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CLINICAL RESEARCH: HEART FAILURE

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

Paul A. Heidenreich, MD, MS^_*,_*, John A. Spertus, MD, MPH, Philip G. Jones, MS, William S. Weintraub, MD, John S. Rumsfeld, MD, PhD, Saif S. Rathore, MPH^||, Eric D. Peterson, MD, MPH^¶, Frederick A. Masoudi, MD, MSPH^#, Harlan M. Krumholz, MD, MS^||, Edward P. Havranek, MD^#, Mark W. Conard, PhD, Randall E. Williams, MD^_** for the Cardiovascular Outcomes Research Consortium

^_* VA Palo Alto Health Care System, Palo Alto, California
Mid America Heart Institute of Saint Luke’s Hospital, Kansas City, Missouri
Emory University, Atlanta, Georgia
Denver VA Medical Center, Denver, Colorado
^|| Yale University, New Haven, Connecticut
^¶ Duke University Medical Center, Durham, North Carolina
^# Denver Health Medical Center, Denver, Colorado
^_** Northwestern University, Evanston, Illinois.

Manuscript received July 26, 2005; revised manuscript received August 23, 2005, accepted September 26, 2005.

^_* Reprint requests and correspondence: Dr. Paul A. Heidenreich, 111C Cardiology, Palo Alto VA Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304. (Email: heiden{at}stanford.edu).

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

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