Assessing patient preferences in heart failure using conjoint methodology

The course of heart failure (HF) is characterized by frequent hospitalizations, a high mortality rate, as well as a severely impaired health-related quality of life (HRQoL). To optimize disease management, understanding of patient preferences is crucial. We aimed to assess patient preferences using conjoint methodology and HRQoL in patients with HF.

Two modules were applied: an initial qualitative module, consisting of in-depth interviews with 12 HF patients, and the main quantitative module in 300 HF patients from across Germany. Patients were stratified according to the time of their last HF hospitalization. Each patient was presented with ten different scenarios during the conjoint exercise. Additionally, patients completed the generic HRQoL instrument, EuroQol health questionnaire (EQ-5D™).

The attribute with the highest relative importance was dyspnea (44%), followed by physical capacity (18%). Of similar importance were exhaustion during mental activities (13%), fear due to HF (13%), and autonomy (12%). The most affected HRQoL dimensions according to the EQ-5D questionnaire were anxiety/depression (23% with severe problems), pain/discomfort (19%), and usual activities (15%). Overall average EQ-5D score was 0.39 with stable, chronic patients (never hospitalized) having a significantly better health state vs the rest of the cohort.

This paper analyzed patient preference in HF using a conjoint methodology. The preference weights resulting from the conjoint analysis could be used in future to design HRQoL questionnaires which could better assess patient preferences in HF care.