Correlates of health-related quality of life among lower-income, urban adults with congestive heart failure Daniel O. Clark, PhD, a,b Wanzhu Tu, PhD, a,b Michael Weiner, MD, MPH, a,b and Michael D. Murray, PharmD, b,c Indianapolis, Indiana BACKGROUND: Improving health-related quality of life (HRQL) is a primary goal in the treatment of patients with congestive heart failure (CHF), yet few studies have explored correlates of HRQL among CHF patients. OBJECTIVES: We report on the association of demographic and pathophysiologic measures, social- cognitive measures, and environmental variables with HRQL as measured by the Kansas City Cardio- myopathy Questionnaire (KCCQ), Chronic Heart Failure (CHQ), and a single question of perceived overall health (PH). METHODS: Cross-sectional data were obtained from the baseline interview and electronic medical records of 212 patients 50 years of age and older who were enrolled during the first 7 months of a medication adherence study. RESULTS: Mean age was 63; 32% were male; 53% were black; the mean Charlson comorbidity score was 3.7; and the mean New York Heart Association class was 2.1. Correlations between KCCQ and CHQ subscale scores and PH ranged from 0.16 to 0.37. Multivariate regression analyses showed that the pathophysiologic measures ejection fraction and comorbidity were not associated with any of the HRQL measures. Overall PH was associated with greater age and more positive health beliefs. Persons of greater age, males, and black respondents had higher CHF-specific HRQL scores, as did persons reporting more positive health beliefs, greater income, social support, and communication with their physician. Variance explained ranged from 14 to 33%. CONCLUSION: These cross-sectional data highlight the potential significance of social and behavioral factors in CHF-specific HRQL. (Heart Lung® 2003;32:391-401.) INTRODUCTION Congestive heart failure (CHF) is a disease as- sociated with considerable suffering and enor- mous costs. The toll on patients and families is high and the vast majority of persons with con- gestive heart failure report reduced function and quality of life. 1 Consequently, improving health- related quality of life (HRQL) has become a focus of many clinical trials and is a major goal in the treatment of patients with CHF. It has been esti- mated that CHF costs nearly $19 billion per year in direct medical costs 2 and is directly or indi- rectly implicated in more than 250,000 deaths per year. 3 In this article, we use the term HRQL to refer to patients’ perceptions of their physical, social, and psychological domains of health. 4 Its purpose is to explore the correlates of HRQL within a sample of urban primary care patients who have CHF. Although there have been reports indicating that CHF-specific HRQL measures are psychometrically superior to generic HRQL mea- sures when studying CHF, 5 there is no gold standard for HRQL among patients with CHF. Consequently, we compare results based on 2 CHF-specific instruments, representing 5 do- mains, and a single question of patients’ percep- tions of their overall health. From the a Indiana University Center for Aging Research, India- napolis, Indiana, b Regenstrief Institute, Inc., Indianapolis, Indi- ana, c Purdue University School of Pharmacy, Purdue University School of Pharmacy, Indianapolis, Indiana. Reprint requests: Daniel O. Clark, PhD, Indiana University Center for Aging Research, 1050 Wishard Blvd., RG 6, Indianapolis, IN 46202. Copyright © 2003 by Mosby, Inc. 0147-9563/2003/$30.00 + 0 doi:10.1016/j.hrtlng.2003.07.005 HEART & LUNG VOL. 32, NO. 6 www.heartandlung.org 391