Poor cardiomyopathy questionnaire score predicts risk for CV death, HF rehospitalization
Among patients with acute HF, poorer cardiomyopathy questionnaire scores predicted both short- and long-term risks for CV death and HF rehospitalization, according to new results published in JACC: Heart Failure.
“Promptly stratifying patients’ risk can help physicians make appropriate decisions in initial treatment. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is an extensively validated instrument for quantitatively measuring HF-specific health status during the past 2 weeks, and it has been shown to be effective in predicting clinical outcomes in patients with chronic HF,” Danli Hu, MD, PhD, from the National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, and colleagues wrote. “However, it is unknown whether KCCQ can predict the short- and long-term clinical outcomes of patients with acute HF.”
Researchers enrolled 4,898 adults who were hospitalized for HF (mean age, 67 years; 38% women) from 52 hospitals in China. All patients completed the KCCQ, and researchers collected the score within 48 hours of admission to assess the association between their score and 30-day and 1-year composite events, including CV death and HF rehospitalization.
In addition, to explore the potential heterogeneity, researchers performed subgroup analyses and evaluated the prognostic value of KCCQ-12 score over N-terminal pro-B-type natriuretic peptide levels and established risk scores by C-statistics, net reclassification improvement and integrated discrimination improvement.
In total, 29.4% of patients had new-onset HF. Patients presented with comorbidities frequently — 58% with CAD, 58.4% with hypertension, 36.4% with atrial fibrillation, 31.5% with diabetes and 28.8% with reduced renal function.
After adjustment, every 10-point KCCQ-12 score decrease was associated with a 13% increase in 30-day (HR = 1.13; 95% CI, 1.08-1.19) and a 7% increase in 1-year (HR = 1.07; 95% CI, 1.05-1.09) composite event risk. These associations remained consistent regardless of the patients’ new-onset HF or acutely decompensated chronic HF, age, sex, left ventricular ejection fraction, NYHA functional class, NT-proBNP level, comorbidities and renal function.
Researchers observed significant improvement in prognostic capabilities measured by C-statistics, net reclassification improvement and integrated discrimination improvement when adding KCCQ-12 score to NT-proBNP and established risk scores.
According to an accompanying editorial, these findings expand the understanding of when patient-reported outcome measurements can be recorded and what these may mean when taken in the inpatient setting.
“Although a reasonable implication of the study by Hu et al would be to implement rapid and relatively inexpensive patient-reported outcome testing for patients admitted with acute HF to assist with risk stratification and communication of prognosis, implementation of such an intervention may not yield as reliable and informative material as suggested by the current data,” Mitchell A. Psotka, MD, PhD, heart failure cardiologist at the Inova Heart and Vascular Institute, Falls Church, Virginia, wrote. “Nevertheless, for resource-limited settings and as part of remote monitoring, patient-reported outcome testing in combination with other easily catalogued variables may offer substantial prognostic information to improve patient care.”
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