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Relationship between changing patient‐reported outcomes and subsequent clinical events in patients with chronic heart failure: insights from HF‐ACTION
Author(s) -
Luo Nancy,
O'Connor Christopher M.,
Cooper Lauren B.,
Sun JieLena,
Coles Adrian,
Reed Shelby D.,
Whellan David J.,
Piña Ileana L.,
Kraus William E.,
Mentz Robert J.
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1299
Subject(s) - medicine , confidence interval , heart failure , hazard ratio , proportional hazards model , clinical endpoint , clinical trial , physical therapy , cardiology
Aims 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. Methods and results 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/hospitalization (adjusted hazard ratio 0.93 per 5‐point increase; 95% confidence interval 0.90–0.97; P < 0.001). Additional improvements in health status beyond an 8‐point increase in KCCQ was not associated with all‐cause death or hospitalization ( P = 0.42). Conclusion In patients with heart failure, small changes in KCCQ are associated with changing future risk, but more research will be necessary to understand how different magnitudes of improving health status affect outcomes.