{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T21:02:02Z","timestamp":1773435722159,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fundo para a Investiga\u00e7\u00e3o e Desenvolvimento do Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: We aimed to identify the factors associated with clinically important changes in quality of life (QoL) of real-world heart failure (HF) patients. Methods: This is a single-centre, prospective cohort study including 419 patients at an HF clinic between January 2013 and February 2020. QoL was assessed regularly using Minnesota Living with Heart Failure Questionnaire (MLHFQ). We used five nested linear mixed-effects models to account for QoL measurements between patients and within-patient. Models were adjusted for time, sociodemographic factors, comorbidities, self-care adherence, and HF severity factors. Results: Median age was 78 years, 54.4% of patients were female, and 49.6% had left ventricle ejection fraction \u2265 50%. At baseline, 62.5% of patients were New York Heart Association (NYHA) class II. Median N-terminal-pro-B type natriuretic peptide level was 1454 pg\/mL. Mean MLHFQ total score at baseline was 25 points (95%CI: 22.97\u201327.60). Having an implanted cardiac resynchronization therapy-pacemaker (CRT-P) was associated with moderate to large improvement in QoL (\u221213.55 points, 95%CI: \u221222.45\u2013\u22124.65). NYHA class II and estimated glomerular filtration rate &lt; 30 mL\/min\/1.73 m2 were associated with small to moderate QoL deterioration (9.74 points, 95%CI: 6.74\u201312.75 and 5.82 points, 95%CI: 1.17\u201310.47, respectively). NYHA classes III or IV and a recent HF hospitalization were associated with large to very large QoL deterioration (28.39 points, 95%CI: 23.82\u201332.96; 60.59 points, 95%CI: 34.46\u201386.72; and 26.91 points, 95%CI: 21.80\u201332.03, respectively). Conclusions: CRT-P implantation, NYHA class and HF hospitalization are associated with the most clinically important QoL changes.<\/jats:p>","DOI":"10.3390\/jcm14145079","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T13:00:51Z","timestamp":1752757251000},"page":"5079","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors Associated with Clinically Important Changes in Quality of Life of Heart Failure Patients: The QUALIFIER Prospective Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4726-800X","authenticated-orcid":false,"given":"Irene","family":"Marques","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Medicina Interna, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio (CHUdSA), Unidade Local de Sa\u00fade de Santo Ant\u00f3nio, 4099-001 Porto, Portugal"},{"name":"Unidade Multidisciplinar de Investiga\u00e7\u00e3o Biom\u00e9dica, Instituto de Ci\u00eancias Biom\u00e9dicas de Abel Salazar (ICBAS), 4050-313 Porto, Portugal"},{"name":"ITR-Laboratory for Integrative and Translational Research in Population Health, 4050-600 Porto, Portugal"},{"name":"Centro Acad\u00e9mico Cl\u00ednico ICBAS-Santo Ant\u00f3nio (CAC ICBAS-Santo Ant\u00f3nio), 4050-313 Porto, Portugal"}]},{"given":"Milton","family":"Severo","sequence":"additional","affiliation":[{"name":"ITR-Laboratory for Integrative and Translational Research in Population Health, 4050-600 Porto, Portugal"},{"name":"EPIUnit, Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, 4050-600 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5059-3567","authenticated-orcid":false,"given":"Ant\u00f3nio Gomes","family":"Pinto","sequence":"additional","affiliation":[{"name":"Unidade Multidisciplinar de Investiga\u00e7\u00e3o Biom\u00e9dica, Instituto de Ci\u00eancias Biom\u00e9dicas de Abel Salazar (ICBAS), 4050-313 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3019-5956","authenticated-orcid":false,"given":"C\u00e2ndida","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de Insufici\u00eancia Card\u00edaca, Servi\u00e7o de Medicina Interna, Unidade Local de Sa\u00fade de Lisboa Ocidental, 1449-005 Lisboa, Portugal"},{"name":"NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9316-1687","authenticated-orcid":false,"given":"Henrique Cyrne","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Unidade Multidisciplinar de Investiga\u00e7\u00e3o Biom\u00e9dica, Instituto de Ci\u00eancias Biom\u00e9dicas de Abel Salazar (ICBAS), 4050-313 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: A comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc. 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