Relationship between changing patient-reported outcomes and subsequent clinical events in patients with chronic heart failure: insights from HF-ACTION

European Journal of Heart Failure
Nancy LuoRobert J Mentz

Abstract

A 5-point change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) is commonly considered to be a clinically significant difference in health status in patients with heart failure. We evaluated how the magnitude of change relates to subsequent clinical outcomes. Using data from the HF-ACTION trial of exercise training in chronic heart failure (n = 2331), we used multivariable Cox regression with piecewise linear splines to examine the relationship between change in KCCQ overall summary score from baseline to 3 months (range 0-100; higher scores reflect better health status) and subsequent all-cause mortality/hospitalization. Among 2038 patients with KCCQ data at the 3-month visit, KCCQ scores increased from baseline by ≥5 points for 45%, scores decreased by ≥5 points for 23%, and scores changed by <5 points for the remaining 32% of patients. There was a non-linear relationship between change in KCCQ and outcomes. Worsening health status was associated with increased all-cause mortality/hospitalization (adjusted hazard ratio 1.07 per 5-point KCCQ decline; 95% confidence interval 1.03-1.12; P < 0.001). In contrast, improving health status, up to an 8-point increase in KCCQ, was associated with decreased all-cause mortality/h...Continue Reading

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Citations

Oct 4, 2018·European Journal of Heart Failure·João Pedro Ferreira, Faiez Zannad
Aug 20, 2020·Journal of the American Heart Association·Nariman SepehrvandUNKNOWN Alberta HEART Investigators*
Nov 21, 2019·Heart Failure Reviews·Mandana MoradiMohammad Raeisi
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Jan 20, 2021·Circulation. Heart Failure·Robert P NolanLisa Marie Mielniczuk
May 2, 2021·European Journal of Heart Failure·Loreena HillSotiris Antoniou

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