Characterizing patient-reported outcomes in veterans with cirrhosis

Background and aims The Veterans Health Administration (VA) cares for over 80,000 Veterans with cirrhosis annually. Given the importance of understanding patient reported outcomes in this complex population, we aimed to assess the associations between attitudes towards care, disease knowledge, and health related quality of life (HRQoL) in a national sample. Methods In this cross-sectional study, we mailed paper surveys to a random sample of Veterans with cirrhosis, oversampling those with decompensated disease. Surveys included the Veterans RAND 12-Item Health Survey (measuring HRQoL) and questions about demographics, characteristics of care, satisfaction with care ("attitudes towards care"), and symptoms of cirrhosis. Those who reported being "unsure" about whether they had decompensation events were defined as "unsure about cirrhosis symptoms" ("disease knowledge"). We used multivariable regression models to assess the factors associated with HRQoL. Results Of 1374 surveys, 551 (40%) completed surveys were included for analysis. Most Veterans (63%) were "satisfied" or "very satisfied" with VA liver care. Patients often self-reported being unsure about whether they had experienced hepatic decompensation events (34%). Overall average physical (PCS) and mental (MCS) component scores of HRQoL were 30 +/- 11 and 41 +/- 12. In multivariable regression models, hepatic decompensation (PCS:beta = -3.8, MCS:beta = -2.2), medical comorbidities (beta = --2.0, beta = -1.7), and being unsure about cirrhosis symptoms (beta = -1.9, beta = -3.3) were associated with worse HRQoL, while age (beta = 0.1, beta = 0.2) and satisfaction with care (beta = 0.6; beta = 1.6) were associated with significantly better HRQoL. Conclusions Hepatic decompensation, lower satisfaction with care, and being unsure about cirrhosis symptoms were associated with reduced QOL scores in this national cohort.