Introduction. Quality of life (QoL) indicators in case of chronic heart failure (CHF) are associated with a number of clinical and instrumental indicators, which makes it possible to consider its assessment as one of the leading indicators of its severity. From a practical point of view, the identification of QoL indicators as the markers of CHF severity in patients with concomitant iron metabolism disorders, including different variants of latent and manifest iron deficiency (ID)is rather interesting.
Purpose. To compare QoL parameters by means of MOS SF-36 and MLHFQ questionnaires in patients with CHF with reduced left ventricular ejection fraction with different iron deficiency types.
Materials and Methods. 152 patients with CHF functional class (FC) II-III according to NYHA with reduced left ventricular (LV) ejection fraction (EF) of hypertensive and ischemic etiology with/and without iron deficiency (ID) were examined. All patients were divided into three clinical groups: the first clinical group (which is presented as a comparison group) amounted to 30 (19.7 %) patients with CHF with reduced LV EF without ID, the second one amounted to 60 (39.5 %) patients with CHF with reduced LV EF and latent ID, which included a number of patients with functional and absolute ID and the third clinical group amounted to 62 (40.79 %) patients with I-II severity degree of concomitant iron deficiency anemia (IDA). In order to assess QoL, all patients were interviewed using MOS SF-36 and MLHFQ. The comparison of the obtained findings was carried out among groups of patients with CHF with reduced LV EF without iron metabolism disorders, with functional ID and absolute ID, and among groups of patients with CHF with reduced LV EF without iron metabolism disorders, with I degree of IDA and II degree of IDA.
Research findings. It was detected that in comparison with the group of patients without ID, QoL indicators according to MLHFQ questionnaire in patients with functional ID and absolute ID were significantly worse – 49.5 versus 53.5 (p = 0.05) and 60 points (p = 0.009), respectively. Physical health (PH) in these groups was 37.9 (p = 0.033) and 37.2 (p = 0.0068), respectively, which significantly differed from PH value in the comparison group – 41.2 points. In patients with functional ID and absolute ID lower PH values were detected due to significantly worse indicators of physical functioning (PF), role-physical functioning (RP) resulting from physical condition and general health (GH). Similar results were obtained during the analysis of QoL in patients with IDA of different degrees. In patients with mild IDA and moderate IDA as compared to the group of patients without ID, QoL indicators, according to MLHFQ questionnaire, were significantly worse (p = 0.007) and (p < 0.00001) 57 and 62 versus 49.5 points, respectively. In addition, it was detected that PH value according to SF-36 questionnaire results in the groups with IDA was also significantly lower than PH value in the group without ID due to low values of PF, RP and GH and amounted to 36.8 (p = 0.01) and 33.6 (p < 0.00001) versus 41.2 points, respectively.
According to the conducted analysis, mental health (MH) decreased with the presence of functional and absolute ID and with an increase of IDA from mild to moderate degree, however significantly lower value was detected only in the group with moderate IDA as compared to the group of patients without ID (p = 0.02).
In addition, a number of significant relations between QoL indicators according to MLHFQ, PH and MH scale SF-36 and hematological parameters and a number of iron metabolism indicators were detected during the study. This confirms the dependence of the patients’ QoL on existing iron metabolism disorders.
Conclusions. Patients with CHF with reduced left ventricular ejection fraction and concomitant ID, regardless of the presence of anemia, are characterized by the worse QoL level as compared to the patient without ID. Whereas, latent functional and absolute ID has the same clinical relevance in terms of deterioration of QoL of patients with CHF. Reduction of iron metabolism levels can be considered as predictors of deterioration of patients' QoL and severe CHF.
2. Voronkov LG, Parashhenjuk LP. [Quality of Life in Chronic Heart Failure: Topical Aspects]. Sertseva nedostatnist. 2010;2:12-16.
3. Ryndina NG, Kravchun PG, Shelest AN, Titova AJu, Mishina MM. [The quality of life in anemic patients with chronic heart failure, depending on the presence or absence of chronic kidney disease]. Zaporojskiy meditsinskiy jurnal. 2013;3:60-62.
4. Nesbitt Th, Doctorvaladan S, Southard JA, Singh S, Fekete A, Marie K, Moser DK, Pelter MM, Robinson S, Wilson MD,Cooper L, Dracup K. Correlates of quality of life in rural patients with heart failure. Circulation: Heart Failure. 2014;7(6):882–887.
5. Voronkov LG, Amosova KM, Dzjak GV, Zharinov OJ, Kovalenko VM, Korkushko OV, Nesukaj OG, Parxomenko OM, Rudy`k YuS, Sy`chov OS. [Heart failure and comorbid condition. Recommendations of the Association of Cardiologists of Ukraine for the Diagnosis and Treatment of Chronic Heart Failure (Special Issue)]. Ukrainskyi naukovo-praktychnyi zhurnal dlia likariv z problem SN. 2017;1(dodatok 1):1-67.
6. Van der Wal HH, Van Deursen VM, Van der Meer P, Voors AA. Comorbidities in Heart Failure. Handb Exp Pharmacol. 2017;243:35-66.
7. Klip I, Comin-Colet J, Voors A, et al. Iron deficiency in chronic heart failure: an international pooled analysis. Am. Heart J. 2013;165:575-82. doi: 10.1016/j.ahj.2013.01.017
8. Jankowska E, Rozentryt P, Witkowska A, Nowak J, Hartman O, Ponikowska B, et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Europ. Heart J. 2010;31:1872-80.
9. Weiss G. Iron metabolism in the anemia of chronic disease. Biochim Biophys Acta. 2009;1790:682–693.
10. Voronkov LG. [Anemia in a patient with CHF: how to evaluate end how to treat?] Sertseva nedostatnist. 2015;2:5-13.
11. Silverberg D, Wexler D, Jaina A. The importance of anemia and its correction in the management of severe congestive heart failure. Europ. J. Heart failure. 2002;4:681-86.
12. Djadyk AI, Bagrij AJe. Hronicheskaya serdechnaya nedostatochnost v sovremennoy klinicheskoy praktike [Chronic heart failure in modern clinical practice]. Doneck: KP «Region», 2005. 549 р.
13. Tang Y, Katz SD. Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation. 2006;113:2454–2461.
14. Anand IS. Anemia and chronic heart failure implications and treatment options. J. Am. Coll. Cardiol. 2008;52(7):501–511.
15. Kolesnyk MO. [Indices of iron metabolism depending on the functional class of chronic heart failure among patients with comorbid iron deficiency]. Visnyk sotsialnoi hihiieny ta orhanizatsii okhorony zdorovia Ukrainy. 2018;3(77):78-83.
16. Voronkov LG, Gorbachova VV, Ljashenko AV, Gavrylenko TI, Mhitarjan LS. [Iron metabolism parameters in patients with chronic heart failure and reduced left ventricular ejection fraction depending on basic demographic, clinical and instrumental characteristics]. Ukrainskyi kardiolohichnyi zhurnal. 2018;4:52-58.