Introduction

Heart failure (HF) is a complex clinical syndrome that results from any structural or
functional impairment of ventricular filling or ejection of blood (Yancy et al., 2013). The
incidence of HF increases with age and is most prevalent in persons over 65 years. In the U.S.,
the lifetime risk of HF is 20% in persons > 40 years of age (Go et al., 2014). Over the past
several decades, the incidence of HF in the U.S.
population has remained relatively stable (Curtis et al., 2008; Go et al., 2014; Rogers et
al., 2004), while prevalence is rising largely due to population aging. Survival for HF is
improving over time (Bahrami et al., 2008; Huffman et al., 2013), with an absolute mortality rate
of approximately 50% within 5 years of diagnosis. (Roger et al., 2004; Levy et al., 2002). In
2012, total costs of HF care were estimated at over $30 billion (Curtis et al., 2008).

Heart failure (HF) is characterized as a group of symptoms including shortness of breath,

edema, fatigue, fluid retention and poor exercise tolerance (Rohyans and Pressler, 2009). In the
area of cardiovascular disease, the risk factors for increased incidence of heart failure continue to
rise among at risk populations and the age for incidence of heart failure has been declining
(Wang et al, 2010). This risk for hospital admission for heart failure has seen an increase due to
several factors. These factors include increased 2 longevity due to improved technology and
aging of the population (Muus, et al, 2009).
Further, hospital admissions for HF as a secondary diagnosis account for approximately
70% of related re-hospitalizations owing to contributing diagnoses, such as obesity, diabetes
mellitus II, hypertension (HTN) and other complex chronic conditions which are often used as
primary diagnosis for admissions. (Epstein, 2009 and Changes in mortality from heart failure—
United States, 1980-1995).

HF therapy focuses on improving the quality of life (QOL) for the patient (Johansson,
Dalstrom, & Brostrom, 2006). Mechanical circulatory support (MCS) devices, one form of
therapy, are implanted into patients who are waiting for a heart transplant (HT) but who are at
risk of dying while waiting for a donor heart (Wray, Hall and Banner, 2007). MCS devices can
improve QOL (Rizzieri, Verheijde, Rady, and McGregor, 2008), but little is known about other
factors that influence QOL as it relates to the health-related quality of life (HRQOL) for patients
with MCS (Grady, Meyer, Mattea, Dressler, Ormaza, & White-Williams, et al. 2002; Rizzieri,
Verheijde, Rady, & McGregor, 2008).

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