The heart's silver lining: Positive psychological well-being and health related quality of life in patients with heart failure

Objective

Psychological distress, including depression, is linked to poor health outcomes in cardiovascular disease. Emerging evidence suggests that positive psychological well-being (PPWB), including optimism and purpose, may also impact health outcomes. However, the role of PPWB in heart failure (HF), a highly prevalent and progressive condition that severely affects health-related quality of life (HRQoL), remains unclear. This study explored the association between PPWB and HRQoL in patients with HF.

Methods

In this cross-sectional study, 101 patients with HF from a cardiac hospital completed validated measures of PPWB (BIT), depression (PHQ-9), disease-specific HRQoL (KCCQ-12), and generic HRQoL (SF-36). Spearman correlations and hierarchical multiple linear regression analyses were conducted, adjusting for sex, age, depression, and comorbidities (Charlson Comorbidity Index).

Results

Participants (mean age = 68.2 ± 9.9; 36 % female; 76 % NYHA class II) reported moderate PPWB (BIT = 3.7 ± 0.7), “fair” disease-specific HRQoL (KCCQ-12 Total score = 61.3 ± 23), and below-average generic HRQoL (SF-36 General Health = 36.2 ± 19.4). PPWB was significantly positively correlated with all KCCQ-12 and SF-36 subscales, with the strongest correlation for SF-36 General Health (r = 0.58, p < .001). In multivariable models, higher BIT scores were associated with better HRQoL across domains, including KCCQ-12-QoL (β = 0.26, p = .012), KCCQ-12 Social Limitations (β = 0.26, p = .017), KCCQ-12 Total score (β = 0.21, p = .042), SF-36 Energy (β = 0.38, p < .001), and SF-36 General Health (β = 0.48, p < .001).

Conclusion

PPWB is significantly associated with both disease-specific and generic HRQoL in patients with HF, even after adjusting for comorbidities and depression. These findings highlight the importance of focusing on well-being, not just distress, in future HF research.