Clinical InvestigationComparison Between the Kansas City Cardiomyopathy Questionnaire and New York Heart Association in Assessing Functional Capacity and Clinical Outcomes
Section snippets
Study Population
This is an observational, prospectively collected, and retrospectively analyzed study of consecutive outpatients with HF who were evaluated at a single institution. Although predominantly a population with systolic HF, it includes those with preserved ejection fraction, including diastolic dysfunction, valvular cardiomyopathy, and hypertrophic cardiomyopathy. The Knowledge Program is an innovative data capture initiative developed at the Cleveland Clinic to electronically collect health status
Study Population
A total of 432 patients meeting the inclusion criteria of completing the KCCQ and undergoing CPET within 30 days were included in this analysis. The median time of CPET relative to the office visit was 0 days (interquartile range 0–3 days). Baseline characteristics are summarized in Table 1. The mean age was 58 ± 12 years, and women accounted for 29% of patients. The predominant etiology of the cardiomyopathy was nonischemic dilated (43%), followed by ischemic (38%) in origin. The remaining 19%
Discussion
In a well characterized cohort of predominantly systolic HF outpatients, this study demonstrates good correlation between the patient-reported KCCQ and clinician-determined NYHA. Both measures correlate well with various exercise parameters. The KCCQ score provides significant incremental predictive ability over NYHA for HF outcomes. This may be related to its evaluation of patient health beyond functional limitations and symptoms, including aspects such as quality of life, social limitation,
Study Limitations
Owing to its observational nature, the present study has inherent limitations and bias. First, the inclusion criteria allowed for a time period of up to 30 days between office visit and CPET. Although this may be a source of error, given the potential for significant change in clinical status within 30 days, it should be noted that the median duration between office visit and stress testing was actually 0 days (interquartile range 0–3 days). Second, our cohort consisted mainly of patients with
Conclusion
HF management is largely directed by symptom severity, and it is essential for health care professionals to accurately determine functional limitations in their outpatients. The patient-reported KCCQ correlated well with measures of functional capacity. KCCQ provides a broader assessment of patient health compared with NYHA, offering value beyond NYHA in predicting HF outcomes. This supports the routine use of KCCQ in addition to NYHA to aid in the outpatient assessment of patients with HF in a
Disclosures
None.
Acknowledgments
The authors acknowledge the Knowledge Program Data Registry of Cleveland Clinic, Cleveland, Ohio, for providing the data used in these analyses.
References (19)
- et al.
Correlates and prognostic implication of exercise capacity in chronic congestive heart failure
Am J Cardiol
(1985) - et al.
Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure
J Am Coll Cardiol
(2000) - et al.
Association of functional and health status measures in heart failure
J Card Fail
(2006) - et al.
Health status identifies heart failure outpatients at risk for hospitalization or death
J Am Coll Cardiol
(2006) - et al.
Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome
Circulation
(1999) - et al.
Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure
Circulation
(1991) - et al.
Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO2 slope and peak VO2
Eur Heart J
(2000) - et al.
Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death
Circulation
(2002) - et al.
Development of a ventilatory classification system in patients with heart failure
Circulation
(2007)
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Stephen S. Gottlieb served as Guest Editor for this paper.
Source of Funding: This work was supported by the Karos Chair for Women's Cardiovascular Research at Cleveland Clinic.