Testing a published model of health-related quality of life in heart failure

Background: Health-related quality of life (HRQOL) in patients with heart failure is compromised and associated with increased mortality and rehospitalization. Inadequate conceptualization of variables related to HRQOL has hampered clinicians' efforts to enhance HRQOL. The purpose of this study was to test the Wilson and Cleary model (WCM) of HRQOL in patients with heart failure. Methods and Results: Data from 293 patients with heart failure were analyzed to determine the best multivariate HRQOL model given variables derived from WCM. HRQOL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Health perception, symptom status, and age predicted the total MLHFQ (P <.0001) and the emotional scale (P <.0001), and health perception, symptom status, New York Heart Association predicted the physical scale(P <.0001). Health perception was a mediator of the effect of symptom status on HRQOL. Functional status was not a mediator of the effect of symptom status on health perception. Conclusion: The most influential variables associated with HRQOL were the subjective variables: health perception and symptom status. Objective variables proposed by WCM to drive the model were not significant predictors. Mediator effects hypothesized in the WCM were not fully demonstrated in this sample. Thus modification of the WCM is warranted.