Use of the Kansas City Cardiomyopathy Questionnaire for Monitoring Health Status in Patients With Aortic Stenosis

Arnold, Suzanne V.; Spertus, John A.; Lei, Yang; Allen, Keith B.; Chhatriwalla, Adnan K.; Leon, Martin B.; Smith, Craig R.; Reynolds, Matthew R.; Webb, John G.; Svensson, Lars G.; Cohen, David J.

doi:10.1161/circheartfailure.112.970053

Cited by 137 publications

(120 citation statements)

References 31 publications

(36 reference statements)

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“…Renal failure events were defined as the need for dialysis of any sort. The Kansas City Cardiomyopathy Questionnaire (KCCQ), a heart failure disease-specific health status measure, was used to assess health status (17,18). …”

Section: Methodsmentioning

confidence: 99%

Early Regression of Severe Left Ventricular Hypertrophy After Transcatheter Aortic Valve Replacement Is Associated With Decreased Hospitalizations

Lindman

Stewart

Pîbarot

et al. 2014

JACC: Cardiovascular Interventions

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124

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Objective Examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). Background LVM regression after valve replacement for aortic stenosis (AS) is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. Methods Of 2115 patients with symptomatic AS at high surgical risk receiving TAVR in the PARTNER randomized trial or continued access registry, 690 had both severe LVH (LVM index [LVMi] ³149 g/m2 men, ³122 g/m2 women) at baseline and an LVMi measurement 30 days post-TAVR. Clinical outcomes were compared for patients with greater than vs. lesser than median percent change in LVMi between baseline and 30 days using Cox proportional hazard models to evaluate event rates from 30 to 365 days. Results Compared to patients with lesser regression, patients with greater LVMi regression had a similar rate of all-cause mortality (14.1% vs. 14.3%, p=0.99), but a lower rate of rehospitalization (9.5% vs. 18.5%, HR 0.50; 95% CI, 0.32–0.78; p=0.002) and a lower rate of rehospitalizations specifically for heart failure (7.3% vs. 13.6%, p=0.01). The association with a lower rate of hospitalizations was consistent across sub-groups and remained significant after multivariable adjustment (HR 0.53; 95% CI, 0.34–0.84; p=0.007). Patients with greater LVMi regression had lower BNP (p=0.002) and a trend toward better quality of life (p=0.06) at 1 year compared to those with lesser regression. Conclusions In high-risk patients with severe AS and severe LVH undergoing TAVR, those with greater early LV mass regression had half the rate of rehospitalization over the subsequent year.

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Section: Methodsmentioning

confidence: 99%

Early Regression of Severe Left Ventricular Hypertrophy After Transcatheter Aortic Valve Replacement Is Associated With Decreased Hospitalizations

Lindman

Stewart

Pîbarot

et al. 2014

JACC: Cardiovascular Interventions

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124

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“…12,13 All tests and questionnaires were administered by trained personnel and/or physicians. Evaluations were performed within 2 weeks before the TAVR procedure and at 6-month follow-up.…”

Section: Methodsmentioning

confidence: 99%

Effect on Outcomes and Exercise Performance of Anemia in Patients With Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement

DeLarochellière

Ureña

Amat‐Santos

et al. 2015

The American Journal of Cardiology

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“…22 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 approximately 5, 10, and 20 points, respectively. The KCCQ has undergone extensive reliability and validity testing in various heart failure populations 21, 23–24 as well as in patients with severe aortic stenosis, 25 and it has been shown to predict mortality, readmission 25–26 and costs. 27 …”

Section: Methodsmentioning

confidence: 99%

How to Define a Poor Outcome After Transcatheter Aortic Valve Replacement

Arnold

Spertus

Lei

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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Background Transcatheter aortic valve replacement (TAVR) has emerged as a less invasive option for valve replacement for patients with severe aortic stenosis. Although it has been recommended that TAVR not be offered to patients who will not improve functionally or derive meaningful survival benefit from the procedure, no guidance exists on how best to identify such patients. The first step in this process is to define a poor outcome that can then be used as a foundation for subsequent case identification. We sought to evaluate potential definitions of a poor outcome after TAVR that combine both mortality and quality of life (QoL) components. Methods and Results Using data from 463 patients who underwent TAVR as part of the Placement of AoRTic TraNscathetER Valve (PARTNER) Trial, we evaluated 6-month mortality and QoL outcomes using the Kansas City Cardiomyopathy Questionnaire (KCCQ) to explore potential definitions of a poor outcome. We then compared the strengths and weaknesses of each potential definition by examining the relationship between baseline and 6-month KCCQ scores for each patient. Based on these analyses, we argue that the most appropriate definition of a poor outcome after TAVR is either (1) death, (2) KCCQ overall summary score <45, or (3) KCCQ decrease of ≥ 10 points, which best reflects a failure to achieve the therapeutic goals of TAVR. Conclusions Using empiric data on a large number of patients enrolled in the PARTNER trial, we propose a definition for poor outcome after TAVR that combines both mortality and QoL measures into a single composite endpoint. Use of this endpoint (or other similar endpoints) in future studies can facilitate development of predictive models that may be useful to identify patients who are poor candidates for TAVR and to provide such patients and their families with appropriate expectations of functional recovery after TAVR.

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Use of the Kansas City Cardiomyopathy Questionnaire for Monitoring Health Status in Patients With Aortic Stenosis

Cited by 137 publications

References 31 publications

Early Regression of Severe Left Ventricular Hypertrophy After Transcatheter Aortic Valve Replacement Is Associated With Decreased Hospitalizations

Early Regression of Severe Left Ventricular Hypertrophy After Transcatheter Aortic Valve Replacement Is Associated With Decreased Hospitalizations

Effect on Outcomes and Exercise Performance of Anemia in Patients With Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement

How to Define a Poor Outcome After Transcatheter Aortic Valve Replacement

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