Advanced Heart Failure in Older Women with Heart Failure and Preserved Systolic Function
Heart failure with preserved systolic function (HFPSF) accounts for approximately half of all heart failure (HF) patients, a majority of whom are older women. Little is known about this HF subgroup since they have not been included in most HF clinical trials and other research studies. Moreover, the characteristics of those who have advanced disease have not been well described.
The primary aims of this dissertation were 1) to use a cross-sectional design to describe the characteristics of older women with advanced HFPSF and 2) to examine potential factors influencing their quality of life (QOL).The variables included were demographic, clinical, symptom, comfort, and functional capacity.
Sixty women (76 ± 7.7 years; 86.7% Caucasian) with New York Heart Association Class III HFPSF were recruited from two outpatient HF clinics. The women had high symptom prevalence (13.2 ± 6.4) and burden (2.1 ± 0.43 on a 0-4 scale), impaired functional capacity (mean 6-minute walk distance: 201.4 ± 117.1 meters) and multiple co-morbidities (4.65 ± 1.55). Co-morbid medical conditions associated with increased mortality and morbidity risk in HFPSF included pulmonary hypertension (76%), compromised renal function (73%), atrial fibrillation (66.7%), coronary artery disease (45%), and diabetes (40%).
Using a multiple linear regression model to control for disease severity, clinical status, and functional capacity, age (p = .023), comfort (p = .002) and symptom burden (p = .001) were significantly associated with QOL. The final overall model explained 66% of the variance in QOL (p < .001). Age explained 4% of the variance (p = 0.023), total symptom burden explained 14% of the variance (p = < .001), and comfort explained 7% of the variance (p = 0.002) in QOL.
Interventions reducing symptom burden and enhancing comfort for older women with advanced HFPSF may result in improved QOL. Addressing factors germane to QOL is congruent with palliative care in advanced chronic illness, since QOL enhancement is a palliative care goal.
The unrecognized palliative need of advanced HFPSF patients, a group comprised largely of older women, must be addressed. This segment of our aging society deserves better quality in the last phase of their life journey.