Examining Health-Related Quality of Life in Ambulatory Adult Patients With Chronic Heart Failure: Insights From Malaysia Using EQ-5D-5L

OBJECTIVES: Health-related quality-of-life (HRQoL) data for the chronic heart failure (HF) population are lacking in the multiracial Malaysia. Using EQ-5D-5L, this study aims to describe and identify predictors of worse HRQoL, derive health state utility values (HSUVs) for New York Heart Association (NYHA) health states to support local cost-utility analyses, and determine the feasibility of routine HRQoL assessment in local clinic setting.

METHODS: A cross-sectional survey was conducted between April and September 2023 to collect EQ-5D-5L, sociodemographic, and clinical data from HF outpatients across seven public hospitals in Malaysia. Multivariable logistic and linear regression models were employed to identify independent predictors of reported problems in the EQ-5D-5L dimensions, and predictors of HSUVs and EQ-VAS, respectively. Marginal mean HSUVs were determined for different NYHA classes.

RESULTS: Data from 424 outpatients of multi-ethnic background (mean age: 57.1 years, 23.8% female, mean left ventricular ejection fraction: 35.7%, 89.7% NYHA I-II) were collected using Malay, English, and Chinese EQ-5D-5L questionnaires, either self- or proxy-administered. The completion rate was 99.8%, with half of the respondents reported issues in the Mobility, Usual Activities, and Pain/Discomfort dimensions. The mean HSUV was 0.820, lower than that of the general population, and significantly lower with NYHA III-IV (0.747) versus NYHA I (0.846) and NYHA II (0.805). Other independent predictors of poorer HRQoL included Indian ethnicity, living alone, lower education, unemployment due to ill-health, and proxy-reported HRQoL, consistent with previous studies.

CONCLUSIONS: Community-dwelling Malaysians with HF reported lower HRQoL compared to the general population. The observed disparities in HRQoL among HF patients may be linked to specific patient characteristics, suggesting potential areas for targeted interventions. The feasibility of HRQoL assessment using EQ-5D-5L has been demonstrated, advocating for its routine implementation in local clinics. This would enable the generation of more real-world data, contributing to a better understanding of HRQoL in this patient group.