COMPARATIVE CHARACTERISTICS OF QUALITY OF LIFE INDICATORS IN PATIENTS WITH CHRONIC HEART FAILURE WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION DEPENDING ON IRON DEFICIENCY TYPE

Abstract

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.