Quality of life among patients with chronic heart failure in Nam Dinh Province, Vietnam

Introduction

In addition to population aging and improvements in cardiovascular diagnosis and treatment, heart failure (HF) is a global clinical and public health problem that is increasing at an alarming rate worldwide.¹ HF is associated with increased morbidity and mortality, places a significant burden on the health care system, and is one of the leading causes of hospitalization for adults and the elderly.² Along with advances in disease diagnosis and treatment, assessing the quality of life (QoL), especially in chronic patients who have to live for many years with the same disease, is considered as one of the important activities in promotion of patient-centred care in which the patient’s views, experiences, and wishes are set forth, help with care decision-making, and ensures that the patient’s wishes are taken into account to guide better management of their condition.^3,4

Studies on QoL in patients with chronic HF reflect a common fact that the patients’ QoL was low.^5,6 In recent years in Vietnam, as the role of nursing care has been increasingly confirmed, assessment of QoL in patients with chronic conditions, including heart failure, has begun to gain more attention. Beside progress in diagnosis and treatment of HF patients in Nam Dinh province, the patient’s QoL need to be concerned. This study was conducted to assess the QoL of patients with chronic HF in the Province, as baseline data for planning to improve the quality of care and healthcare provision.

Methods

Results

The mean age of 89 patients in the study was 62.28 ± 13.26 years (median: 65), the youngest was 33 years old and the oldest was 88 years old.²⁴ The mean duration living with HF since the first HF diagnosis was 8.49 ± 4.59 years (median: 8), the shortest was 1 year and the longest was 21 years. All the 89 participants selected based on the criteria completed the study.

The overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) mean score of 89 patients was 67.19 ± 13.31 points, the lowest score was 33 points and the highest score was 98 points. There were 89.9% of the total patients who had the overall MLHFQ score more than 45 points and no one had MLHFQ score less than 24 points. The scores of physical and emotional domains were 25.78 ± 5.98 points and 16.80 ± 4.19 points, respectively.

The majority of patients (64%) were over 60 years old and the proportions of male and female patients were 46.1% and 53.9%, respectively. More than half of participants (57.3%) were farmers. Regarding educational level, 42.7% of participants graduated from secondary school, no one had a university degree or higher. The percentages of patients living with a spouse and living with family were 83.1% and 89.9%, respectively.

The MLHFQ scores were higher (i.e. poorer QoL) in female patients compared with male patients (67.52 ± 11.80 points vs 66.80 ± 15.02 points; p-value of 0.032), divorced; single; widowed patients compared with married patients (67.58 ± 11.62 points vs 65.27 ± 20.11 points; p-value of 0.000), patients living alone compared with patients living with family (73.33 ± 14.95 points vs 66.50 ± 13.04 points; p-value of 0.014).

The number of patients lived with HF for 6-10 years, had NYHA-III, had severe depressive symptoms, and perceived low social support accounted for high percentages in the study sample which were 48.3%, 50.5%, 89.9%, and 86.5%, respectively.

The MLHFQ scores were higher (i.e. poorer QoL) in patients lived longer with HF, had more severe heart failure, had more severe depression, and had lower levels of social support in comparison with patients who had lower levels of corresponding features (all p-values of 0.000).

Discussion

The mean age of the HF patients in our study was 62.28 ± 13.26 years old. This age may be similar to or different from the age of HF patients in other studies regarding HF for example, it was 62.9 ± 14.6 years old in the study by Pressler et al. (2010)¹⁴; 64.4 ± 15.0 years old in the study by T.N.P. Do et al. (2019)¹⁵; 77.8 ± 5.9 years old in the study by Erceg et al. (2013)¹⁶; or 65.8 ± 12.9 years old in the study by Nesbitt et al. (2014).¹⁷ These age differences may be due to differences in the sample size, study time, and country. However, they reflect that population aging and heart failure tend to increase with age, especially at ≥ 60 years.¹⁸

A systematic review and meta-analysis of 60 studies after the screening of 5423 studies showed a change in survival with chronic heart failure with an improvement in 5-year HF survival.¹⁹ In our study, the number of years patients had been living with HF was 8.49 ± 4.59 years. This number is not yet representative of the population of HF patients due to the small sample size and convenient sampling. However, it has contributed to the proof that patients with HF live longer thanks to the progress in HF diagnosis and treatment in the province and Vietnam. This is accompanied by a trend of increasing life expectancy, raising concerns about the quality of life of patients with HF, and a genuine need to improve the quality of life of HF patients.

The overall MLHFQ score of HF patients in our study was 67.19 ± 13.31 points (Table 1). A potential source of bias could be the sample size. The small sample size could limit the generalizability of our findings. Additionally, the use of self-reported surveys could lead to bias, as patients might overreport or underreport their symptoms. Finally, the researchers’ personal beliefs or interests could also influence the results, highlighting the need for transparency and ethical conduct in research. Evaluating and addressing these potential sources of bias is crucial to ensure the validity and reliability of the study, thus providing accurate information for healthcare providers to improve health outcomes for patients with chronic heart failure in Vietnam. According to the classification of Behlouli et al.,⁹ HF patients with MLHFQ scores > 45 points were considered to have poor QoL. In other words, although the study was the first to assess the QoL at a provincial hospital, it revealed a very low level of QoL, which needs to be addressed to improve accompanied advances in diagnosis and treatment. In comparison with the MLHFQ scores of HF patients in studies recently published, the MLHFQ score in our study was quite similar to the MLHFQ score of 74.16 ± 3.78 points in the study of Zhang et al. (2019) in China.²⁰ Meanwhile, it was much higher (i.e., much poorer QoL) than the MLHFQ score of 35.8 ± 21.4 points in the study of Fonseca et al. (2021) in Europe.²¹ These differences might be explained by the study of Fonseca et al., which measured the QoL among HF patients in France, Germany, Italy, Spain, and the United Kingdom, where better care deliveries have been available and in contrast, Vietnam and China are populated countries where in general, people’s living conditions have been limited. They feel it is harder to live with HF’s condition. Regarding the classification of quality of life, in our study, the majority (89.9%) of patients had a poor QoL (MLHFQ score > 45 points, based on the classification of Behlouli et al.⁹), the remaining small number of patients (10.1%) had a moderate level of QoL. None had a high QoL (MLHFQ score < 24 points), which was also consistent with a common situation as mentioned in the study by Moradi et al. (2020)⁵ and in the study by Polikandrioti et al. (2019).⁶

As seen in Table 2, the female patients had poorer QoL (i.e., higher MLHFQ scores) than the male patients. Regarding the QoL of female and male patients, it is likely to see different results in different studies. For example, the study of Polikandrioti M et al.¹ in 100 HF patients found no difference in the MLHFQ scores between male and female patients. In comparison, Fonseca A.F. et al.²¹ studied 804 HF patients. The results showed that the MLHFQ score of female patients (n = 223) was higher than that of male patients (n = 401) detailed (37.9 ± 20.9 points vs. 34.6 ± 21.6 points; p = 0.0481). In Vietnam, in terms of cultural traditions, the majority of women, besides working to earn, also have to shoulder a lot of responsibility, including raising children and housework, even for the logistics of family, relatives, and clan events. Their life becomes more complicated when having an illness, especially with chronic heart failure, resulting in feeling that their QoL is poor, which may be a reasonable explanation for the poorer QoL in female HF patients than in male patients HF patients in this study. Table 2 also shows that the group of patients in single, divorced, and widowed conditions had poorer QoL than those in the married group. The group of patients living alone had poorer QoL than those living with their families. Persons living in conditions of single, divorced, widowed, and alone, together with Vietnamese customs, are likely to be disadvantaged and vulnerable. Naturally, bearing the burden of chronic heart failure without supporting/sharing with a wife/husband or family members will make them feel complicated and worse about life. These findings should be considered when planning and delivering care to HF patients.

As shown in Table 3, patients with HF living with longer HF, more severe HF, more severe depression, and lower levels of social support had poorer QoL. Other studies, for example, the study of Audi,²² the study of Nesbitt et al.,¹⁷ and the study of Erceg et al.,¹⁶ also had similar results. It is reasonable for these results because heart failure tends to worsen over time with increasing severity of symptoms, which may initially have only a slight effect on patients’ activities, gradually reduce the patient’s independence in daily living activities, and seriously affect the patient’s life.²³ These findings should be considered when planning care for HF patients, taking into account factors that worsen the patient’s QoL to improve the patient’s quality of life with appropriate support.

Conclusion

This study showed a poor QoL of the HF patients with the MLHFQ score of 67.19 ± 13.31 points and factors those made the HF patients’ QoL worse such as gender, marital and living status, HF duration, NYHA classification, depression, and social support. Health professionals need to understand and focus more on the quality of life (QoL) of patients with chronic heart failure to plan effective interventions and provide them with beneficial and holistic care.