Journal of Cardiac Failure
Volume 15, Issue 10 , Pages 835-842, December 2009

Relationship of Quality of Life Scores With Baseline Characteristics and Outcomes in the African-American Heart Failure Trial

  • Peter Carson, MD

      Affiliations

    • Veterans Affairs Medical Center, Washington, DC
    • Corresponding Author InformationReprint requests: Peter Carson, MD, Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422-0001. Tel: (202) 745-8109; Fax: (202) 745-8172.
    • ,
  • S. William Tam, PhD

      Affiliations

    • NitroMed, Inc., Lexington, MA
    • ,
  • Jalal K. Ghali, MD

      Affiliations

    • Wayne State University, Detroit, MI
    • ,
  • W. Tad Archambault, PhD

      Affiliations

    • Virtu Stat, Ltd, North Wales, PA
    • ,
  • Anne Taylor, MD, FACC

      Affiliations

    • Columbia University Medical Center, New York, NY
    • ,
  • Jay N. Cohn, MD, FACC

      Affiliations

    • University of Minnesota, Minneapolis, MN
    • ,
  • Virginia M. Braman

      Affiliations

    • NitroMed, Inc., Lexington, MA
    • ,
  • Manuel Worcel, MD

      Affiliations

    • NitroMed, Inc., Lexington, MA
    • ,
  • Inder S. Anand, MD, FACC, FRCP, DPHIL (OXON.)

      Affiliations

    • University of Minnesota, Minneapolis, MN
    • Veterans Affairs Medical Center, Minneapolis, MN

Received 6 January 2009; received in revised form 28 May 2009; accepted 29 May 2009. published online 13 July 2009.

Abstract 

Background

To characterize the quality of life (QOL) in the African-American Heart Failure Trial (A-HeFT) for factors associated with baseline score, relation of score to prognosis, and response to therapy with a fixed-dose combination of isosorbide dinitrate/hydralazine (FDC I/H). Limited data exist on QOL scores in African-American heart failure patients or on the prognostic value of theses scores in any population. Finally, the effect of FDC I/H on QOL scores, particularly in A-HeFT, is not known.

Methods and Results

A-HeFT randomized 1050 African-American patients with New York Heart Association (NYHA) Class III-IV heart failure and systolic dysfunction. QOL measurements using Minnesota Living with Heart Failure Questionnaire (MLHFQ) were done at baseline and 3-month intervals. At baseline, worse MLHFQ scores were associated with younger age, female sex, greater body mass index, nonischemic etiology, high heart rate and NYHA Class, low systolic blood pressure, and chronic obstructive pulmonary disease. Both baseline and change in MLHFQ score were associated with a higher risk for combined all-cause mortality or heart failure hospitalization (baseline P < .0001, change at 3 months P=.001, and at 6 months P=.0008), but not mortality. Treatment with FDC I/H significantly improved MLHFQ score compared with placebo.

Conclusions

In A-HeFT, baseline QOL (MLHFQ) scores and change in score were predictive of combined HF morbidity and mortality outcomes. FDC I/H consistently improved QOL scores in A-HeFT compared with placebo.

Key Words: Heart failure, quality of life, nitric oxide, morbidity, race

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 All decisions for this manuscript were made by a guest editor.

 A-HeFT was funded by NitroMed, Inc, Lexington, MA. Authors are either consultants of NitroMed, Inc. (A.N.T., I.S.A., J.K.G., J.N.C., P.C., W.T.A.) or are/were employees of NitroMed (V.B., M.W., S.W.T.). Dr. Cohn has a royalty relationship with NitroMed based on his patents of the drug combination.

 Dr. Braman was an employee of NitroMed, Inc. from 2001-2008.

 Dr. Taylor has received research support and honoraria from NitroMed, Inc.

 Dr. Archambault served as a consultant to NitroMed, Inc.

 A-HeFT = African-American Heart Failure Trial BEST = Beta-Blocker Evaluation of Survival Trial CHARM = Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity.

PII: S1071-9164(09)00192-4

doi:10.1016/j.cardfail.2009.05.016

Journal of Cardiac Failure
Volume 15, Issue 10 , Pages 835-842, December 2009

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