Renal dysfunction and health-related quality of life in patients with heart failure: the mediating roles of patient-centered outcomes

Background: Heart failure (HF) is frequently complicated by renal dysfunction, which is consistently associated with worse health-related quality of life (HRQoL). However, the indirect pathways underlying this association remain insufficiently explored. Patient-centered outcomes (PCOs), including depressive symptoms, functional status, adherence to recommended self-care strategies, and self-care behaviors, may mediate this relationship. Objectives: We aimed to examine whether PCOs mediate the relationship between renal dysfunction and HRQoL in HF. Methods: A cross-sectional secondary analysis (N = 518) was conducted using baseline data from patients with HF in the Research and Interventions for Cardiovascular Health (RICH) Heart Program Database. Depressive symptoms (Patient Health Questionnaire-9), functional status (Duke Activity Status Index), adherence to recommended self-care strategies (Medical Outcomes Study Specific Adherence Scale), self-care behaviors (Self-Care of Heart Failure Index), and HRQoL (Minnesota Living with Heart Failure Questionnaire) were assessed. The PROCESS macro (Model = 4) was used to determine the indirect effects of renal dysfunction on HRQoL. Results: Renal dysfunction had significant indirect effects on HRQoL only through depressive symptoms (Indirect effect = 4.57, SE = 1.39, 95% Bootstrap Confidence Interval [CI]:1.92, 7.33), functional status (Indirect effect = 3.41, SE = 0.68, 95% Bootstrap CI: 2.06, 4.82), and self-care management (Indirect effect = 1.14, SE = 0.50, 95% Bootstrap CI: 0.32, 2.29) controlling for age and gender. Conclusions: Our findings indicate that renal dysfunction can lead to worse HRQoL by increasing depressive symptoms, decreasing functional status, and decreasing self-care management. Interventions targeting these factors may improve HRQoL in this population.