J Clin Outcomes Manage
Impact of guideline-recommended therapy on quality of life in veterans with heart failure
Killian JH, Pentecost AG, Porter AK, Borries A, Al-Achi A
Abstract: Objective: To determine if there are therapy-related differences in quality of life (QOL) in patients with heart failure receiving guideline-recommended optimal medication therapy versus suboptimal therapy or undertreatment. Methods: Veteran patients with heart failure (as identified by ICD-9 codes) were mailed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to complete at home. Patients were contacted by telephone to obtain their MLHFQ scores. Patient medication regimens, comorbidities, and demographic data were obtained from the electronic medical charts. Patients were categorized into 1 of 3 groups based on receipt of guideline-recommended therapy with ACE inhibitors and beta blockers: (1) optimal therapy, (2) suboptimal therapy, or (3) undertreatment. A sample size of 56 patients per group was needed to meet power and a statistical significance of 0.05. Results: The mean scores for the MLHFQ in the optimal, suboptimal, and undertreatment groups were 51.1, 47.7, and 49.9, respectively. Groups contained 57, 62, and 106 patients, respectively, for a total of 225 patients. The difference between the scores was not statistically significant. Conclusion: Optimal treatment with guideline recommended ACE inhibitors and beta blockers at target doses does not significantly correlate with a difference in reported QOL. These medications have shown significant benefit on morbidity and mortality; they should continue to be prescribed and titrated without concern of adversely impacting a patientís overall QOL.
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