{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:52:31Z","timestamp":1792507951435,"version":"4.5.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used the Kansas City Cardiomyopathy Questionnaire\u201312 (KCCQ-12) to record HRQL in 23\u2009291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction \u226540%. Average HRQL differed between regions (lowest in Africa [mean\u00b1 SE, 39.5\u00b10.3], highest in Western Europe [62.5\u00b10.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17\u20131.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03\u20131.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21\u20131.42]; interaction\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14\u20131.19] and HR, 1.14 [95% CI, 1.12\u20131.17]; interaction\n                      <jats:italic>P<\/jats:italic>\n                      =0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13\u20131.17] versus 1.09 [95% CI, [1.07\u20131.11]; interaction\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001). HR for death was greater in ejection fraction \u226540 versus &lt;40% (HR, 1.23 [95% CI, 1.20\u20131.26] and HR, 1.15 [95% CI, 1.13\u20131.17]; interaction\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03078166.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.120.050850","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T05:05:05Z","timestamp":1619586305000},"page":"2129-2142","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":293,"title":["Health-Related Quality of Life and Mortality in Heart Failure: The Global Congestive Heart Failure Study of 23 000 Patients From 40 Countries"],"prefix":"10.1161","volume":"143","clinical-trial-number":[{"clinical-trial-number":"nct03078166","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4577-0530","authenticated-orcid":true,"given":"Isabelle","family":"Johansson","sequence":"first","affiliation":[{"name":"Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)."},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Canada (S.Y., I.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Joseph","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar","family":"Balasubramanian","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-3975","authenticated-orcid":true,"given":"John J.V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre, University of Glasgow, Scotland (J.J.V.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars H.","family":"Lund","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (L.H.L.)."},{"name":"Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2724-4086","authenticated-orcid":true,"given":"Justin A.","family":"Ezekowitz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, University of Alberta Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8044-7747","authenticated-orcid":true,"given":"Deepak","family":"Kamath","sequence":"additional","affiliation":[{"name":"Division of Clinical Research and Training, St John\u2019s Research Institute, India (D.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Alhabib","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia (K.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3044-197X","authenticated-orcid":true,"given":"Antoni","family":"Bayes-Genis","sequence":"additional","affiliation":[{"name":"Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.B.-G.)."},{"name":"Department of Medicine, Universitat Autonoma Barcelona, CIBERCV, Spain (A.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6395-2098","authenticated-orcid":true,"given":"Andrzej","family":"Budaj","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland (A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio L.L.","family":"Dans","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences, University of Philippines, Manila, Philippines (A.L.L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastase","family":"Dzudie","sequence":"additional","affiliation":[{"name":"Douala General Hospital, Cameroon (A.D.)."},{"name":"Clinical Research Education, Networking and Consultancy, Douala, Cameroon (A.D.)."},{"name":"Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon (A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4899-9971","authenticated-orcid":true,"given":"Jefferey L.","family":"Probstfield","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington School of Medicine, Seattle (J.L.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0140-2752","authenticated-orcid":true,"given":"Keith A.A.","family":"Fox","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7992-2398","authenticated-orcid":true,"given":"Kamilu M.","family":"Karaye","sequence":"additional","affiliation":[{"name":"Department of Medicine, Aminu Kano Teaching Hospital and Bayero University Kano, Nigeria (K.M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abel","family":"Makubi","sequence":"additional","affiliation":[{"name":"Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania (A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Fukakusa","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koon","family":"Teo","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2605-159X","authenticated-orcid":true,"given":"Ahmet","family":"Temizhan","sequence":"additional","affiliation":[{"name":"Ankara City Hospital, Department of Cardiology, University of Health Sciences, Turkey (A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Wittlinger","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Goslar Hospital, Germany (T.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2764-6779","authenticated-orcid":true,"given":"Aldo P.","family":"Maggioni","sequence":"additional","affiliation":[{"name":"ANMCO Research Center, Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy (A.P.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Lanas","sequence":"additional","affiliation":[{"name":"Universidad de La Frontera, Temuco, Chile (F.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricio","family":"Lopez-Jaramillo","sequence":"additional","affiliation":[{"name":"Masira Research Institute, UDES, Bucaramanga, Colombia (P.L.-J.)."},{"name":"Facultad de Ciencias de la Salud, UTE, Quito, Ecuador (P.L.-J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Silva-Cardoso","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Porto, Sao Joao University Hospital Centre, Porto, Portugal (J.S.-C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Sliwa","sequence":"additional","affiliation":[{"name":"Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa 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