Assessment of quality of life in severe heart failure

Improvement of health-related quality of life (HRQL) is increasingly recognized as a priority in the management of heart failure (HF). In this review, we highlight the dramatic improvement in HRQL often observed in patients with severe HF and give particular emphasis to the nonpharmacologic therapy of cardiac resynchronization therapy, left ventricular assist devices, and cardiac rehabilitation. We juxtapose this to the less consistent improvement in HRQL seen with interventions aimed at treatment of acute HF syndromes. Conflicting data wherein HRQL improves in parallel to a detrimental or neutral effect on cardiovascular morbidity and mortality are also presented. We conclude with future directions and make the case for HF-specific instruments intended for the assessment of HRQL in hospitalized patients, longitudinal studies in which HRQL is followed over time, and continued attention to the preferences of those with severe and acute HF.