QOL Negatively Impacted by Non–Cardiovascular-Related Comorbidities Among Patients With Chronic Heart Failure

Patients with chronic heart failure and comorbid mental/behavioral disorders or diabetes had worse quality of life (QOL), according to a recent literature review.

Patients with chronic heart failure (CHF) and comorbid mental/behavioral disorders or diabetes had worse health-related quality of life (HRQOL), according to a recent scoping review of the scientific literature published in Health and Quality of Life Outcomes.

Other non–cardiovascular-related chronic comorbidities that contributed to a decrease in overall HRQOL for these patients were anemia and/or iron deficiency and respiratory diseases.

The authors, whose review covered 2009 through 2019 and, ultimately, 21 studies, noted that although previous studies have investigated similar outcomes, they utilized methodological differences that “complicate classifying the published evidence and obtaining accurate conclusions. A scoping review to outline the available evidence on the impact of noncardiovascular comorbidities on the HRQoL in patients with CHF would provide the basis for future research to guide clinical practice on this matter.”

Twelve of the studies investigated diabetes; 8, mental and behavioral health disorders; 7, anemia and/or iron deficiency; and 6, respiratory diseases. The PubMed, MEDLINE, and Embase electronic databases were used in the review search, as were the terms “observational studies,” systematic reviews,” multicenter studies,” heart failure,” quality of life,” health-related quality of life,” QALY,” quality-adjusted life years,” health utilities,” and utility.”

Overall results demonstrate that the 21 studies (10, cross-sectional; 10, cohort; 1, retrospective) included in the final analysis investigated 93 situations in which noncardiovascular comorbidities could lead to a decrease in HRQOL among patients with CHF. Most of these connections had to do with anemia or iron deficiency (21.5%), followed by mental and behavioral health disorders (20.4%), diabetes (20.4%), and respiratory diseases (14.0%).

All of the studies included in the final analysis utilized specific (72.2%), generic (16.7%), or both (11.1%) types of questionnaires to evaluate HRQOL.

Of the 93 total possible associations, the greatest number of statistically significant associations for worsening HRQOL were seen for the studies that looked at the negative impact of mental and behavioral health disorders (84.2%). Anemia and/or iron deficiency were second (75%), with diabetes a close third (73.7%) and respiratory diseases fourth (61.5%).

Additional analysis revealed:

  • 200% worse HRQOL in patients with CHF plus depression vs no depression
  • 25.6% worse HRQOL in patients with CHF plus anemia and/or iron deficiency vs no anemia/iron deficiency
  • 21.8% worse HRQOL in patients with CHF and diabetes vs no diabetes
  • 21.3% worse HRQOL in patients with CHF and a respiratory disease vs no respiratory disease

The majority of patients from the included studies were nonhospitalized, male, and older than 60 years. Most had New York Heart Association class I-II functional level disease, reduced left ventricular ejection fraction, and multiple comorbidities.

Worse HRQOL was also seen in patients with HF and renal failure, thyroid gland dysfunction, neoplasms, and obesity, but these associations, although still statistically significant, were evaluated in fewer studies.

“The results highlight the relevance of including the comorbidities associated with a worse HRQoL in the integrated clinical management of CHF, with special emphasis on treating or adequately controlling comorbidities of greater prevalence in these patients,” the authors concluded. “Control of these comorbidities can contribute not only to significantly increasing the HRQoL of patients but it can also provide other social benefits. Further studies are needed to clearly estimate the impact that noncardiovascular comorbidities have on HRQoL in patients with CHF.”


Comín-Colet J, Martín Lorenzo T, González-Domínguez A, Oliva J, Merino SJ. Impact of non-cardiovascular comorbidities on the quality of life of patients with chronic heart failure: a scoping review. Health Qual Life Outcomes. Published online October 7, 2020. doi:10.1186/s12955-020-01566-y