Heterogeneous trajectories of health-related quality of life and their association with prognosis in patients with coronary heart disease and chronic heart failure

AIMS: Currently, there is limited knowledge regarding the long-term health-related quality-of-life (HRQoL) trajectories of patients with coronary heart disease (CHD) and chronic heart failure (CHF) after discharge. In this study, we identified the HRQoL trajectories of these people through group-based trajectory modelling (GBTM) and explored their prognosis. METHODS AND RESULTS: A total of 658 patients with CHD and CHF were recruited in this multi-centre, prospective cohort study from June 2017. Health-related quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire-12 at seven time points: at admission and at 1, 3, 6, 12, 18, and 24 months after discharge. Group-based trajectory modelling identified four distinct patterns of HRQoL trajectories: quick deterioration (7.14%), slow deterioration (14.74%), quick improvement (34.19%), and stable improvement (43.92%). Age >65 years, male, higher N-terminal pro-B-type natriuretic peptide levels, poor baseline health status, lower diastolic blood pressure and albumin levels, as well as comorbid chronic kidney disease, hypertension, and stroke were associated with HRQoL deteriorating trajectory (P < 0.05). After adjusting for confounders, Cox proportional hazards models indicated that compared with the high HRQoL-stable improvement group, the low HRQoL-quick deterioration group, moderate HRQoL-slow deterioration group, and moderate HRQoL-quick improvement group had increased risks of all-cause mortality in the following years. CONCLUSION: The HRQoL trajectories within 2 years after discharge in patients with CHD and CHF exhibit significant heterogeneity and are closely linked to subsequent risk of mortality. This finding enhances the understanding of disease progression and provides scientific evidence to inform personalized nursing interventions and treatment strategies in clinical practice. REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2100043337.