Association of cumulative health status with subsequent mortality in patients with acute heart failure

Aims We aim to examine the association between long-term cumulative health status and subsequent mortality among patients with acute heart failure (HF).Methods and results Based on a national prospective cohort study of patients hospitalized for HF, we measured health status by Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 at four time points, i.e. admission and 1, 6 and 12 months after discharge. Cumulative health status was interpreted by cumulative KCCQ-12 score and cumulative times of good health status. Outcomes included subsequent all-cause and cardiovascular mortality. Multivariable Cox proportional hazard models were performed to examine the association between cumulative health status and subsequent mortality. Totally, 2328 patients {36.7% women with median age 66 [interquartile range (IQR): 56-75] years} were included, and the median follow-up was 4.34 (IQR: 3.93-4.96) years. Compared with quartile 4, the lowest quartile 1 had the highest hazard ratio (HR) for all-cause mortality [2.96; 95% confidence interval (CI): 2.26-3.87], followed by quartile 2 (1.79; 95% CI: 1.37-2.34) and quartile 3 (1.62; 95% CI: 1.23-2.12). Patients with zero times of good health status had the highest risk of all-cause mortality (HR: 2.41, 95% CI: 1.69-3.46) compared with patients with four times of good health status. Similar associations persisted for cardiovascular mortality.Conclusion A greater burden of cumulative health status indicated worse survival among patients hospitalized for HF. Repeated KCCQ measurements could be helpful to monitor long-term health status and identify patients vulnerable to death. Graphical Abstract