M Shively, VA San Diego Health Care System and San Diego State University; T Smith, VA San Diego Health Care System; M Kodiath, VA San Diego Health Care System; A Kelly, VA San Diego Health Care System; P Bone, VA San Diego Health Care System; L Fetterly, VA San Diego Health Care System; R Shabetai, VA San Diego Health Care System; N Gardetto, VA San Diego Health Care System; K Dracup, University of California San Francisco; S Bozzette, VA San Diego Health Care System and University of California San Diego

Objectives: The purposes of this study were to 1) examine the multiple dimensions of health-related quality of life (HRQL) and 2) compare the differences in HRQL outcomes based on functional status classification in veterans with medically-managed heart failure.

Methods: This is a cross-sectional analysis of multidimensional measures of HRQL completed by veterans enrolled in a behavioral intervention randomized trial. Participants were 87 outpatients with a primary diagnosis of dilated cardiomyopathy or heart failure, a VA primary care provider, stable symptoms for at least one month and able to walk without assistance. Functional status was measured using the New York Heart Association (NYHA) classification and the Specific Activity Scale (SAS). The generic measures of HRQL were depression (Beck Depression Inventory/BDI-II), physical functioning (SF-36V physical component summary score), mental functioning (SF-36V mental component summary score), and exercise capability (6-minute walk). Disease-specific HRQL was measured with the Minnesota Living with Heart Failure Questionnaire (MLHF physical and emotional domain scores). Descriptive statistics were used to examine sample characteristics and HRQL measures. Independent t tests were used to evaluate the differences in HRQL scores according to dichotomized functional status (SAS class); a Bonferroni-corrected alpha of .008 was used.

Results: Participants were typically male (93%), Caucasian (71%), and married (43%); the mean age was 67 (SD 10.6). Participants had the following NYHA functional classifications: I (34%), II (45%), III (21%), IV (0%). SAS class frequencies were I (4%), II (44%), III (51%), IV (1%). Participants with better functional status (SAS I or II) were significantly different than those with poorer functional status (SAS III or IV) in the following HRQL dimensions:

- lower depression scores on the BDI-II: 7.3 (8.4) vs 14.1 (9.4)

- better SF-36V physical component summary scores: 41.2 (10.8) vs

28.6 (7.1)

- greater distances walked in meters: 398 (60.5) vs 268 (78.5)

- better physical MHLF scores: 11.1 (9.5) vs 24 (9.5)

- better emotional MHLF scores: 4.8 (5.3) vs 11.3 (7).

The SF-36V mental component summary scores were not significantly different between the functional status classifications.

Conclusions: Functional status impacts the multidimensional aspects of HRQL. Multidimensional HRQL assessment should be part of efficacy and effectiveness research related to improving outcomes in patients with heart failure.

Impact: Patient-centered HRQL outcomes measurement and tracking in veterans with heart failure can produce a more comprehensive evaluation of illness impact and treatment effectiveness than current endpoints such as morbidity and mortality.