1. Presenter:Ibishi Nazmie MD, PhD University Clinical Center of Kosovo Clinic Of Psychiatry Mesic Srebrenka, Nebi Musliu

2. We have no potential conflict of interest to declare

3.  The main clinical symptoms in Chronic Heart Failure (CHF) affect quality of life (QoL)through their limiting effect on:  physical functioning,  psychological problems, and  social limitations

4.  Patients and family members, health care providers, employers, health insurers, pension administration department, have a need to fully understand and measure the course and prognosis of CHF disease.  CHF also may affect working age population and can lead to permanent retirement.

5.  To explore the prevalence of Work Disability (WD) in CHF outpatients, and to identify sociodemographic and biopsychological factors that are associated with HRQoL and WD.

6.  In this study 104 outpatients with CHF, NYHA class I-IV, were cross sectionally studied. The study included patients age 18≤ 65, of both gender, with echocardiography assessed Left ventricular ejection fraction (LVEF) ≤60%.  Assessment included sociodemografic variables and health status measures(SF-36 questionnaire, HAM-A, HAM-D tools, risk factors for cardiovascular disease).

7.  Patients receiving a permanent, national WD pension corresponding to < 45% of LVEF, were defined as work disabled.  We examined group differences with regard to anxiety and depression symptoms manifestations, HRQoL and disease characteristics.

8. Results Socio-demografic characteristics NYHA class I- II NYHA class III-IV WD Total Age (years) 49,13±8,71 51,16±9,83 50,14±9,3 Female 25(36,4%) 37(48,8%) 62(65,28%) Male 23(13,52%) 19(9,36)% 42(42,88%) LVEF47,13±3,61 36,13±5,21 41,5±4,43 Basic education 6(6,24%) 22(22,88%) 28(28,12%) Middle school 13(13,52%) 24(24,94%) 37(38,48%) High degree 29(30,16%) 10(10,4%) 39(40,56%) Marital status Yes 37 (38,4%) 49(50,96%) 86(89,44%) No 11(11,44%( 7 (7,28%) 18(18,73%) Coomorb. and risk factors Diabetes 34 (35,36%) 28(29,12%( 62(64,48%) HTA 14 (14,56%) 54(56.15%) 68(70,72%) Dyslipidemia 8(8,32%) 7(7,28%) 15(15,6%) Smoking 17(17,68%( 27(28,08%) 44(45,76%) Positive family history 21(21,85%) 34(35,36%) 55(57,2%) Obesity 13(13,52%) 31 (32,34%) 44(45,76%)

9. Etiology of Heart Failure

10. Risk factors of Heart Failure

11. In the study of Health insurance and Hypertension prevention (Mesic, S, 2012, Zagreb, Croatia) was found that 28,79 percent of insurers were obese, 26 percent with smoking attitude, 64,3 percent presented with dyslipidemia and 62.3 percent were diagnosed with Diabetes.

12. Risk factors in WD group

13. Anxiety/depression symptoms and HR Quality of life

14. The prevalence of anxiety / depression symptoms based on HAM-A and HAM-D, in WD sample was 57,7% :  11,7% were presented mild anxiety/depression,  66,7% moderate anxiety/depression and  21,7% of them presented severe anxiety/depression symptoms

15. Differences of means between groups in HRQoL and anxiety/depression WD group(n=56) Others (n=48) p-value Mean score SD Mean score SD Age 51,16 ± 9,62 49,13 ± 8,7 n.s. LVEF 36,13 ± 5,21 47,52 ± 3,61 0.02 HAM-A 20.77 ±4,35 8,95 ±1,82 0.003 HAM-D 21.34 ±5,15 6,32 ±2,42 0.001 SF-36 Physical function 48,15 ±26,49 85,82 ± 13,76 0.001 Role physical 34,15 ±18,97 50,0 ±15,25 0.03 Bodily pain 55,07 ±11,55 73,73 ± 11,55 0.007 General health 52,0 ±13,38 66,00 ± 9,43 0.05 Vitality 59.17 ± 10,93 62,59 ±10,89 0.04 Social function 64,43 ±11,54 67,36 ±9,57 0.06 Role emotional 30,80 ±17,04 84,55 ±17,13 0.0001 Mental health 49,20 ±8,91 59,64 ±9,20 0.03

16. Differences of means between gender in WD group Female group(n=37) Male group(n=19) p-value Mean score SD Mean score SD Age 51,16 ± 9,62 49,13 ± 8,7 n.s. LVEF 36,13 ± 5,21 37,52 ± 3,61 n.s. HAM-A 21.47 ±4,35 16,35 ±4,82 0.03 HAM-D 20.34 ±4,15 19,32 ±3,92 n.s. SF-36 Physical function 47,5 ±6,49 46,82 ± 3,76 n.s Role physical 33,15 ±6,97 36,0 ±5,25 0.08 Bodily pain 53,07 ±4,55 45,73 ± 5,23 0.01 General health 54,0 ±3,38 51,00 ± 4,43 0.05 Vitality 59.17 ± 8,93 62,59 ±6,89 0.07 Social function 64,43 ±5,54 67,36 ±4,57 0.06 Role emotional 30,80 ±7,04 45,32 ±7,03 0.001 Mental health 48,20 ±8,91 50,64 ±9,20 0.09

17.  CHF disease may often affect working age population and can rapidly lead to severe physical and mental disability and retirement, through psychological reaction to disease, HRQoL decline and incapability of recovery to return at work, as outcome.  MMI(maximum medical improvement) in CHF patients should consider psychological reaction and HRQoL decline as outcome, in recovery and RW management programme of treatment.