A Cross sectional descriptive study to investigate the different effects of using approved therapeutic regimens options on the quality of life for chronic heart disease patients with reduced ejection fraction
Authors: Metwally Mohamed , Elaziz Enas Abd , Wafaie Rasha , AlAyoubi Fakhr , Emam Engy M , Kosba Rabab Y , Elaaty Ahmed Abd 
Published: September 2023

Abstract

Aim
Investigate the different effects on the quality of life (QOL) between the approved regimens used for Heart failure patients with reduced ejection fraction (HFrEF) treatment in clinical practice.

Methods
Cross Sectional descriptive study on (HFrEF) patients was conducted from December 2021 to Mars 2023 at governmental and private hospitals in Egypt and Saudi Arabia, the 118 patients were receiving different treatment regimens divided into 4 groups, all groups have B-blockers and mineralocorticoid receptor antagonist (MRA); 1.Conventional therapy group of 33 patients: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARBs), 2. Group of 22 patients: Sacubitril/Valsartan as an angiotensin receptor-neprilysin inhibitor (ARNI), 3. Group of 33 patients (ACEi/ARBs) + Sodium−glucose co-transporter 2 inhibitors (SGLT2i), 4. Group of 30 patients (ARNI) with SGLT2i. Their quality of life assessment was done using validated questionnaire MLHFQ (Minnesota Living with Heart Failure Questionnaire) as face to face interviews and data were collected from hospital records. Statistical software IBM SPSS package version 27.0, a one-way ANOVA test was conducted to compare the difference between 4 groups normally distributed quantitative variables. Post hoc pairwise multiple comparisons were executed using the Tukey HSD test. A multiple linear regression analysis was conducted to assess the ability of the independent variables (Platelets count, Ejection Fraction EF%, Hemoglobin, S.Cr, Gender, WBCs and Urea) to predict the value of MLHFQ score. Significance was judged at the 5% level.

Results
There was a statistically significant difference In MLHFQ Score for the four groups: F (3, 114) = 8.135, P = 0.000. The actual difference in mean scores was relatively high and this was approved by a large effect size, calculated using eta squared (0.176). Post hoc comparisons indicated that the mean score for Conventional regimen group (M = 68.06, SD = 19.77, CI95% 11.92–38.67, P &lt; 0.05) and SGLT2i containing regimen group (M = 56.88, SD = 22.21, CI95% 0.74–27.48, P = 0.034) both were significantly different from that of ARNI + SGLT2i combination containing regimen group (M = 42.77, SD = 19.04). By comparing the EF% between the 4 groups, There was a statistically significant difference: F (3, 114) = 2.725, P = 0.047. Post hoc comparisons indicated that the mean score for Conventional containing regimen (M = 33, SD = 8.746, CI95% 0.1–10.43, P = 0.044) was significantly different from that of ARNI + SGLT2i combination regimen (M = 27.73, SD = 7.497). The linear regression analysis for variables showed statistical significance (F Change (7,110) = 5.234, P = .000).The statistically significant affected predicted variables are (S.Cr, P = 0.01), (B.urea, P = 0.003), (Hb, P = 0.011), while R2 = 0.25 explained only 25% of the variance in the dependent variable (MLHFQ score).

Conclusions
The early beginning of ARNI + SGLT2i with B-blocker + MRA may improve the QOL beside the approved reduction in heart failure hospitalizations.

Additional Content
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