HEALTH RELATED QUALITY OF LIFE AND ASSOCIATED FACTORS AMONG HEART FAILURE WITH REDUCED EJECTION FRACTION ADULT PATIENTS ATTENDING CARDIAC CLINIC AT UNIVERSITY OF GONDAR COMPREHENSIVE SPECIALIZED HOSPITAL NORTH WEST ETHIOPIA, 2023: A CROSS-SECTIONAL STUDY

Abstract

Background: Health related quality of life is patient reported impact of disease and its treatment on health. Living with heart failure is challenging as it has a poor prognosis and increased socioeconomic burden, debilitating symptoms and frequent hospitalisations which collectively, significantly impact quality of life. Despite significant advances in treatment of heart failure with reduced ejection fraction, studies are showing most patients are still having poor quality of life mentioning different associated factors. Poor quality of life in turn correlates with increased hospitalization and mortality rates, and higher costs imposed on health systems, families, and patients. Since there is scarcity of study in Ethiopia, the ability to determine quality of life and its associated factors among heart failure with reduced ejection fraction patients is crucial in improving clinical care and determining targets of intervention for improving patient’s quality of life. Therefore, this study was done to assess quality of life and associated factors among heart failure with reduced ejection fraction patients attending cardiac clinic at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Methods: Institution-based cross-sectional study was conducted at University of Gondar Comprehensive Specialized Hospital. Data were collected using interviewer administered questionnaire. The Health related quality of life was measured using Minnesota Living with Heart Failure Questionnaire. Socio-demographic, behavioral, clinical, biochemical and echocardiographic characteristics were included in the Questionnaire. The collected data were entered into EpiData version 4.6 and exported into SPSS version 25 for analysis, and multiple linear regression analysis with p-value < 0.05 was used to measure the degree of association between quality of life and independent variables. Results: A total of 240 patients with heart failure with reduced ejection fraction participated in the study. The Health related quality of life score for the physical, emotional, and total were 17.60±10.33, 10.58±6.33 and 46.12±26.06, respectively. 43.3% of participants had poor quality of life. Multiple linear regression analysis revealed total health related quality of life was significantly associated with age (β= 0.37, 95% CI 0.24,0.50), marital status: single (β= 8.67, 95% CI 4.66, 12.68) widowed (β= 5.46, 95% CI 1.94,8.98), occupation: employed (β= 5.79, 95% CI 2.53,9.05), income (β= -0.002, 95% CI -0.002,-0.001), duration of heart failure (β= -1.73, 95% CI -3.05,-0.40), recent hospitalization within past six months (β= 8.56, 95% CI 4.38,12.74), New York Heart Association functional class: III (β= 6.39, 95% CI 3.04, 9.74) IV(β= 17.89, 95% CI 12.57, 23.20), etiology of heart failure: dilated cardiomyopathy (β= 3.20, 95% CI 0.34, 6.07), atrial fibrillation comorbidity (β= 8.11, 95% CI 4.26, 11.97), systolic blood pressure (β= -0.15, 95% CI -0.27,-0.04), heart rate (β= 0.19, 95% CI 0.07, 0.31), heart failure medications: diuretics (β= 6.70, 95% CI 3.88,9.52) anticoagulant (β= 3.04, 95% CI 0.01,6.07), Left ventricle severe systolic dysfunction (β= 3.41, 95% CI 0.38,6.43) and severe/moderate pulmonary hypertension (β= 7.76, 95% CI 3.47,12.04). These identified associated factors explained 87.9% (R2=0.879) of the variation in total health related quality of life. Echocardiographic factors explained most of the variability (partial R2 = 0.644), followed by clinical factors (partial R2 = 0.120). Conclusion and recommendation: This study found that people with heart failure with reduced ejection fraction had poor health related quality of life, influenced by age, marital status, occupation, income, duration of heart failure, recent hospitalization, New York Heart Association functional class, etiology of heart failure, atrial fibrillation comorbidity, systolic blood pressure, heart rate, diuretics and anticoagulant use, left ventricle systolic dysfunction and pulmonary hypertension severity. The findings can help health professionals to asses’ heart failure with reduced ejection fraction patients for health related quality of life and to identify appropriate interventions to improve these patients quality of life.