Patient Health Status and Costs in Heart Failure

Abstract

Background-Although a variety of prognostic tools have been shown to predict rehospitalization and mortality in heart failure patients, their utility in assessing future costs is less clear. We assessed whether health status assessment with the Kansas City Cardiomyopathy Questionnaire (KCCQ) predicts future costs in stable heart failure outpatients with left ventricular dysfunction after myocardial infarction. Methods and Results-We evaluated 12-month cost utilization data from 1516 heart failure outpatients enrolled in the Quality-of-Life Substudy of the Eplerenone Post-Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Multivariable hierarchical models assessed whether the KCCQ (categorized as 0 to Ͻ25, 25 to Ͻ50, 50 to Ͻ75, and 75 to 100) was an independent predictor of future resource use.

Health-Related Quality of Life After Transcatheter Aortic Valve Replacement in Inoperable Patients With Severe Aortic Stenosis

“…In previous studies, changes of as little as 5 points on the KCCQ summary scale have been shown to correlate with important differences in survival and health- care costs in heart failure patients. 18,19 In our study, the mean between-group differences in the KCCQ summary score 6 and 12 months after enrollment met or exceeded the 20-point threshold considered to signify a very large improvement in heart failure status, and Ͼ75% of surviving patients had at least moderately large (10-point) improvements over baseline. Moreover, the proportion of patients who achieved an excellent outcome at 12 months (defined as surviving with at least a 20-point improvement in the KCCQ summary score) was far greater with TAVR than with standard care (absolute treatment difference, 28%; number needed to treat, 3.5).…”

“…17 The KCCQ has undergone extensive validation and has been shown to independently predict mortality and healthcare costs in heart failure populations. 18,19 Among outpatients with heart failure, small, moderate, or large clinical improvements as rated by treating physicians corresponded with changes in the KCCQ summary score of Ϸ5, 10, and 20 points, respectively. 17 Generic health status was evaluated with the Medical Outcomes Study Short-Form 12 (SF-12) Health Survey.…”

Cardiac Resynchronization Therapy for Mild Heart Failure

“…22,39 NYHA class is notoriously difficult to standardize and furthermore has been shown to be a poor predictor of future cost in patients with LV dysfunction and recent myocardial infarction. 25 However, 6-minute walk times and quality of life indicators are consistent with mild HF. The Kansas City Cardiomyopathy Questionnaire has been shown by Chan et al 25 to more accurately identify HF patients likely to be high utilizers of health resources in the future.…”

“…25 However, 6-minute walk times and quality of life indicators are consistent with mild HF. The Kansas City Cardiomyopathy Questionnaire has been shown by Chan et al 25 to more accurately identify HF patients likely to be high utilizers of health resources in the future. Utilizing more sophisticated yet accessible tools such as the Kansas City Cardiomyopathy Questionnaire instead of NYHA class might prove to hold great utility, potentially streamlining the delivery of a limited resource to patients with the most to gain, patients who, by extension, are the ones who would make CRT as economically advantageous as possible.…”

“…The incidence of the disease is estimated now at Ͼ550 000 cases per year, and the cost to treat all of these patients exceeds $33 billion in the United States alone. 24,25 Asymptomatic LV dysfunction is believed to be as common as symptomatic HF. 26,27 Clearly, the opportunity exists in this very large population of patients to offer a new, effective therapy to slow or prevent an insidious slide toward worsened quality of life and eventual death.…”