NYHA classes, and higher psychological symptoms predicted 35.7% of the variance on physical domain, participants who had CAD comorbidity and psychological symptoms predicted 31.4% of the variance on psychological domain, participants who had CAD comorbidity, high number of medication use and higher heart failure symptoms predicted 29.5% of the variance on social relationship domain, while lower income level and had CAD comorbidity predicted 40.7% of the variance on environment domain, and whereas longer duration of HF diagnosis, had CAD comorbidity, diuretics medication use, and higher heart failure symptom predicted 11.8% of the variance on overall QoL domain, in HRQOL by WHOQOL-BREF measurement, respectively.
Conclusion: The study found that symptom burden has a great impact on quality of life. The consistency of the finding on NYHA classes and CAD comorbidity as major predictors in the two measurements of HRQOL across every model for the domains is impressive. This suggests that CAD comorbidity and NYHA classes are essential for patients with heart failure experiences decreased HRQOL. Future interventions directed to make the condition of patients with HF more stable and decrease the prevalence of the symptoms in order to improve HRQOL.

Keywords
Heart failure, symptom burden, health-related quality of life

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