Journal of Modern Rehabilitation 2017. 11(3):161-166.

The Relationship Between Disease Severity and Quality of Life in Patients With Heart Failure Based on Kansas City Questionnaire
Hassan Tamartash, Behrouz Attarbashi Moghadam, Kianoush Hosseini, Shiva Musavi


Introduction: The present study aimed to determine the relationship between New York Heart Association (NYHA) classification and disease characteristics on the quality of life scores and the distribution of the scores at different stages of Heart Failure (HF).
Materials and Methods: A total of 150 patients with HF participated in this cross-sectional study. The method of data collection was interview based on NYHA classification and using the validated Persian version of the Kansas City Cardiomyopathy Questionnaire (PKCCQ).
Results: According to NYHA classification, 10% of patients were classified as mild HF, 16% as moderate HF, 63% as severe HF, and 11% as very severe HF. Significant differences were observed for total score and the component scores of PKCCQ among four stages of the disease (P<0.001). By comparing the PKCCQ total score and three domains in male and female groups, it was revealed that sex cannot affect quality of life based on PKCCQ total score and its functional areas (P=0.18).
Conclusion: Distribution of the quality of life scores in patients with different stages of HF showed that quality of life scores overlap in the severe and very severe stages. Classifying the disease using NYHA classification cannot distinct patients with HF according to impairments in their health status between severe and very severe stages. In addition, the degree of education is the factor that may affect the quality of life.


Quality of life, Heart failure disease, New York Heart Association classification information, Clinical HF Questionnaire, Kansas City Cardiomyopathy Questionnaire

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Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). European Journal of Heart Failure. 2008; 10(10):933-89. doi: 10.1016/j.ejheart.2008.08.005

Davie A. Assessing diagnosis in heart failure: Which features are any use? QJM. 1997; 90(5):335–9. doi: 10.1093/qjmed/90.5.335

Kelder JC, Cramer MJ, van Wijngaarden J, van Tooren R, Mosterd A, Moons KGM, et al. The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Journal of Circulation. 2011; 124(25):2865–73. doi: 10.1161/circulationaha.111.019216

Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007; 93(9):1137–46. doi: 10.1136/hrt.2003.025270

Garin O, Ferrer M, Pont À, Rué M, Kotzeva A, Wiklund I, et al. Disease-specific health-related quality of life questionnaires for heart failure: A systematic review with meta-analyses. Quality of Life Researc. 2008; 18(1):71–85. doi: 10.1007/s11136-008-9416-4

Curtis JR, Patrick DL. The assessment of health status among patients with COPD. European Respiratory Journal. 2003; 21(41):36S–45S. doi: 10.1183/09031936.03.00078102

Anguita Sánchez M, Crespo Leiro MG, de Teresa Galván E, Jiménez Navarro M, Alonso-Pulpón L, Muñiz García J. [Prevalence of heart failure in the general Spanish population over 45 years. PRICE study (Spanish)]. Revista Española de Cardiologí. 2008; 61(10):1041–9. doi: 10.1157/13126044

Anand IS, Florea VG. Traditional and novel approaches to management of heart failure: Successes and failures. ardiology Clinics. 2008; 26(1):59–72. doi: 10.1016/j.ccl.2008.01.001

Myers J, Zaheer N, Quaglietti S, Madhavan R, Froelicher V, Heidenreich P. Association of Functional and Health Status Measures in Heart Failure. Journal of Cardiac Failure. 2006; 12(6):439–45. doi:10.1016/j.cardfail.2006.04.004

Van der Molen T, Willemse BW, Schokker S, ten Hacken NH, Postma DS, Juniper EF. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health and Quality of Life Outcomes. 2003; 1(1):13. doi: 10.1186/1477-7525-1-13

Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: A new health status measure for heart failure. Journal of the American College of Cardiology. 2000; 35(5):1245–55. doi: 10.1016/s0735-1097(00)00531-3

Masoudi FA, Rumsfeld JS, Havranek EP, House JA, Peterson ED, Krumholz HM, et al. Age, functional capacity, and health-related quality of life in patients with heart failure. Journal of Cardiac Failure. 2004; 10(5):368–73. doi: 10.1016/j.cardfail.2004.01.009

Hou N, Chui MA, Eckert GJ, Oldridge NB, Murray MD, Bennett SJ. Relationship of age and sex to health-related quality of life in patients with heart failure. American Journal of Critical Care. 2004; 13(2):153-161. PMID: 15043243

Lesman-Leegte I, Jaarsma T, Coyne JC, Hillege HL, Van Veldhuisen DJ, Sanderman R. Quality of life and depressive symptoms in the elderly: A comparison between patients with heart failure and age- and gender-matched community controls. Journal of Cardiac Failure. 2009; 15(1):17–23. doi: 10.1016/j.cardfail.2008.09.006

Ortega T, Díaz-Molina B, Montoliu MA, Ortega F, Valdés C, Rebollo P, et al. The utility of a specific measure for heart transplant patients: Reliability and validity of the Kansas City Cardiomyopathy Questionnaire. Transplantation. 2008; 86(6):804–10. doi: 10.1097/tp.0b013e318183eda4

Sauser K, Spertus JA, Pierchala L, Davis E, Pang PS. Quality of life assessment for acute heart failure patients from emergency department presentation through 30 days after dis-charge: A pilot study with the Kansas City Cardiomyopathy Questionnaire. Journal of Cardiac Failure. 2014; 20(1):18–22. doi: 10.1016/j.cardfail.2013.11.010


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