LightGBM-Based Prediction of Poor Quality of Life Among Patients With Heart Failure Using Clinical, Behavioral, and Psychological Features
Keywords:
Heart failure, quality of life, LightGBM, machine learning, depression, anxiety, sleep quality, self-care, SHAP, predictive modelingAbstract
Objective: This study aimed to develop and interpret a LightGBM-based machine learning model for predicting poor quality of life among patients with heart failure using clinical, behavioral, and psychological features.
Methods and Materials: This multicenter cross-sectional predictive modeling study was conducted among 428 patients with heart failure recruited from cardiology outpatient clinics and heart failure units in Sweden. Clinical data included left ventricular ejection fraction, NYHA functional class, duration of heart failure, comorbidities, hospitalization history, blood pressure, heart rate, and medication-related indicators. Behavioral variables included physical activity, sleep quality, and heart failure self-care behaviors. Psychological variables included depressive symptoms, anxiety symptoms, perceived stress, and perceived social support. Quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire, and poor quality of life was defined as an overall summary score below 50. The dataset was divided into training and testing subsets, and an optimized LightGBM model was developed using cross-validation and hyperparameter tuning. Model performance was evaluated using AUC, accuracy, sensitivity, specificity, precision, F1-score, balanced accuracy, and Brier score. SHAP analysis was used for model interpretation.
Findings: Poor quality of life was identified in 174 patients, representing 40.7% of the sample. Compared with patients without poor quality of life, patients with poor quality of life had significantly lower left ventricular ejection fraction, higher NYHA class, longer disease duration, higher comorbidity burden, more previous heart failure hospitalization, lower physical activity, poorer sleep quality, weaker self-care, higher depression, higher anxiety, higher perceived stress, and lower perceived social support. The optimized LightGBM model achieved strong predictive performance in the test set, with an AUC of 0.859, accuracy of 0.806, sensitivity of 0.788, specificity of 0.818, F1-score of 0.764, balanced accuracy of 0.803, and Brier score of 0.137. SHAP analysis identified depressive symptoms, NYHA functional class, sleep quality, anxiety symptoms, previous hospitalization, self-care maintenance, physical activity, ejection fraction, perceived stress, and social support as the most influential predictors.
Conclusion: The LightGBM model demonstrated strong ability to predict poor quality of life among patients with heart failure and showed that quality-of-life impairment is influenced by a combination of clinical severity, behavioral limitations, sleep disturbance, psychological distress, and reduced social support.
Downloads
References
Abiko, Y., Paudel, D., Matsuoka, H., Moriya, M., & Toyofuku, A. (2021). Psychological Backgrounds of Medically Compromised Patients and Its Implication in Dentistry: A Narrative Review. International journal of environmental research and public health, 18(16), 8792. https://doi.org/10.3390/ijerph18168792
Atay, M. E., & Çiftçi, B. (2025). Insomnıa ın Heart Faılure Patıents ın a Hospıtal Settıng: Causes, Consequences, and Interventıons. Current Cardiology Reports, 27(1). https://doi.org/10.1007/s11886-025-02256-1
Chen, X., Zeng, M., Chen, C., Zhu, D., Chen, L., & Jiang, Z. (2023). Efficacy of Psycho-Cardiology Therapy in Patients With Acute Myocardial Infarction Complicated With Mild Anxiety and Depression. Frontiers in Cardiovascular Medicine, 9. https://doi.org/10.3389/fcvm.2022.1031255
Chernoff, R. A. (2022). Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis. Psychosomatic Medicine, 84(5), 560-580. https://doi.org/10.1097/psy.0000000000001073
Cook, S. C., Saidi, A., Singh, H., Madder, R. D., Cohen, S. B., Oosterhout, S. V., Samuel, B. P., & Finn, M. T. M. (2023). Preprocedural Anxiety in Adults With Congenital Heart Disease. Jacc Advances, 2(7), 100589. https://doi.org/10.1016/j.jacadv.2023.100589
Fang, C., Jiang, Y., Yang, C., Zhou, Q., Cai, Y., Yan, W., & Fan, X. (2025). Novel Opportunity of Treatment for Psycho-Cardiologic Disease by Gut Microbiome. Frontiers in Cardiovascular Medicine, 12. https://doi.org/10.3389/fcvm.2025.1604962
Fava, G. A., Patierno, C., Sonino, N., & Cosci, F. (2024). Key Psychosocial Issues in Medical Care. Acta Psychiatrica Scandinavica, 149(5), 368-377. https://doi.org/10.1111/acps.13667
Florou, E., Sfairopoulos, D., Plakoutsi, S., Bechlioulis, A., Zekios, K., Milionis, H., Skapinakis, P., & Korantzopoulos, P. (2025). Depression and Anxiety in Patients Who Received a CRT Device and Did Not Have Shock Therapy During a 12‐Month Follow‐Up. Pacing and Clinical Electrophysiology, 48(8), 925-931. https://doi.org/10.1111/pace.70002
Garrels, E., Kainth, T., Silva, B., Yadav, G., Gill, G., Salehi, M., & Gunturu, S. (2023). Pathophysiological Mechanisms of Post-Myocardial Infarction Depression: A Narrative Review. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1225794
Giacomo, D. D., Ranieri, J., Guerra, F., Cilli, E., Sciarra, L., & Romano, S. (2023). Cardiovascular Risk and Biopsychosocial Interplay: Association Among Hypertension, Anxiety, and Emotional Dysregulation—observational Study in Primary Care Setting for Efficient Self‐care. Clinical Cardiology, 47(1). https://doi.org/10.1002/clc.24152
Gostoli, S., Buzzichelli, S., Guidi, J., Sirri, L., Marzola, E., Roncuzzi, R., Abbate‐Daga, G., Fava, G. A., & Rafanelli, C. (2021). An Innovative Approach to the Assessment of Mood Disturbances in Patients With Acute Coronary Syndrome. CNS Spectrums, 28(1), 78-89. https://doi.org/10.1017/s1092852921000924
Katta, M. R., Prasad, S., Tiwari, A., Abouzid, M. R. A., & Mitra, S. (2023). The Effectiveness of Cognitive-Behavioral Therapy for Heart Failure Patients: A Narrative Review. Journal of International Medical Research, 51(9). https://doi.org/10.1177/03000605231198371
Kovacs, A. H., Brouillette, J., Ibeziako, P., Jackson, J. L., Kasparian, N. A., Kim, Y. Y., Livecchi, T., Sillman, C., & Kochilas, L. (2022). Psychological Outcomes and Interventions for Individuals With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation Cardiovascular Quality and Outcomes, 15(8). https://doi.org/10.1161/hcq.0000000000000110
Liu, H.-C., Chaou, C. H., Lo, C. W., Chung, H. T., & Hwang, M. S. (2022). Factors Affecting Psychological and Health-Related Quality-of-Life Status in Children and Adolescents With Congenital Heart Diseases. Children, 9(4), 578. https://doi.org/10.3390/children9040578
Lu, C. W. (2022). Heart Failure and Patient‐Reported Outcomes in Adults With Congenital Heart Disease From 15 Countries. Journal of the American Heart Association, 11(9). https://doi.org/10.1161/jaha.121.024993
Martínez, E. (2023). Risk Factors for Depresion and Anxiety in the Patient With Aortic Valve Stenosis. Mexican Journal of Medical Research ICSA, 11(22), 41-47. https://doi.org/10.29057/mjmr.v11i22.10628
Moran, C., Flynn, M., Campbell, T. S., Rouleau, C. R., Arena, R., Chirico, D., Aggarwal, S., & Laddu, D. (2021). Symptoms of Depression and Anxiety in Patients With Type 2 Diabetes in a Canadian Outpatient Cardiac Rehabilitation Program. Journal of Cardiopulmonary Rehabilitation and Prevention, 41(5), 328-335. https://doi.org/10.1097/hcr.0000000000000603
Parlati, A. L. M., Nardi, E., Basile, C., Paolillo, S., Marzano, F., Chirico, A., Buonocore, D., Colella, A., Fontanarosa, S., Gallo, L., Fierro, M. F., Carbone, F., Gargiulo, P., Prastaro, M., Grottaglie, S. D., Santoro, C., Marchesi, A., Marchetti, M. F., Carta, M., . . . Montisci, R. (2024). Cardiovascular Disease and Psychiatric Disorders: An-Up-to Date Review. Journal of Public Health Research, 13(4). https://doi.org/10.1177/22799036241278817
Pawlak, A., Bielecka‐Dąbrowa, A., Dzierżanowski, T., Holas, P., Jaworska, I., Kolasa, J., Tomaszuk−Kazberuk, A., Mierzyńska, A., Muszala, A., Pudło, R., Rymaszewska, J., Sobański, P., & Dudek, D. (2024). Expert Opinion of the Heart Failure Association of the Polish Cardiac Society and the Polish Psychiatric Association on the Management of Patients With Heart Failure and Selected Mental Disorders (Depression, Anxiety Disorders, Sleep Disorders, Delirium). Kardiologia Polska. https://doi.org/10.33963/v.phj.103100
Princip, M., Ledermann, K., Altwegg, R., & Känel, R. v. (2024). Cardiac Disease-Induced Trauma and Stress-Related Disorders. Herz, 49(4), 254-260. https://doi.org/10.1007/s00059-024-05255-0
Princip, M., Ledermann, K., & Känel, R. v. (2023). Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease. Current Cardiology Reports, 25(6), 455-465. https://doi.org/10.1007/s11886-023-01870-1
Repova, K., Aziriova, S., Krajcirovicova, K., & Šimko, F. (2022). Cardiovascular Therapeutics: A New Potential for Anxiety Treatment? Medicinal Research Reviews, 42(3), 1202-1245. https://doi.org/10.1002/med.21875
Sall, K. E., Griffith, A. M., Midgette, E. P., Winters, A., Tripp, C., Nekkanti, R., & Sears, S. F. (2022). Cardiac Psychology Training in a Rural Health Care Setting: East Carolina Heart Institute. Health Psychology, 41(10), 803-812. https://doi.org/10.1037/hea0001167
Sandhu, U., Kovacs, A. H., & Nazer, B. (2021). Psychosocial Symptoms of Ventricular Arrhythmias: Integrating Patient-Reported Outcomes Into Clinical Care. Heart Rhythm O2, 2(6), 832-839. https://doi.org/10.1016/j.hroo.2021.09.011
Särnholm, J., Gaffey, A. E., Turchio, M. R., Biviano, A., & Burg, M. M. (2025). Psychological Interventions for Reducing Distress in Patients With Cardiac Arrhythmias. Current Cardiology Reports, 27(1). https://doi.org/10.1007/s11886-025-02253-4
Smolderen, K. G., Gillaspy, S. R., Evers, A. W., Kovacs, A. H., Massa-Carroll, I., Moons, P., & Mena‐Hurtado, C. (2024). The Role of the Clinical Psychologist In the Care of Adults With Cardiovascular Disease. Jacc Advances, 3(4), 100910. https://doi.org/10.1016/j.jacadv.2024.100910
Sobolewska-Nowak, J., Wachowska, K., Nowak, A., Orzechowska, A., Szulc, A., Płaza, O., & Gałecki, P. (2023). Exploring the Heart–Mind Connection: Unraveling the Shared Pathways Between Depression and Cardiovascular Diseases. Biomedicines, 11(7), 1903. https://doi.org/10.3390/biomedicines11071903
Sowan, W., Masarwe, S., Aboud, R. J., Rayan-Gharra, N., Baziliansky, S., Konstantin, A., & Grosman, L. (2026). Which Coping Classifications—problem Versus Emotion or Engaged Versus Disengaged—best Predict Psychological Distress in Individuals With Cardiac Diseases? A Systematic Review and Meta-Analysis. Health Psychology, 45(7), 786-795. https://doi.org/10.1037/hea0001581
Suksatan, W., & Tankumpuan, T. (2021). Mind–Body Interventions in Patients With Heart Failure: State of the Science. Journal of Applied Gerontology, 41(4), 1232-1243. https://doi.org/10.1177/07334648211053000
Tizzoni, F., Canella, G., Fave, A. D., Lernia, D. D., Lorusso, M. L., Nobile, M., & D’Angelo, M. G. (2025). Living With Duchenne Muscular Dystrophy Beyond the Physical Implications: Cognitive Features, Psychopathology Aspects, and Psychosocial Resources—A Narrative Review. Brain Sciences, 15(7), 695. https://doi.org/10.3390/brainsci15070695
Topuz, İ., & Topuz, A. (2024). Cardiovascular Diseases and Community Mental Health. Cardiac and Cardiovascular Research, 4(1), 2284. https://doi.org/10.54517/ccr.v4i1.2284
Wagner‐Skacel, J., Mörkl, S., Dalkner, N., Fellendorf, F. T., Fitz, W., Brix, B., Neshev, R., Wedenig, S., Mächler, P., Dorr, A., Picha, R., Rudlof, M. E., Bartel, T. O., Tatschl, J. M., Gostner, J. M., Bengesser, S., Reininghaus, E. Z., Jenewein, J., & Goswami, N. (2021). The Impact of Cardiovascular Rehabilitation on Psychophysiological Stress, Personality and Tryptophan Metabolism: A Randomized Pilot Feasibility Study. Antioxidants, 10(9), 1425. https://doi.org/10.3390/antiox10091425
Wagner, M. K., Berg, S. K., Hassager, C., Armand, S., Møller, J. E., Ekholm, O., Rasmussen, T. B., Fisher, P. M., Knudsen, G. M., & Stenbæk, D. S. (2020). Cognitive Impairment and Psychopathology in Out-of-Hospital Cardiac Arrest Survivors in Denmark: The REVIVAL Cohort Study Protocol. BMJ open, 10(9), e038633. https://doi.org/10.1136/bmjopen-2020-038633
Willy, K., Meyer, T., Eckardt, L., & Morina, N. (2024). Selection of Social Comparison Standards in Cardiac Patients With and Without Experienced Defibrillator Shock. Scientific reports, 14(1). https://doi.org/10.1038/s41598-024-51366-3
Wungouw, H. I. S. (2021). Physical Exercise and Quality of Life in Patients With Cardiac Disease. Jurnal Kedokteran Yarsi, 14(3). https://doi.org/10.33476/jky.v14i3.1848
Yi, Y., Seo, E., & An, J. (2022). Does Forest Therapy Have Physio-Psychological Benefits? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. International journal of environmental research and public health, 19(17), 10512. https://doi.org/10.3390/ijerph191710512
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2026 Rúnar Guðmundsson (Author); Elin Sjöberg
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
