Clinical Investigation
Comparison Between the Kansas City Cardiomyopathy Questionnaire and New York Heart Association in Assessing Functional Capacity and Clinical Outcomes

https://doi.org/10.1016/j.cardfail.2016.12.002Get rights and content

Abstract

Objective

The Kansas City Cardiomyopathy Questionnaire (KCCQ) has emerged as a patient-centered heart failure–specific health status measure. It currently lacks routine and widespread use in clinical practice and trials. The purpose of this study was to examine the correlation between KCCQ and cardiopulmonary exercise testing (CPET) parameters and clinical outcomes, compared with the New York Heart Association functional classification (NYHA).

Methods and Results

We performed a single-centered observational analysis of 432 patients who presented to the Heart Failure Department, completed the KCCQ, and underwent CPET. The 1-year clinical outcome assessed was a composite of mortality, heart failure hospitalization, and need for heart transplantation or left ventricular assist device. In the KCCQ, the physical limitation domain had a correlation with peak VO2 similar to NYHA (r = 0.48; P < .001; and r = −0.48; P < .001; respectively), and slightly better correlation with ventilatory threshold (r = 0.42; P < .001; and r = −0.40; P < .001; respectively). According to model validation, the KCCQ physical limitation domain and NYHA were similar predictors of peak VO2 (r2 = 0.229; and r2 = 0.227; respectively). KCCQ predicted the specified 1-year clinical outcome (hazard ratio 0.75, 95% confidence interval 0.69–0.82; P < .001) and provided incremental predictive ability when added to a model that included NYHA, with a net reclassification index of 76.1% (P < .001).

Conclusions

KCCQ and NYHA provide similar assessment of functional capacity. KCCQ predicts 1-year clinical outcomes, providing incremental value over NYHA. These findings support its routine use in clinical care, as well as its potential to serve as a measure in clinical trials.

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.

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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.

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