Objective measures may be more reliable than patient reports of HF severity
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HF severity objectively measured by ventilatory efficiency during exercise was more closely associated with all-cause death and hospitalization compared with subjective, patient-perceived measures of HF severity, researchers reported.
According to data published in the Journal of the American Heart Association, patient perception of HF severity was concordant with objective measures just as often as it was discordant.
“Given the present focus on patient-reported outcomes, these observations highlight key insights that clarify the utility of health-related quality of life instruments for risk stratification,” Katherine C. Michelis, MD, cardiologist at the University of Texas Southwestern Medical Center, and colleagues wrote.
As Healio previously reported, exercise training may be beneficial among patients with HF who experienced modest improvements in time to all-cause mortality, hospitalization, CV mortality and CV hospitalization.
For this post hoc analysis of the HF-ACTION study, the Kansas City Cardiomyopathy Clinical Questionnaire clinical summary score (KCCQ-CS) was used as a subjective measure for HF severity, and ventilatory efficiency measure during exercise training, as assessed by the slope of minute ventilation (VE) vs. carbon dioxide production (VCO2), was used as the objective measure.
Perception of HF severity among 2,062 participants was classified in one of four ways:
- concordant-lower severity (high KCCQ-CS, low VE/VCO2 slope);
- concordant-higher severity (low KCCQ-CS, high VE/VCO2 slope);
- discordant-symptom minimizer (high KCCQ-CS, high VE/VCO2 slope); and
- discordant-symptom magnifier (low KCCQ-CS, low VE/VCO2 slope).
According to the study, the concordance rate for both subjective and objective measures was only slightly better than chance (54.1%).
Researchers observed that, despite similar KCCQ-CS, risk for all-cause mortality was greater among patients classified as HF symptom minimizers compared with participants who were concordant-lower HF severity (HR = 1.79; 95% CI, 1.27-2.5; P < .001).
Moreover, although individuals in the symptom magnifier group reported lower KCCQ-CS compared with those who were classified as symptom minimizers, their risk for all-cause mortality was no greater (HR = 0.79; 95% CI, 0.57-1.1; P = .18).
Researchers also noted that patients in the symptom magnifier group were more likely to be classified as NYHA class III (44.8% vs. 16.3%; P < .001), have depression (30.4% vs. 17.7%; P < .001) and have poorer health-related quality of life (EuroQoL visual analog scale score, 60 vs. 76; P < .001).
Additionally, symptom magnifiers were more likely to experience all-cause hospitalization and the composite endpoint of all-cause mortality and hospitalization compared with the concordant-lower HF severity group (P for all < .001).
“Our findings suggest that enhanced treatment of depression could lead to a reduction in heart failure hospitalization in some patients,” the researchers wrote. “Of note, the symptom minimizers did not have higher mortality as compared with the concordant-higher severity participants, suggesting that their minimization of symptoms did not place them at an unduly higher risk of death.”
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