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Current Health Status Is the Most Prognostic for Patients With Heart Failure

Jaime Rosenberg
While current, prior, and change in the Kansas City Cardiomyopathy Questionnaire score were all significnatly associated with lower risk of mortality and heart failure hospitalization in isolation, when the current score was included with either prior or change score, only the current score was significantly associated with lower risk for all-cause mortality.
While interpreting current, prior, or a change in Kansas City Cardiomyopathy Questionnaire (KCCQ) Score, a study found that the most recent assessment provides the most important information about the risks for subsequent clinical events.

There has been an increasing emphasis on incorporating patient-reported outcome measures in care for patients with heart failure (HF), but there is still clarity needed on how to interpret longitudinally collected information for clinicians.

“As new technologies, such as patient portals and smart devices, further improve the feasibility of routinely collecting patient-reported outcome measures, a key challenge is to develop a framework through which clinicians can clinically interpret these measures,” wrote the authors.

The study, published in JAMA Cardiology, examined the strength of association between prior, current, or a recent change in questionnaire scores with death and hospitalization of patients with HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction.

Authors of the study conducted analyses of the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial of 1372 patients with HFpEF, conducted between August 2006 and January 2012, and the HF-ACTION trial that included 1669 patients with HFrEF, conducted between April 2003 and February 2007.

The KCCQ is a 23-item questionnaire that assesses HF-specific symptoms, functions, and quality of life and is scored 0-100, with higher scores indicating better HF-specific health status.

Results showed that, in both cohorts, patients with worse baseline health status were more likely to be younger, have a higher mass body index, and have diabetes. In patients with HFpEF, 321 experienced a cardiovascular death or first HF hospitalization during follow up and 229 patients died. In patients with HFrEF, 327 experienced a cardiovascular death or first HF hospitalization and 237 died.

Higher scores on the current KCCQ Overall Summary (KCCQ-os) assessment or the prior KCCQ-os assessment were both associated with a lower risk of cardiovascular death or first HF hospitalization. In addition, an increase in KCCQ-os from prior to current visit was associated with lower risk of cardiovascular death or first HF hospitalization.

However, the authors found that when the current visit KCCQ-os was included in the model with either the prior or change scores, only the current KCCQ-os was significantly associated with cardiovascular death or first HF hospitalization.

The results for the all-cause mortality were similar. While higher scores on current, prior, and change scores were all associated with lower risk of all-cause mortality, when the current scores were included along with either the pro or change scores, only the current KCCQ-os was significantly associated with lower risk for all-cause mortality.

Overall, these results showed that patients’ current health status was the most prognostic.

“When routinely monitoring symptoms, function, and quality of life in patients with HF, serially collected health status data can provide updated risk estimates for cardiovascular death or HF hospitalization as well as death from any cause,” concluded the authors.

 
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