KCCQ-12 Improved Accuracy of Health Status Assessment in Heart Failure Clinic

Data presented today at the American Heart Association (AHA) Scientific Sessions offer a look at how 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' health status assessments and patients’ confidence in how well their doctors understood their symptoms.

Early results from the study, formally known as the Patient Reported Outcomes in Heart Failure Clinic trial, were presented in a late-breaking session at the conference, which opened Saturday in Chicago, Illinois, and concludes Monday.

Results were simultaneously published 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 symptom frequency relating to heart failure,” said Alexander Sandhu, MD, a study author who presented the findings.

The aim of the substudy presented at AHA was to determine if patient-reported health status would be able to improve the accuracy of clinician assessments, as clinicians typically assess the health status of patients with heart failure by using the New York Heart Association (NYHA) class. Sandhu explained that the KCCQ-12 had 4 domain scores and an overall 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, nonblinded trial that studied the effect of routine KCCQ-12 collection in a HF clinic. Patients who went to the Stanford HF clinic with a scheduled visit from August 30, 2021, to June 30, 2022, were enrolled in the study. 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 about how they perceived the implementation of the KCCQ-12. These answers were then compared with the answers that 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 regarding their clinician’s understanding of their health status, communication, alignment of treatment goals, and the relationship between the clinician and patient.

Those included in the trial had a median (interquartile range) age of 63.9 (51.8-72.8) years, and 87.3% had a prior heart failure or cardiomyopathy diagnosis; 53.3% had an ejection fraction greater than 50%. The median KCCQ-12 summary score was 82.

Of the 1248 patients in the PRO-HF trial, 1051 patients attended a visit during the substudy. The KCCQ-12 arm included 528 patients whose KCCQ-12 results were given to the clinicians treating them. Patients in the usual care arm completed the KCCQ-12 but the results were not given to their clinicians.

The study found that the correlation between the NYHA class and patient-reported health status was stronger when clinicians had the KCCQ-12 score compared with the usual care score (r, –0.73 vs r, –0.61). A chart that illustrated where clinicians classified the patients according to the NYHA was presented, with the results of the patient reported outcomes of the usual care arm and the patients who completed the KCCQ-12.

“Directing attention to NYHA Class 3…patients with usual care are more likely, despite being classified as having Class 3 symptoms, to describe very good health status with a KCCQ-12 score of over 70 or very poor status with a KCCQ-12 score of less than 20, indicating greater disagreement in the usual care arm,” said Sandhu.

Patients in the KCCQ-12 arm found more concordance between clinician and patient assessment of quality of life and symptom frequency compared with patients in the usual care arm, with 7 of the 8 responses to the positive statements having higher odds of concordant assessments in the KCCQ-12 arm.

Patients more frequently agreed 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 with patients in the usual care group. Both groups reported similar quality in therapeutic alliance and clinician communication.

Clinicians treating HF also found that KCCQ-12 was useful in improving consistency in history taking, accurately understanding quality of life, focusing conversations, and tracking trends.

There were some limitations to this study. The trial was single center and nonblinded, which may have affected clinician interactions. The cohort was less symptomatic with a high KCCQ-12 score. The follow-up was short, and it may take time for clinicians to be able to fully implement these results into their practice.

The study concluded that KCCQ-12 collection can improve the accuracy of clinician health status assessment and patients perceive better clinician health status assessment when using the KCCQ-12. Clinicians were also found to find value in the KCCQ-12 data. How this will affect clinical processes and outcomes is still being evaluated long-term.

Reference

Sandhu AT, Zheng J, Kalwani NM, et al. Early results of the patient-reported outcome measurement in heart failure clinic (PRO-HF) trial. Presented at: AHA 2022; Chicago, IL; November 5-7, 2022. Session LBS.02