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Identifying heart failure patients at high risk for near-term cardiovascular events with serial health status assessments.
- Source :
-
Circulation [Circulation] 2007 Apr 17; Vol. 115 (15), pp. 1975-81. Date of Electronic Publication: 2007 Apr 09. - Publication Year :
- 2007
-
Abstract
- Background: Identification of heart failure outpatients at increased risk for clinical deterioration remains a critical challenge, with few tools currently available to assist clinicians. We tested whether serial health status assessments with the Kansas City Cardiomyopathy Questionnaire (KCCQ) can identify patients at increased risk for mortality and hospitalization.<br />Methods and Results: We evaluated 1358 patients with heart failure after an acute myocardial infarction in the Eplerenone's Neurohormonal Efficacy and Survival Study, a multicenter randomized trial that included serial KCCQ assessments. Cox proportional-hazards models were used to examine whether changes in KCCQ scores during successive outpatient visits were independently associated with all-cause mortality and cardiovascular mortality or hospitalization. Change in KCCQ (deltaKCCQ) was linearly associated with all-cause mortality (hazard ratio [HR], for each 5-point decrease in deltaKCCQ, 1.11; 95% CI, 1.04 to 1.19) and the combined outcome of cardiovascular mortality or hospitalization (HR for each 5-point decrease in deltaKCCQ, 1.12; 95% CI 1.07 to 1.18). In Kaplan-Meier survival analysis, all-cause mortality among patients with deltaKCCQ of < or = -10, > -10 to < 10, and > 10 points was 26%, 16%, and 13%, respectively (P=0.008). After multivariable adjustment, the linear relationship between deltaKCCQ and both all-cause mortality and combined cardiovascular death and hospitalization persisted (HR, 1.09; 95% CI, 1.00 to 1.18; and HR, 1.11; 95% CI, 1.05 to 1.17 for each 5-point decrease in deltaKCCQ, respectively).<br />Conclusions: In heart failure outpatients, serial health status assessments with the KCCQ can identify high-risk patients and may prove useful in directing the frequency of follow-up and the intensity of treatment.
- Subjects :
- Female
Hospitalization statistics & numerical data
Humans
Male
Middle Aged
Outpatients statistics & numerical data
Predictive Value of Tests
Proportional Hazards Models
Surveys and Questionnaires
Survival Analysis
Health Status Indicators
Heart Failure diagnosis
Heart Failure mortality
Risk Assessment
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 115
- Issue :
- 15
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 17420346
- Full Text :
- https://doi.org/10.1161/CIRCULATIONAHA.106.670901