Patient perceived physician empathy, treatment adherence and quality of life predict mid-term outcomes in heart failure
N Bozini, K Mourouzis, E Oikonomou, E Bletsa, V Tsigkou, M Zaromitidou, G Siasos, K Tsioufis, D TousoulisAbstract
Background
Heart failure (HF) is a complex syndrome linked to high morbidity and mortality. Quality of life (QoL), treatment adherence, and perceived physician empathy may influence prognosis, yet their interrelations in HF remain understudied.
Purpose
To examine associations among QoL, treatment adherence, and perceived physician empathy and their effects on mid-term outcomes in patients with HF.
Methods
A total of 187 patients (85% male, mean age 71 ± 12 years) with established HF were prospectively observed for 6 (5–7) months. The composite endpoint included emergency department (ED) visits, all-cause hospitalization, or all-cause death. QoL was measured with the Minnesota Living with Heart Failure Questionnaire (MLHFQ), adherence with the Simplified Medication Adherence Questionnaire (SMAQ), and empathy with the Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE) at baseline. Demographic and clinical characteristics were also recorded.
Results
Empathy was predicted by adherence (b = 3.05, p < 0.001), emotional (b = 0.28, p = 0.01) and physical MLHFQ subscales (b = –0.15, p = 0.04) after adjusting for traditional risk factors. Adherence depended on empathy (b = 0.15, p < 0.001) and both MLHFQ subscales independently of confounders, while QoL did not depend on empathy or adherence. During follow-up, 43.3% (n = 81, 78% male) reached the composite endpoint. The leading cause of hospitalisation was HF-related (48.2%), whereas 7 patients died. These patients were older, had lower LVEF [30 (27–40)% vs. 40 (32–55)%], worse NYHA class, more frequent history of valve surgery (19.4% vs. 6.3%) and pacemaker implantation (9.3% vs. 0%). They more often received > 6 medications (67.9% vs. 51.1%). Compared to event-free patients, they had worse QoL [MLHFQ 59 (38–82) vs. 36 (14–52), p < 0.001], lower patient-perceived empathy of treating physician [JSPPPE 18 (13–27) vs. 32 (17–35), p < 0.001], and poorer adherence [SMAQ 4 (3–6) vs. 4.5 (4–7), p = 0.01]. Logistic regression showed that increased MLHFQ meaning worse QoL [OR 1.02 (95% CI 1.01–1.04), p = 0.04] and improved patient-perceived empathy [OR 0.90 (95% CI 0.84–0.97), p < 0.001], but not adherence, predicted the composite outcome after multivariable adjustment.
Conclusions
In HF patients, better QoL and higher patient-perceived physician empathy are associated with improved mid-term prognosis. Greater empathy correlates with better adherence and QoL-especially physical and emotional domains-, while adherence alone does not independently predict outcomes. Strengthening physician–patient empathetic communication may improve both adherence and prognosis in HF management.Event-free patients vs primary endpointFor image description, please refer to the figure legend and surrounding text.MLHFQ, JSPPPE and SMAQ and logistic regrFor image description, please refer to the figure legend and surrounding text.