Clinical Research
Heart Failure
Health Status Identifies Heart Failure Outpatients at Risk for Hospitalization or Death

https://doi.org/10.1016/j.jacc.2005.11.021Get rights and content
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Objectives

We tested the hypothesis that one health status measure, the Kansas City Cardiomyopathy Questionnaire (KCCQ), provides prognostic information independent of other clinical data in outpatients with heart failure (HF).

Background

Health status measures are used to describe a patient’s clinical condition and have been shown to predict mortality in some populations. Their prognostic value may be particularly useful among patients with HF for identifying candidates for disease management in whom increased care may reduce hospitalizations and prevent death.

Methods

We evaluated 505 HF patients from 13 outpatient clinics who had an ejection fraction <40% using the KCCQ summary score. Proportional hazards regression was used to evaluate the association between the KCCQ summary score (range, 0 to 100; higher scores indicate better health status) and the primary outcome of death or HF admission, adjusting for baseline patient characteristics, 6-min walk distance, and B-type natriuretic peptide (BNP).

Results

The mean age was 61 years, 76% of patients were male, 51% had an ischemic HF etiology, and 5% were New York Heart Association functional class IV. At 12 months, among the 9% of patients with a KCCQ score <25, 37% had been admitted for HF and 20% had died, compared with 7% (HF admissions) and 5% (death) of those with a KCCQ score ≥75 (33% of patients, p < 0.0001 for both comparisons). In sequential multivariable models adjusting for clinical variables, 6-min walk, and BNP levels, the KCCQ score remained significantly associated with survival free of HF hospitalization.

Conclusions

A low KCCQ score is an independent predictor of poor prognosis in outpatients with HF.

Abbreviations and Acronyms

BNP
B-type natriuretic peptide
HF
heart failure
KCCQ
Kansas City Cardiomyopathy Questionnaire
NYHA
New York Heart Association

Cited by (0)

Project support was from an unrestricted grant by Pharmacia, Inc. Biosite, Inc., donated supplies to measure B-type natriuretic peptide. Drs. Rumsfeld and Heidenreich were supported by VA Health Services Research Career Development Awards. Saif Rathore was supported by NIH/National Institute of General Medical Sciences Medical Scientist Training Grant GM07205.