Original Article

The Relationship between Serum Albumin Level and Quality of Life and Mortality in Patients with Heart Failure with Reduced Ejection Fraction

Abstract

Background: Heart failure remains a global health challenge, necessitating a deeper understanding of factors affecting mortality and quality of life. Given the paucity of studies investigating the relationship between serum albumin levels and outcomes in patients with chronic heart failure, particularly their quality of life, we conducted this study.
Methods: This prospective study evaluated demographic information, laboratory findings, and ejection fraction (EF) in hospitalized patients with ischemic and non-ischemic heart failure. Patients with an EF of less than 50% were included as having heart failure. Serum albumin levels were measured. Patients completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) during hospitalization and were followed up for six months after discharge.
Results: A total of 102 individuals were included in this study. Among them, 59.8% had a history of chronic heart failure. There was a weak but significant inverse relationship between serum albumin level and the MLHFQ index (r=−0.263; P=0.018). There was no significant difference in serum albumin level or MLHFQ index between deceased and surviving patients (P=0.816 and P=0.12, respectively).
Conclusion: This study indicates that serum albumin levels were weakly associated with quality of life in patients with heart failure with reduced EF, as assessed by the MLHFQ. Nonetheless, serum albumin levels did not predict short-term mortality over the 6-month follow-up period.

1. Gopal DM, Kalogeropoulos AP, Georgiopoulou V V, Tang WWH, Methvin A, Smith AL, et al. Serum albumin concentration and heart failure risk: the Health, Aging, and Body Composition Study. Am Heart J. 2010;160(2):279-85.
2. Li Z, Ling Y, Yuan X, Liu X, Huang W, Chen Q, Wang J, Chen Y, Xu M, Wu B. Impact of albumin infusion on prognosis of intensive care unit patients with congestive heart failure-hypoalbuminemia overlap: a retrospective cohort study. J Thorac Dis. 2022 Jun;14(6):2235-2246
3. Chao P, Cui X, Wang S, Zhang L, Ma Q, Zhang X. Serum albumin and the short-term mortality in individuals with congestive heart failure in intensive care unit: an analysis of MIMIC. Sci Rep. 2022;12(1):16251.
4. Miura M, Sakata Y, Miyata S, Nochioka K, Takada T, Tadaki S, et al. Prognostic impact of subclinical microalbuminuria in patients with chronic heart failure. Eur Heart J. 2013;34(Suppl 1):1493.
5. Jabbour R, Ling HZ, Norrington K, Amaral N, Zaman N, Aggarwal S, et al. Serum albumin changes and multivariate dynamic risk modelling in chronic heart failure. Int J Cardiol. 2014;176(2):437-43.
6. Ling HZ, Flint J, Damgaard M, Bonfils PK, Cheng AS, Aggarwal S, et al. Calculated plasma volume status and prognosis in chronic heart failure. Eur J Heart Fail. 2015;17(1):35-43.
7. Grodin JL, Lala A, Stevens SR, DeVore AD, Cooper LB, AbouEzzeddine OF, et al. Clinical implications of serum albumin levels in acute heart failure: insights from DOSE-AHF and ROSE-AHF. J Card Fail. 2016;22(11):884-90.
8. Niedziela JT, Hudzik B, Szygula-Jurkiewicz B, Nowak JU, Polonski L, Gasior M, et al. Albumin-to-globulin ratio as an independent predictor of mortality in chronic heart failure. Biomark Med. 2018;12(7):749-57.
9. Peng W, Zhang C, Wang Z, Yang W. Prediction of all-cause mortality with hypoalbuminemia in patients with heart failure: a meta-analysis. Biomarkers. 2019;24(7):631-7.
10. Gotsman I, Shauer A, Zwas DR, Tahiroglu I, Lotan C, Keren A. Low serum albumin: A significant predictor of reduced survival in patients with chronic heart failure. Clin Cardiol. 2019;42(3):365-72.
11. Sze S, Pellicori P, Zhang J, Weston J, Clark AL. The impact of malnutrition on short-term morbidity and mortality in ambulatory patients with heart failure. Am J Clin Nutr. 2021;113(3):695-705.
12. Yi S, Chen M. Decreased albumin is associated with elevated N-terminal pro-brain natriuretic peptide and poor long-term prognosis in patients with chronic heart failure. Medicine (Baltimore). 2020;99(51):e23872.
13. Wei X, Min Y, Yu J, Wang Q, Wang H, Li S, et al. The value of admission serological indicators for predicting 28-day mortality in intensive care patients with acute heart failure: construction and validation of a nomogram. Front Cardiovasc Med. 2021;8:741351.
14. Pocock SJ, Ferreira JP, Packer M, Zannad F, Filippatos G, Kondo T, et al. Biomarker‐driven prognostic models in chronic heart failure with preserved ejection fraction: the EMPEROR–Preserved trial. Eur J Heart Fail. 2022;24(10):1869-78.
15. Wang X, Zhang Y, Wang Y, Liu J, Xu X, Liu J, et al. The neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with chronic heart failure. BMC Cardiovasc Disord. 2023;23(1):568.
16. Bragazzi NL, Zhong W, Shu J, Abu Much A, Lotan D, Grupper A, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol. 2021;28(15):1682-90.
17. Arques S, Ambrosi P. Human serum albumin in the clinical syndrome of heart failure. J Card Fail. 2011;17(6):451-8.
18. Liu M, Chan C, Yan BP, Zhang Q, Lam Y, Li R, et al. Albumin levels predict survival in patients with heart failure and preserved ejection fraction. Eur J Heart Fail. 2012;14(1):39-44.
19. El Iskandarani M, El Kurdi B, Murtaza G, Paul TK, Refaat MM. Prognostic role of albumin level in heart failure: A systematic review and meta-analysis. Medicine. 2021;100(10):e24785.
20. Su W, An T, Zhou Q, Huang Y, Zhang J, Zhang Y, et al. Serum albumin is a useful prognostic indicator and adds important information to NT-proBNP in a Chinese cohort of heart failure. Clin Biochem. 2012;45(7–8):561-5.
21. Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, et al. Association of an increase in serum albumin levels with positive 1-year outcomes in acute decompensated heart failure: A cohort study. PLoS One. 2020;15(12):e0243818.
22. Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med. 2018;52:8-12.
23. Feng KY, Ambrosy AP, Zhou Z, Li D, Kong J, Zaroff JG, et al. Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial. Eur J Heart Fail. 2023;25(4):553-61.
Files
IssueVol 20 No 3 (2025) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v20i3.20112
Keywords
Heart Failure Quality of Life Mortality Albumin

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Taban MR, Shamsian Z, Abdollahzadeh A, Mardani H, Maleki M, Yaghubi R. The Relationship between Serum Albumin Level and Quality of Life and Mortality in Patients with Heart Failure with Reduced Ejection Fraction. Res Heart Yield Transl Med. 2025;20(3):213-220.