ABC | Volume 114, Nº1, January 2019

Original Article Figueiredo et al. Poor quality of life in heart failure outpatients Arq Bras Cardiol. 2020; 114(1):25-32 1. Roger VL. Epidemiology of Heart Failure. Circ Res. 2013;113(6):646-59. 2. Ramos S, Prata J, Gonçalves FR, Coelho R. Depression predictsmortality and hospitalization in heart failure: A six-years follow-up study. J Affect Disord. 2016 Sep;201:162-70. 3. Mahmood SS, Wang TJ. The epidemiology of congestive heart failure: the FraminghamHeart Study perspective. Glob Heart. 2013;8(1):77–82. 4. Sherwood , A, Blumenthal JA, Trivedi R, Johnson KS, O’Connor CM, Adams KF Jr, et al. Relationship of depression to death or hospitalization in patients with heart failure. Arch Intern Med. 2007;167(4):367-73. 5. Sherwood A, Blumenthal JA, Hinderliter AL, Koch GG, Adams KF Jr, Dupree CS, et al. Worsening depressive symptoms are associated with adverse clinical outcomes in patients with heart failure. J Am Coll Cardiol. 2011;57(4):418-23. 6. HallasCN,Wray J,AndreouP,BannerNR.Depressionandperceptionsabout heart failure predict quality of life in patients with advanced heart failure. Heart Lung. 2011;40(2):111-21. 7. BekelmanDB,HavranekEP,BeckerDM,Kutner JS,PetersonPN,Wittstein IS, et al. Symptoms, depression, and quality of life in patients with heart failure. J Card Fail. 2007;13(8):643-8. 8. Mulligan K, Mehta PA, Fteropoulli T, Dubrey SW, McIntyre HF, McDonagh TA, et al. Newly diagnosed heart failure: Change in quality of life, mood, and illness beliefs in the first 6 months after diagnosis. Br J Health Psychol. 2012;17(3):447-62. 9. Heo S, Doering LV, Widener J, Moser DK. Predictors and effect of physical symptom status on health-related quality of life in patients with heart failure. Eur J Cardiovasc Nurs. 2015;14(2):137-44. 10. Ponikowski P, Voors AA, Anker SD, BuenoH, Cleland JG, Coats AJ, et al, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891-975. 11. Rector TS, Kubo SH, Cohn, JN. Patients’ self-assessment of their congestive heart failure:content,reliabilityandvalidityofanewmeasure,theMinnesota Living with Heart Failure Questionnaire. Heart Fail. 1987May;3:198-209. 12. Carvalho VO, Guimarães GV, Carrara D, Bacal F, Bocchi, EA. Validação da versão emportuguês doMinnesota Living withHeart FailureQuestionnaire. Arq Bras Cardiol. 2011;97(6):444-5. 13. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-70. 14. Botega NJ, Bio MR, Zomignani A, Garcia Jr C, Pereira WA. Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão. Rev Saude Publica. 1995;29(5):355-63. 15. Ferrari SL, Cribari-Neto F. Beta-Regression for modelling rates and proportions. J Appl Statistics. 2004;31(7):799-815. 16. HothornT,HornikK,Zeileis,A.Unbiasedrecursivepartitioning:Aconditional inference framework. J Comput Graphical Statistics. 2006;15(3):651-74. References How and by what mechanisms such associations are given are not clear. Probably physiological and behavioral factors including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities, may link depression and anxiety with adverse cardiac outcomes and poorer QoL in HF. 29,30 This study has some limitations. This was a single-center study, although it can encourage future studies in other specialized centers. Also, its cross-sectional design made it difficult to assess possible changes in patients’ QoL and what factors contributed to such changes and to make speculations that would only be possible with a longitudinal design. Thus, generalizations must be made with caution. Conclusion Based on these findings, it is possible to conclude that a reduced LVEF is associated with many factors that compromise the QoL of HF outpatients, even in clinically less severe cases, like in NYHA functional class I or II . These findings may aid in the full approach of patients with HF, suggesting the diagnosis and treatment of anxiety symptoms, especially those with multiple hospitalizations and younger than 60 years. Author contributions Conception and design of the research: Figueiredo JHC, Oliveira GMM, Xavier SS; Acquisition of data: Figueiredo JHC, Oliveira GMM, Garcia MI; Analysis and interpretation of the data and Writing of the manuscript: Figueiredo JHC, Oliveira GMM, Pereira BB, Figueiredo AEB, Nascimento EM, Garcia MI, Xavier SS; Statistical analysis: Pereira BB, Figueiredo AEB, Nascimento EM; Critical revision of the manuscript for intellectual content: Oliveira GMM, Pereira BB, Figueiredo AEB, Nascimento EM, Garcia MI, Xavier SS. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This article is part of the thesis of Doctoral submitted by José Henrique Cunha Figueiredo, from Universidade Federal do Rio de Janeiro. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Hospital Universitário Clementino Fraga Filho under the protocol number 104/2010. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 31