Health-related quality of life and six-month hospitalization in older outpatients with heart failure with reduced ejection fraction: a prospective observational study

Health-related quality of life (HRQoL) is an important component of heart failure (HF) management but remains insufficiently characterized among older outpatients in low- and middle-income countries. The primary objective of this study was to determine the prevalence of impaired HRQoL in older Vietnamese outpatients with heart failure with reduced ejection fraction (HFrEF). The secondary objectives were to identify factors associated with impaired HRQoL and to examine factors associated with six-month HF hospitalization. We conducted a prospective observational study between August 2024 and June 2025 among outpatients aged ≥ 60 years with confirmed HFrEF at two specialized HF clinics. HRQoL was assessed using the Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23), with impaired HRQoL defined as a score < 50. Participants were followed for six months for first HF hospitalization. Multivariable logistic regression was used to assess factors associated with impaired HRQoL, and Cox proportional hazards models were applied to evaluate factors associated with hospitalization. Among 310 patients (median age 71 years), 48 (15.5%) had impaired HRQoL at baseline. Depression (odds ratio [OR] 4.12, 95% confidence interval [CI] 1.70–9.97; P = 0.002) and New York Heart Association (NYHA) class III (OR 6.55, 95% CI 3.01–13.9; P < 0.001) were independently associated with impaired HRQoL. During follow-up, 92 patients (29.7%) experienced a first HF hospitalization, of whom 32 (34.8%) had impaired HRQoL at baseline. Age ≥ 75 years (hazard ratio [HR] 1.93, 95% CI 1.22–3.06; P = 0.005), limitations in instrumental activities of daily living (HR 2.34, 95% CI 1.16–4.73; P = 0.018), and impaired HRQoL (HR 2.10, 95% CI 1.26–3.51; P = 0.004) were independently associated with a higher risk of hospitalization. Receipt of quadruple therapy was associated with a lower risk (HR 0.63, 95% CI 0.40–0.99; P = 0.047). In older outpatients with HFrEF, impaired HRQoL was observed in approximately one-sixth of patients and was associated with depression and NYHA class III. Over six months, impaired HRQoL, advanced age, and limitations in instrumental activities of daily living were associated with an increased risk of HF hospitalization, whereas receipt of quadruple therapy was associated with a reduced risk. This study was not registered as a clinical trial.