Comparable Performance of the Kansas City Cardiomyopathy Questionnaire in Patients With Heart Failure With Preserved and Reduced Ejection Fraction

Joseph, Susan; Novak, Eric; Arnold, Suzanne V.; Jones, Philip G.; Khattak, Himad; Platts, Anne; Dávila‐Román, Víctor G.; Mann, Douglas L.; Spertus, John A.

doi:10.1161/circheartfailure.113.000359

Cited by 143 publications

(138 citation statements)

References 44 publications

(48 reference statements)

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“…6–9 This instrument has been widely used in recent international HF clinical trials and has been validated in several languages. 16–22 The KCCQ is scored from 0 to 100; higher scores represent better health status.…”

Section: Methodsmentioning

confidence: 99%

Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure

Luo

Teng

Tay

et al. 2017

American Heart Journal

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Background Assessing health-related quality of life (HRQoL) in patients with heart failure (HF) are important goals of clinical care and HF research. We sought to investigate ethnic differences in perceived HRQoL and its association with mortality among patients with HF and left ventricular ejection fraction ≤35%, controlling for demographic characteristics and HF severity. Methods and results We compared 5,697 chronic HF patients of Indian (26%), White (23%), Chinese (17%), Japanese/Koreans (12%), Black (12%), and Malay (10%) ethnicities from the HF-ACTION and ASIAN-HF multinational studies using the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0–100; higher scores reflect better health status). KCCQ scores were lowest in Malay (58±22) and Chinese (60±23), intermediate in Black (64±21) and Indian (65±23), and highest in White (67±20) and Japanese or Korean patients (67±22), after adjusting for age, sex, educational status, HF severity and risk factors. Self-efficacy, which measures confidence in the ability to manage symptoms, was lower in all Asian ethnicities (especially Japanese/Koreans [60±26], Malay [66±23] and Chinese [64±28]) compared to Black (80±21) and White (82±19) patients, even after multivariable adjustment (p<0.001). In all ethnicities, KCCQ strongly predicted 1-year mortality (HR 0.45, 95% CI 0.30–0.67 for highest vs lowest quintile of KCCQ; p for interaction by ethnicity 0.101). Conclusions Overall, HRQoL is inversely and independently related to mortality in chronic HF, but is not modified by ethnicity. Nevertheless, ethnic differences exist independent of HF severity and comorbidities. These data may have important implications for future global clinical HF trials that use patient-reported outcomes as endpoints. Clinical Trial Registration NCT00047437 and NCT01633398

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Section: Methodsmentioning

confidence: 99%

Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure

Luo

Teng

Tay

et al. 2017

American Heart Journal

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“…64 Effects of nitrite on LV filling pressures will be assessed at trough nitrite concentrations (i.e. prior to study drug dose) using echocardiography (E/e' ratio, left atrial volume index and estimated pulmonary artery systolic pressure) and plasma NT-proBNP levels.…”

Section: Pathophysiology Of Hfpefmentioning

confidence: 99%

INDIE-HFpEF (Inorganic Nitrite Delivery to Improve Exercise Capacity in Heart Failure With Preserved Ejection Fraction)

Reddy

Lewis

Shah

et al. 2017

Circ: Heart Failure

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Approximately half of patients with heart failure (HF) have preserved ejection fraction (HFpEF). There is no proven treatment that improves outcome. The pathophysiology of HFpEF is complex and includes left ventricular (LV) systolic and diastolic dysfunction, pulmonary vascular disease, endothelial dysfunction, and peripheral abnormalities. Multiple lines of evidence point to impaired nitric oxide-cyclic guanosine monophosphate (NO-cGMP) bioavailability as playing a central role in each of these abnormalities. In contrast to traditional organic nitrate therapies, an alternative strategy to restore NO-cGMP signaling is via inorganic nitrite. Inorganic nitrite, previously considered to be an inert byproduct of NO metabolism, functions as an important in vivo reservoir for NO generation, particularly under hypoxic and acidemic conditions. As such, inorganic nitrite becomes most active at times of greater need for NO signaling, as during exercise when LV filling pressures and pulmonary artery pressures increase. Herein, we present the rationale and design for the Inorganic Nitrite Delivery to Improve Exercise Capacity in Heart Failure with Preserved Ejection Fraction (INDIE-HFpEF) trial, which is a multicenter, randomized, double-blind, placebo controlled crossover study assessing the effect of inhaled inorganic nitrite on peak exercise capacity, conducted in the NHLBI-sponsored Heart Failure Clinical Research Network. Clinical Trial Registration: clinicaltrials.gov; NCT02742129

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“…Each response is given an ordinal value, and scale scores are transformed into a 0 to 100 range, with higher scores indicating better HRQL. KCCQ has been validated in HF populations, including in HF-PEF, 16 and is responsive to important changes in health state. 17,18 A clinically meaningful difference in KCCQ score is established as 5 points.…”

Section: Assessment Of Quality Of Lifementioning

confidence: 99%

Impact of Spironolactone on Longitudinal Changes in Health-Related Quality of Life in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial

Lewis

Kim

Claggett

et al. 2016

Circ: Heart Failure

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Background— Heart failure (HF) with preserved ejection fraction patients have equally impaired health-related quality of life (HRQL) compared with those with HF with reduced ejection fraction, but limited studies have evaluated the impact of therapies on changes in HRQL. Methods and Results— Patients ≥50 years of age, with symptomatic HF and left ventricular ejection fraction ≥45%, were enrolled in Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) and randomized to spironolactone or placebo. Patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ), which was the primary HRQL instrument, and EQ5D visual analog scale at baseline, 4 months, 12 months, and annually thereafter. McMaster Overall Treatment Evaluation was assessed at 4 and 12 months to assess global change scores. Change scores (+SD) were calculated to determine between-group differences, and multivariable repeated-measures models were created to identify other factors associated with change scores. Paired KCCQ data were available for 91.7% of 3445 TOPCAT patients. By 4 months, the mean change in KCCQ was 7.7±16 and mean change in EQ5D visual analog scale was 4.7±16. Adjusted mean changes in KCCQ for the spironolactone group were significantly better than those for the placebo group at 4-month (1.54 better; P =0.002), 12-month (1.35 better; P =0.02), and 36-month (1.86 better; P =0.02) visits. No between-group differences in EQ5D visual analog scale change scores or McMaster Overall Treatment Evaluation were noted. Older age, obesity, current smoking, New York Heart Association class III/IV, and comorbid illnesses were associated with declines in KCCQ scores. Use of spironolactone was an independent predictor of improved KCCQ scores. Conclusions— In symptomatic HF with preserved ejection fraction patients, use of spironolactone was associated with an improvement in HF-specific HRQL. Several modifiable risk factors were associated with HRQL deterioration. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00094302.

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Comparable Performance of the Kansas City Cardiomyopathy Questionnaire in Patients With Heart Failure With Preserved and Reduced Ejection Fraction

Cited by 143 publications

References 44 publications

Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure

Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure

INDIE-HFpEF (Inorganic Nitrite Delivery to Improve Exercise Capacity in Heart Failure With Preserved Ejection Fraction)

Impact of Spironolactone on Longitudinal Changes in Health-Related Quality of Life in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial

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