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 assess symptoms in patients with more precision for clinicians.
Data presented today at the American Heart Association (AHA) Scientific Sessions offer insight into how the use of patient-reported outcomes (PRO) can help physicians better manage heart failure ( CI).
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 patient confidence in the understanding of their symptoms by their doctors.
The first results of the study, officially known as the Patient Reported Outcomes in Heart Failure Clinic trial, were presented during a late-breaking session at the conference, which opened Saturday in Chicago, in 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 symptoms related to heart failure,” said Alexander Sandhu, MD, author of the study who presented the results.
The objective of the substudy presented to the AHA was to determine whether patient-reported health status would be able to improve the accuracy of clinician assessments, since clinicians typically assess the health status of heart failure patients using the New York Heart Association (NYHA) classification. Sandhu explained that the KCCQ-12 has 4 domain scores and an overall processing score, each ranging from 0 to 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 collection of KCCQ-12 in an HF clinic. Patients who attended 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 asked how they perceived the implementation of KCCQ-12. These responses were then compared to the responses provided by the patients in their KCCQ-12 survey. Patients were also asked about their interactions with their clinicians.
Patients also received another survey to assess their level of agreement with 8 positive statements regarding their clinician’s understanding of their condition, communication, alignment of treatment goals, and clinician-patient relationship. .
People included in the trial 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 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 provided to the clinicians treating them. Patients in the usual care group completed the KCCQ-12, but the results were not reported to their clinicians.
The study found that the correlation between NYHA class and patient-reported health status was stronger when clinicians had the KCCQ-12 score compared to the usual care score (r, -0.73 vs r , -0.61). A table illustrating where clinicians categorized patients according to the NYHA was presented, along with the results of outcomes reported by patients in the usual care group and patients who completed the KCCQ-12.
“Drawing attention to NYHA Class 3…patients receiving usual care are more likely, despite being classified as having Class 3 symptoms, to describe very good health with a KCCQ- 12 greater than 70 or very poor condition with a KCCQ-12 score less than 20, indicating greater disagreement in the usual care arm,” Sandhu said.
Patients in the KCCQ-12 arm found more agreement between clinician and patient assessment of quality of life and frequency of symptoms compared to patients in the usual care arm, with 7 of 8 responding to positive statements having a higher likelihood 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% versus 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 therapeutic alliance and clinician communication.
Clinicians treating HF have also found the KCCQ-12 to be useful in improving history consistency, accurately understanding quality of life, focusing conversations, and tracking trends.
There were some limitations to this study. The trial was single center and unblinded, which may have affected interactions with clinicians. 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 findings into their practice.
The study concluded that collecting the KCCQ-12 can improve the accuracy of the clinician’s assessment of health status and that patients perceive a better assessment of the clinician’s health status when using the KCCQ. -12. Clinicians have also found value in KCCQ-12 data. How this will affect clinical processes and outcomes is still being evaluated over the long term.
Sandhu AT, Zheng J, Kalwani NM, et al. First results from the PRO-HF trial (Measuring Patient-Reported Outcomes in the Heart Failure Clinic). Presented at: AHA 2022; Chicago, Ill.; November 5-7, 2022. Session LBS.02