Beyond the bedside: measuring the impact of daily healthcare interactions in patients with heart failure
O Chausiaux, O Chausiaux, G Williams, S HusheerAbstract
Introduction
Health authorities, including the UK National Institute for Health and Care Excellence (NICE) and the US Food and Drug Administration (FDA), increasingly require medical interventions to show quality-of-life benefits and cost-effectiveness. However, these assessments often overlook patient priorities.1 While hospitalisation impacts on quality of life are well known, minor healthcare events—such as doctor visits, medication changes, and remote monitoring—also add to patient burden. For those with heart failure, these disruptions can be frustrating, exhausting, and intrusive. Evidence suggests frequent minor disruptions significantly affect well-being, yet they remain underrepresented in health economic models.2 This feasibility study integrates patient perspectives into a UK heart failure trial to refine methods and expand future research.
Methods
A structured questionnaire, developed with patient input, was administered over six months to assess willingness to trade life expectancy for improved health states. The questionnaire presented two scenarios: (1) trading current health for a shorter period of perfect health and (2) trading lifespan to avoid specific healthcare events such as hospitalisations, doctor visits, blood tests, medication changes, and remote interactions (example in Figure 1). To reduce respondent burden, questions were randomly assigned, with up to seven asked in months 1, 3, and 6. Responses were analysed to quantify utility decrements and their cumulative impact on QALYs.
Results
Preliminary data from 50 heart failure patients in the HF-TRACK trial showed an average age of 78.2 years (SD 11.3), with 48% female. Response rates matched those of the EQ-5D, indicating strong engagement. Many participants noted that while hospitalisations were disruptive, frequent minor healthcare interactions—such as weekly doctor visits, daily phone calls, and medication changes—created a sense of constant medical surveillance, impacting their independence. While minor events had smaller per-event decrements compared to hospitalisations, their cumulative burden was substantial, as seen in Figure 2. Time Trade-Off-derived utilities aligned with existing QoL scores, demonstrating consistency.
Conclusions
This study confirms the feasibility of using Time Trade-Off (TTO) to assess the quality-of-life impact of both major and minor healthcare events in heart failure patients. While hospitalisations remain significant, frequent minor healthcare interactions also meaningfully contribute to patient burden. Incorporating these utility decrements into health economic models may improve cost-effectiveness evaluations of interventions to reduce hospitalisations and optimise remote monitoring strategies. Future research should validate these findings by cross-referencing with established tools (EQ-5D, KCCQ, and MLHFQ) to provide a more comprehensive assessment of healthcare interventions.