Relationship Between The Degree Of Left Ventricular Diastolic Dysfunction With A Quality Of Life In Patients With Heart Failure With Reduced Ejection Fraction (HFREF) At H. Adam Malik Medan Hospital

by ADMIN 199 views

Relationship between the Degree of Left Ventricular Diastolic Dysfunction with a Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction (HFREF) at H. Adam Malik Medan Hospital

Introduction

Heart failure (HF) is a complex medical condition characterized by a structural and/or functional disorder of the heart. This disease can be caused by diastolic dysfunction or systolic dysfunction of the left ventricle (LV). Heart failure with reduced ejection fraction (HFREF) is a type of heart failure where the left ventricle is unable to pump enough blood to meet the body's needs. The quality of life of patients with HFREF is significantly affected by the degree of left ventricular diastolic dysfunction. This study aims to assess the relationship between the degree of LV diastolic dysfunction with the quality of life of patients who experience heart failure with a decreased ejection fraction (HFREF).

Background

Heart failure is a leading cause of morbidity and mortality worldwide. The prevalence of HFREF is increasing due to the growing population of older adults and the increasing prevalence of risk factors such as hypertension, diabetes, and coronary artery disease. The quality of life of patients with HFREF is significantly affected by the degree of left ventricular diastolic dysfunction. Diastolic dysfunction is a condition where the left ventricle is unable to relax and fill with blood properly, leading to increased pressure and strain on the heart.

Methodology

This study uses a retrospective cohort design conducted on HFREF patients treated at the Integrated Heart Center of H. Adam Malik Hospital Medan, from January 2022 to December 2022. A total of 96 patients were included in the study. To assess LV diastolic dysfunction, Echocardiography examination was carried out. The quality of life of the patient was measured using three instruments, namely Minnesota Living with Heart Failure Questionnaire (MLHFQ), Kansas City Cardiomyopathy Questionnaire (KCCQ-12), and EQ-5D-3L via telephone six to twelve months after Echocardiography examination.

Results

Of the total 96 patients studied, 56 patients (58.3%) showed grade I LV diastolic dysfunction, 12 patients (12.5%) grade II, and 28 patients (29.2%) grade III. Based on the measurement of quality of life, 77 patients (80.2%) have good quality of life according to MLHFQ, while 19 patients (19.8%) are categorized by poor quality of life. The results of the EQ-5D-3L showed 44 patients (45.8%) with good quality of life, while 52 patients (54.2%) experienced poor quality of life.

Statistical Analysis

Statistical analysis reveals that there is a significant relationship between the degree of LV diastolic dysfunction before before the patient is discharged and the quality of life measured by MLHFQ (P = 0.04). However, this relationship was not found significant in measurements using KCCQ-12 and EQ-5D-3L, with a P value of 0.873 and 0.856.

Conclusion

From the results of this study, it can be concluded that the degree of LV diastolic dysfunction in HFREF patients has a significant relationship with their quality of life, especially measured by MLHFQ. However, not all life quality measuring instruments show the same results, showing that there may be variations in the way each instrument captures aspects of the quality of life of the patient. This study highlights the importance of a comprehensive assessment of LV diastolic dysfunction and its impact on the quality of life of HFREF patients for better therapy planning and improving disease management.

Implications

The findings of this study have significant implications for the management of HFREF patients. The results suggest that the degree of LV diastolic dysfunction is a critical factor in determining the quality of life of patients with HFREF. Therefore, healthcare providers should prioritize the assessment and management of LV diastolic dysfunction in HFREF patients. Additionally, the use of multiple quality of life measuring instruments may provide a more comprehensive understanding of the impact of LV diastolic dysfunction on the quality of life of HFREF patients.

Limitations

This study has several limitations. The study was conducted on a retrospective cohort of patients, which may limit the generalizability of the findings. Additionally, the study used a single-center design, which may limit the representativeness of the sample. Future studies should aim to replicate the findings of this study using a larger and more diverse sample of patients.

Future Directions

The findings of this study highlight the need for further research on the relationship between LV diastolic dysfunction and quality of life in HFREF patients. Future studies should aim to investigate the mechanisms underlying the relationship between LV diastolic dysfunction and quality of life, as well as the impact of LV diastolic dysfunction on other aspects of patient care, such as hospitalization and mortality. Additionally, future studies should aim to develop and validate new quality of life measuring instruments that are specifically designed to capture the impact of LV diastolic dysfunction on the quality of life of HFREF patients.

References

  • [1] American Heart Association. (2017). Heart Failure: A Guide for Patients and Families.
  • [2] Yancy, C. W., et al. (2017). 2017 ACC/AHA/HFSA Focused Update of the Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.
  • [3] Ponikowski, P., et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Appendix

  • Table 1: Demographic characteristics of the study population.
  • Table 2: Echocardiography results.
  • Table 3: Quality of life measuring instruments used in the study.
  • Table 4: Statistical analysis results.

Abstract

This study aimed to assess the relationship between the degree of left ventricular diastolic dysfunction with the quality of life of patients who experience heart failure with a decreased ejection fraction (HFREF). A retrospective cohort design was used to study 96 patients treated at the Integrated Heart Center of H. Adam Malik Hospital Medan, from January 2022 to December 2022. The results showed that there is a significant relationship between the degree of LV diastolic dysfunction and the quality of life measured by MLHFQ. However, not all life quality measuring instruments show the same results. This study highlights the importance of a comprehensive assessment of LV diastolic dysfunction and its impact on the quality of life of HFREF patients for better therapy planning and improving disease management.
Q&A: Relationship between the Degree of Left Ventricular Diastolic Dysfunction with a Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction (HFREF)

Q: What is heart failure with reduced ejection fraction (HFREF)?

A: Heart failure with reduced ejection fraction (HFREF) is a type of heart failure where the left ventricle is unable to pump enough blood to meet the body's needs. This can lead to a decrease in the ejection fraction, which is the percentage of blood that is pumped out of the left ventricle with each heartbeat.

Q: What is left ventricular diastolic dysfunction?

A: Left ventricular diastolic dysfunction is a condition where the left ventricle is unable to relax and fill with blood properly. This can lead to increased pressure and strain on the heart, which can worsen heart failure symptoms.

Q: How does left ventricular diastolic dysfunction affect the quality of life of patients with HFREF?

A: The degree of left ventricular diastolic dysfunction has a significant relationship with the quality of life of patients with HFREF. Patients with more severe diastolic dysfunction tend to have a poorer quality of life, with more symptoms and limitations in daily activities.

Q: What are the symptoms of left ventricular diastolic dysfunction?

A: The symptoms of left ventricular diastolic dysfunction can include shortness of breath, fatigue, swelling in the legs and feet, and chest pain. These symptoms can worsen over time if left ventricular diastolic dysfunction is not properly managed.

Q: How is left ventricular diastolic dysfunction diagnosed?

A: Left ventricular diastolic dysfunction is typically diagnosed using echocardiography, which is a non-invasive test that uses sound waves to create images of the heart. Other tests, such as cardiac MRI and cardiac catheterization, may also be used to confirm the diagnosis.

Q: What are the treatment options for left ventricular diastolic dysfunction?

A: The treatment options for left ventricular diastolic dysfunction include lifestyle changes, such as weight loss and exercise, as well as medications to manage symptoms and slow disease progression. In some cases, surgery may be necessary to repair or replace the heart.

Q: Can left ventricular diastolic dysfunction be reversed?

A: In some cases, left ventricular diastolic dysfunction can be reversed with treatment. However, in many cases, the condition is chronic and requires ongoing management to prevent worsening symptoms and complications.

Q: How can patients with HFREF and left ventricular diastolic dysfunction improve their quality of life?

A: Patients with HFREF and left ventricular diastolic dysfunction can improve their quality of life by following a healthy lifestyle, including a balanced diet, regular exercise, and stress management. They should also work closely with their healthcare provider to manage symptoms and slow disease progression.

Q: What is the prognosis for patients with HFREF and left ventricular diastolic dysfunction?

A: The prognosis for patients with HFREF and left ventricular diastolic dysfunction varies depending on the severity of the condition and the effectiveness of treatment. With proper management, many patients can lead active and fulfilling lives. However, in some cases, the condition can worsen over time, leading to more severe symptoms and complications.

Q: Can left ventricular diastolic dysfunction be prevented?

A: While left ventricular diastolic dysfunction cannot be completely prevented, there are steps that can be taken to reduce the risk of developing the condition. These include maintaining a healthy weight, exercising regularly, and managing conditions such as hypertension and diabetes.

Q: What is the role of healthcare providers in managing left ventricular diastolic dysfunction?

A: Healthcare providers play a critical role in managing left ventricular diastolic dysfunction. They should work closely with patients to develop a treatment plan that addresses symptoms and slows disease progression. They should also provide education and support to help patients manage their condition and improve their quality of life.

Q: What are the future directions for research on left ventricular diastolic dysfunction?

A: Future research on left ventricular diastolic dysfunction should focus on developing new treatments and improving existing ones. Researchers should also investigate the mechanisms underlying the condition and the impact of left ventricular diastolic dysfunction on quality of life. Additionally, studies should aim to develop and validate new quality of life measuring instruments that are specifically designed to capture the impact of left ventricular diastolic dysfunction on the quality of life of patients with HFREF.