Comparison of Psychological Distress between Heart Failure Patients with Different Ejection Fraction Phenotypes

Background: Heart failure (HF) patients suffer high non-cardiac comorbidity burden, which adversely affect on quality of life (QoL) and prognosis. We aimed to identify the major psychological distress in HF patients, and compare the distress between HF patients with preserved, mid-range and reduced ejection fraction (HFpEF vs. HFmrEF vs. HFrEF).Methods and Results: A multicenter cross-sectional study with 440 consecutive hospitalized HF patients was performed. Anxiety and depression were assessed by Hospital Anxiety and Depression Scale (HADS), insomnia was assessed by Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI), QoL was assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ), and chronic stress was indicated by hair cortisol concentration examination. We enrolled HF patients of 263 HFpEF (59% female, age 72±14), 75 HFmrEF (40% female, age 71±12) and 102 HFrEF (27% female, age 65±14) respectively. All the three HF groups showed a high prevalence of depression (21%), insomnia (52%), QoL impairment (57%) and chronic stress (46%). Depression, insomnia and QoL between HFpEF, HFmrEF and HFrEF patients did not differ significantly when adjusted confounders for gender, age, and NYHA functional class (P>0.05). Anxiety scores were found lower in HFpEF/HFmrEF patients compared with HFrEF patients (P=0.045). Chronic stress did not differ between the three groups, while remained significant correlation with occupation (R=0.23, P=0.004), oedema (R=0.19, P=0.019) and KCCQ-physical limitation (R =-0.164, P=0.044).Conclusions: Compared with HFrEF patients, HFpEF/HFmrEF patients suffer similarly severe chronic stress, depression, insomnia and QoL impairment but less anxiety.