Skip to main content

Research Repository

Advanced Search

Exploring quality of life in patients with and without heart failure

Zhang, Jufen; Hobkirk, James; Carroll, Sean; Pellicori, Pierpaolo; Clark, Andrew L.; Cleland, John G.F.


Jufen Zhang

Profile Image

Dr James Hobkirk
Lecturer in Physiology & Pathophysiology & Honorary Medical Scientist

Pierpaolo Pellicori

Andrew L. Clark

John G.F. Cleland


Aims The EuroHeart Failure Survey Questionnaire (EHFSQ-1) has 39 questions on symptoms and quality of life (QoL); many items are related. We sought to identify underlying clusters amongst EHFSQ-1 questions, construct an overall “QoL score” and investigate its relationship to a single question asking patients to self-rate QoL. Methods and results Factor analysis based on the principal component technique was used to identify patterns amongst responses to QoL questions from patients referred with symptoms suggesting heart failure (HF). Of 1031 patients, median age 71 (IQR: 63–77) years, 64% were men and 626 had confirmed HF. For patients with HF, seven symptom-clusters were identified: “breathlessness”, “psychological distress”, “sleep quality”, “frailty”, “cognitive/psychomotor function”, “cough” and “chest pain”. These clusters accounted for 65% of the total variance in QoL score. Cluster pattern was similar in patients with and without HF. A summary factor score was tightly correlated with summary QoL score (correlation coefficient: r = 0.96; p < 0.0001). Both summary factors and QoL scores were highly correlated with patient self-rating of overall health (r₁ = 0.61 and r₂ = 0.66 respectively, p < 0.0001) or overall QoL (r₁ = 0.60 and r₂ = 0.66, p < 0.0001). The medians (IQR) of the summary QoL score for patients with HFrEF, HFnEF and no-HF were, respectively, 83 (60–106), 82 (59–104) and 71 (51–94). Conclusions EHFSQ-1, comprises seven symptom clusters in patients with HF. Either summary factors or QoL scores can be used as a QoL outcome measure. However, if the key question is ‘what is this patient's QoL?’ rather than the reason why it is impaired, then a single, direct question may suffice.


Zhang, J., Hobkirk, J., Carroll, S., Pellicori, P., Clark, A. L., & Cleland, J. G. (2016). Exploring quality of life in patients with and without heart failure. International journal of cardiology, 202, 676-684.

Journal Article Type Article
Acceptance Date Sep 21, 2015
Online Publication Date Sep 25, 2015
Publication Date Jan 1, 2016
Deposit Date Feb 8, 2016
Publicly Available Date Feb 8, 2016
Journal International journal of cardiology
Print ISSN 0167-5273
Electronic ISSN 1874-1754
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 202
Pages 676-684
Keywords Patterns of quality of life, Suspected heart failure, Left ventricular systolic dysfunction
Public URL
Publisher URL
Additional Information This article is maintained by: Elsevier; Article Title: Exploring quality of life in patients with and without heart failure; Journal Title: International Journal of Cardiology; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.


You might also like

Downloadable Citations