ARTICLE
Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure
C. Patrick Green, MD*,
Charles B. Porter, MD, FACC*  ,
Dennis R. Bresnahan, MD, FACC* and
John A. Spertus, MD, MPH, FACC*
* Section of Cardiology, Department of Medicine, University of Missouri—Kansas City, Kansas City, Missouri, USA
Mid America Heart Institute, Saint Luke’s Hospital, Kansas City, Missouri, USA
Manuscript received August 4, 1999;
accepted December 15, 1999.
Reprint requests and correspondence: Dr. John A. Spertus, Mid America Heart Institute/University of Missouri—Kansas City, 4401 Wornall Road, Kansas City, Missouri 64111
jspertus{at}cctr.umkc.edu
OBJECTIVES
To create a valid, sensitive, disease-specific health status measure for patients with congestive heart failure (CHF).
BACKGROUND
Quantifying health status is becoming increasingly important for CHF. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a new, self-administered, 23-item questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life.
METHODS
To establish the performance characteristics of the KCCQ, two distinct patient cohorts were recruited: 70 stable and 59 decompensated CHF patients with ejection fractions of <40. Upon entry into the study, patients were administered the KCCQ, the Minnesota Living with Heart Failure Questionnaire and the Short Form-36 (SF-36). Questionnaires were repeated three months later.
RESULTS
Convergent validity of each KCCQ domain was documented by comparison with available criterion standards (r = 0.46 to 0.74; p < 0.001 for all). Among those with stable CHF who remained stable by predefined criteria (n = 39), minimal changes in KCCQ domains were detected over three months of observation (mean change = 0.8 to 4.0 points, p = NS for all). In contrast, large changes in score were observed among patients whose decompensated CHF improved three months later (n = 39; mean change = 15.4 to 40.4 points, p < 0.01 for all). The sensitivity of the KCCQ was substantially greater than that of the Minnesota Living with Heart Failure and the SF-36 questionnaires.
CONCLUSIONS
The KCCQ is a valid, reliable and responsive health status measure for patients with CHF and may serve as a clinically meaningful outcome in cardiovascular research, patient management and quality assessment.
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Abbreviations and Acronyms
| | CHF | = congestive heart failure | | EF | = ejection fraction | | HRQoL | = health-related quality of life | | KCCQ | = Kansas City Cardiomyopathy Questionnaire | | LiHFe | = Minnesota Living with Heart Failure Questionnaire | | NYHA | = New York Heart Association | | QoL | = quality of life | | SF-36 | = Short Form 36 | | 6 MWT | = 6 minute walk test |
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|
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|
|
|
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|
|
|
|
|
|
|
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191 - 205.
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|
|
|
|
|
|
|
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February 28, 2005;
165(4):
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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September 1, 2004;
11(5):
410 - 417.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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August 3, 2004;
110(5):
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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J. Am. Soc. Nephrol.,
August 1, 2004;
15(8):
2195 - 2203.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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J. Am. Coll. Cardiol.,
November 19, 2003;
42(10):
1811 - 1817.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. L. Smith, F. A. Masoudi, V. Vaccarino, M. J. Radford, and H. M. Krumholz
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J. Am. Coll. Cardiol.,
May 7, 2003;
41(9):
1510 - 1518.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Hulsmann, R. Berger, B. Sturm, A. Bojic, W. Woloszczuk, J. Bergler-Klein, and R. Pacher
Prediction of outcome by neurohumoral activation, the six-minute walk test and the Minnesota Living with Heart Failure Questionnaire in an outpatient cohort with congestive heart failure
Eur. Heart J.,
June 1, 2002;
23(11):
886 - 891.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J Juenger, D Schellberg, S Kraemer, A Haunstetter, C Zugck, W Herzog, and M Haass
Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables
Heart,
March 1, 2002;
87(3):
235 - 241.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
