Author + information
- Received July 26, 2005
- Revision received August 23, 2005
- Accepted September 26, 2005
- Published online February 21, 2006.
- 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⁎⁎,
- Cardiovascular Outcomes Research Consortium
- ↵⁎Reprint requests and correspondence:
Dr. Paul A. Heidenreich, 111C Cardiology, Palo Alto VA Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304.
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.
Project support was from an unrestricted grant by Pharmacia, Inc. Biosite, Inc., donated supplies to measure B-type natriuretic peptide. Drs. Rumsfeld and Heidenreich were supported by VA Health Services Research Career Development Awards. Saif Rathore was supported by NIH/National Institute of General Medical Sciences Medical Scientist Training Grant GM07205.
- Received July 26, 2005.
- Revision received August 23, 2005.
- Accepted September 26, 2005.
- American College of Cardiology Foundation