Association of living alone with quality of life in heart failure
A Poljansek Avsenak, M Lainscak, M Petek Ster, L PetravicAbstract
Background
Heart failure (HF) is a chronic disease, with prevalence increasing with age, that is continuing to rise in ageing populations. HF limits patients' ability to perform daily activities, resulting in a poor quality of life (QoL). Patient-reported outcome measures may help identify patients who require additional non-pharmacological support. Living alone is a known determinant of poorer QoL and may be particularly relevant in HF.
Methods
A prospective cohort study was conducted in Slovene-speaking HF patients recruited from outpatient clinics. HF patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). Living arrangement was classified as living alone versus living with others. KCCQ domain scores (0–100; higher scores indicate better health status) were compared using Welch’s t-tests. The independent association between living alone and KCCQ scores was assessed using multivariable linear regression with HC3 robust standard errors, adjusting for age, sex, and left ventricular ejection fraction (LVEF).
Results
Among 230 HF patients, 42 (18%) lived alone. Patients living alone reported significantly worse KCCQ scores for social interference (p=0.0259), physical limitation (p=0.0013), symptom burden (p=0.0140), and independent care (p=0.0413), while self-efficacy did not differ. After multivariable adjustment, living alone remained independently associated with lower scores for social interference (β=−8.14, p=0.023), physical limitation (β=−12.18, p=0.002), and symptoms (β=−8.54, p=0.026), with a borderline association for independent care (β=−7.71, p=0.055).
Conclusion
Living alone is independently associated with worse patient-reported health status in HF. These findings support the need to incorporate QoL assessment and social context into HF care as a tool to help us identify patients at risk, because worse QoL directly correlates with health outcomes, such as mortality and hospitalisations. In ageing populations and in settings with reduced informal support or limited ability of institutional care, systematic identification of patients living alone may facilitate targeted non-pharmacological interventions aimed at improving patient-centred outcomes.Living Alone and Patient-Reported HealthFor image description, please refer to the figure legend and surrounding text.