Quality of life post heart failure diagnosis: population-level trends in the U.S.

Abstract

Background: Individuals with heart failure (HF) experience various symptoms making both diagnosis and disease burden estimates challenging. While HF-specific patient-reported outcome measures (PROMs) are widely used, their focus on clinical cohorts limits their generalizability. Preference-based measures like the EQ-5D enable standardized health-related quality of life (HRQoL) comparisons across conditions, supporting resource allocation decisions. The CDC's Healthy Days (HD) Survey-a simple two-question tool that can be mapped to the EQ-5D-offers a broader approach to tracking HRQoL but remains underutilized in HF populations.

Methods: Using a nationally representative U.S. sample, we mapped HD Survey responses to EQ-5D utility scores to compare HRQoL between individuals with and without HF and examined changes in HRQoL over time. We assessed whether HD-derived scores align with HF-specific utility measures to support population-level health monitoring.

Results: Individuals with HF report significantly more physically unhealthy days (8.46 vs. 3.42) and mentally unhealthy days (5.42 vs. 3.86) compared to those without HF. HF respondents are, on average, 20 years older than those without HF, consistent with HF's prevalence in older adults. The likelihood of an HF diagnosis is similar for men and women but higher among non-Hispanic whites and blacks than Hispanics and other races. Those with HF are more likely to have health insurance. Adjusting for age, sex, race, and insurance, mean EQ-5D utility scores for individuals with and without HF are 0.785 (95% CI: 0.714-0.825) and 0.840 (95% CI: 0.827-0.851), respectively. Utility scores for HF patients remain significantly lower than those without HF up to 10 years post-diagnosis.

Conclusion: HF reduces HRQoL by 6.55%, surpassing the clinically significant threshold of a 1-2% decrement. These findings highlight the potential of the HD Survey to inform public health monitoring and underscore the need for tailored interventions to address HRQoL deficits in HF populations.