Research presented at the American Heart Association (AHA) Scientific Sessions in Chicago, Illinois, found that the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) was able to more accurately assess patients’ symptoms for clinicians.
Data presented today at the American Heart Association (AHA) Scientific Sessions offer insight into how the use of patient-reported outcomes (PROs) can help physicians better manage heart failure (HF).
A substudy of the PRO-HF trial found that use of the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) improved both the accuracy of clinicians’ assessments of health status and patients’ confidence in how well their physicians understood their symptoms.
Early results from the study, formally known as Patient-Reported Outcomes in a Heart Failure Clinical Trial, were presented in the final session of the conference, which opened Saturday in Chicago, Illinois, and ended Monday.
The results were published simultaneously in Circulation: Heart failure.
“The KCCQ-12 is a validated patient-reported health status instrument that assesses functional limitations, social limitations, quality of life, and frequency of heart failure-related symptoms,” said Dr. Alexander Sandhu, study author, who presented the findings.
The purpose of the substudy presented at the AHA was to determine whether patient-reported health status could improve the accuracy of clinician ratings, as clinicians typically rate the health status of heart failure patients using the New York Heart Association (NYHA) class . Sandhu explained that the KCCQ-12 has 4 domain scores and a total treatment score, each ranging from 0-100.
“Patient-reported health status is a better predictor of cardiovascular outcomes than NYHA class,” he said.
The substudy was a randomized, unblinded trial that investigated the effect of routine KCCQ-12 collection in a HF clinic. The study enrolled patients who attended the Stanford HF Clinic with a scheduled visit from August 30, 2021, to June 30, 2022. These patients were then randomized into 2 groups: usual care or KCCQ-12 assessment .
Clinicians were asked about their patients’ NYHA class, quality of life, disease trajectory, and symptom frequency, and they were asked how they perceived the administration of the KCCQ-12. These responses were then compared to the responses patients provided through their KCCQ-12 survey. Patients were also asked about their interactions with their clinicians.
Patients were also given another survey to assess their level of agreement with 8 positive statements about their clinician’s understanding of their health condition, communication, agreement on treatment goals, and the clinician-patient relationship.
Study subjects had a median age (interquartile range) of 63.9 (51.8-72.8) years, and 87.3% had a previous diagnosis of heart failure or cardiomyopathy; 53.3% had an ejection fraction greater than 50%. The mean KCCQ-12 total score was 82.
Of the 1248 patients in the PRO-HF study, 1051 patients had a visit during the substudy. The KCCQ-12 cohort included 528 patients whose KCCQ-12 scores were provided to their treating clinicians. Patients in the usual care group completed the KCCQ-12, but the results were not provided to their clinicians.
The study found that the correlation between NYHA class and patient-reported health status was stronger when clinicians scored the KCCQ-12 compared to the usual care score (r, –0.73 vs r, –0.61). A chart is presented that illustrates where clinicians classified patients according to the NYHA, with patient-reported outcomes from the usual care arm and patients who completed the KCCQ-12.
“Focusing on NYHA class 3…usual care patients were more likely, despite being classified as having class 3 symptoms, to describe very good health status with a KCCQ-12 score above 70 or very poor health status with a KCCQ-12 score less than 20, indicating greater disagreement in the usual care arm,” Sandhu said.
Patients in the KCCQ-12 group found greater concordance between clinician and patient assessment of quality of life and symptom frequency compared to patients in the usual care group, with 7 of 8 responses to the positive statements having higher odds of being concordant scores in KCCQ -12 hand.
Patients were more likely to agree that clinicians understood their symptoms if they were in the KCCQ-12 arm (95.2% vs. 89.7%; odds ratio, 2.27; 95% CI, 1.32-3 .87) compared to patients in the usual care group. Both groups reported similar quality in the therapeutic alliance and communication between clinicians.
Heart failure clinicians have also found the KCCQ-12 useful in improving consistency in history taking, accurate understanding of quality of life, focusing conversations, and tracking trends.
There were some limitations to this study. The study was single-center and unblinded, which may have influenced interactions between clinicians. The cohort was less symptomatic with a high KCCQ-12 score. Follow-up was short and it may take time for clinicians to fully implement these results in their practice.
The study concluded that collecting the KCCQ-12 can improve the accuracy of the clinician’s assessment of health status, and patients perceive a better assessment of the clinician’s health status when using the KCCQ-12. Clinicians were also found to find value in KCCQ-12 data. How this will affect clinical processes and outcomes is still being evaluated in the long term.
reference
Sandhu AT, Zheng J, Kalwani NM, et al. Early results of the patient-reported outcome measure in heart failure clinical trial (PRO-HF). Presented at: AHA 2022; Chicago, Illinois; November 5-7, 2022 Session LBS.02