Abstract 4143989: Differences in Patient-Centered Outcomes Between Patients with Heart Failure and With and Without Renal Dysfunction

Background: Heart failure (HF) is not a homogeneous condition, and comorbidities, such as renal dysfunction, commonly complicate the clinical picture. However, differences in patient-centered outcomes (PCO), such as depressive symptoms, health-related quality of life, functional status, adherence, and self-care behaviors, have not been explored in patients with HF with and without renal dysfunction. Hypothesis: We hypothesized that there is a significant difference in PCO between patients diagnosed with heart failure with renal dysfunction and those without renal dysfunction. Methods: A secondary data analysis was conducted using the RICH Heart Program Heart Failure Database. We included 517 patients (61 ± 13 years old, 66% male, 66% NYHA class III/IV) with HF with (22%) and without (78%) renal dysfunction. Depressive symptoms were measured using the Patient Health Questionnaire-9, health-related quality of life using the Minnesota Living with Heart Failure Questionnaire, functional status using the Duke Activity Status Index, adherence using the Medical Outcomes Study Specific Adherence Scale, and Self-care using the Self-care of Heart Failure Index. Independent samples t-tests were conducted to compare PCO between the two groups. Results: All PCO were significantly different between the two groups. Compared to patients without renal dysfunction, those with renal dysfunction had worse depressive symptoms (8.1 ± 5.9 vs 10.0 ± 6.0, respectively, p = 0.001), poorer health-related quality of life (50.5 ± 24.9 vs 58.0 ± 25.6, p = 0.005, respectively), and lower functional status (11.7 ± 11.7 vs 77.0 ± 7.1, p < 0.001, respectively). Patients with renal dysfunction had better scores on self-reported adherence (29.2 ± 6.0 vs 25.6 ± 7.7, p < 0.001), self-care maintenance (61.6 ± 21.1 vs 54.3 ± 23.2, p = 0.03), and self-care management (60.9 ± 23.0 vs 53.8 ± 22.9, p = 0.04) than those without. Conclusions: Even though patients with HF and renal dysfunction reported better adherence and self-care behaviors, they still had higher levels of depressive symptoms, worse health-related quality of life, and lower functional status. This suggests that knowledge of their comorbidity prompted better self-care, but other PCO remained poor. Increased attention to promoting specific self-care behaviors that focus on renal dysfunction in the context of HF should be tested to determine if PCO can be improved in this patient population.