Disease-specific health status as a predictor of mortality in patients with heart failure: a systematic literature review and meta-analysis of prospective cohort studies

Aims Some, but not all, studies have shown that patient-reported health status, including symptoms, functioning, and health-related quality of life, provides additional information to traditional clinical factors in predicting prognosis in heart failure patients. To evaluate the overall evidence, the association of disease-specific health status on mortality in heart failure was examined through a systematic review and meta-analysis. Methods and results Prospective cohort studies that assessed the independent association of disease-specific health status with mortality in heart failure were selected. Searching PubMed (until March 2013) resulted in 17 articles in the systematic review and 17 studies in the meta-analysis. About half of the studies reported a significant relationship between disease-specific health status and mortality in heart failure, while the remainder found no association. A larger sample size increased the chance of identification of a significant association. The results of the meta-analysis (including studies using a dichotomized heart failure-specific health status variable as predictor) showed that heart failure patients reporting poor disease-specific health status had a 39% increased risk of dying [hazard ratio 1.39 (1.25-1.54)] when compared with patients experiencing moderate or good disease-specific health status. Conclusion Patient-reported health status was an independent risk indicator for mortality in heart failure patients and may facilitate the identification of patients at high risk for poor prognosis above and beyond traditional risk variables. These findings suggest that patient-reported health status should be routinely assessed in determining prognosis, as this information cannot be captured from patients' medical records.