Skip to main content
SpringerLink
Log in

Should patients perception of health status be integrated in the prognostic assessment of heart failure patients? A prospective study

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Health status measures are widely recognized as providing substantial information on heart failure (HF) patients conditions and prognosis, but they are not included in the data routinely collected. The aim of the study was to assess in a prospective cohort of HF patients, the independent prognostic value of health status measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) on mortality and hospital admissions over a period of 3.3 years.

Methods

Eighty-three Italian cardiology centers included all their patients randomized in the GISSI-HF trial in an observational outcome study where the KCCQ was administered at baseline by nursing personnel. A total of 1,465 outpatients with chronic HF, NYHA classes II–III, with coronary and non-coronary etiology were included and followed up for mortality and admissions.

Results

The effect of baseline perception of health status on mortality and all causes hospitalizations was explored with Cox proportional hazard regression models progressively adjusted for several variables. When stratified according to pre-defined criteria, lower values of KCCQ scores (<25) as compared with best scores (>75) were predictive of mortality (1.85; 95 % CI 1.16–2.95) but not of hospital admissions risk (p for trend significant for mortality with decreasing scores). Lower KCCQ scores discriminated the risk also within the NYHA II and III classes.

Conclusions

KCCQ scores provide a clinically important and statistically robust independent prognostic information on hard outcome endpoints of HF patients on the top of the clinical scores. It is suggested that KCCQ should become a routine component of the patients care and of prognostic profiles.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rumsfeld, J. S. (2002). Health status and clinical practice: When will they meet? Circulation, 106(1), 5–7.

    Article  PubMed  Google Scholar 

  2. Spertus, J. A. (2008). Evolving applications for patient-centered health status measures. Circulation, 118(20), 2103–2110.

    Article  PubMed  Google Scholar 

  3. Garratt, A. (2009). Patient reported outcome measures in trials. British Medical Journal, 338, a2597.

    Article  PubMed  Google Scholar 

  4. Greenhalgh, J. (2009). The application of PROs in clinical practice. What are they, do they work and why? Quality of Life Research, 18(1), 115–123.

    Article  PubMed  Google Scholar 

  5. Konstam, V., Salem, D., Pouleur, H., Kostis, J., Gorkin, L., Shumaker, S., et al. (1996). Baseline quality of life as a predictor of mortality and hospitalization in 5.025 patients with congestive heart failure. SOLVD Investigations. Studies of Left Ventricular Dysfunction Investigators. American Journal of Cardiology, 78(8), 890–895.

    Article  CAS  PubMed  Google Scholar 

  6. Soto, G. E., Jones, P., Weintraub, W. S., Krumholz, H. M., & Spertus, J. A. (2004). Prognostic value of health status in patients with heart failure after acute myocardial infarction. Circulation, 110(5), 546–551.

    Article  PubMed  Google Scholar 

  7. Rodríguez-Artalejo, F., Guallar-Castillón, P., Pascual, C. R., Otero, C. M., Montes, A. O., Garcia, A. N., et al. (2005). Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Archives of Internal Medicine, 165(11), 1274–1279.

    Article  PubMed  Google Scholar 

  8. Heidenreich, P. A., Spertus, J. A., Jones, P. G., Weintraub, W. S., Rumsfeld, J. S., Rathore, S. S., et al. (2006). Health status identifies heart failure patients at risk for hospitalization or death. Journal of American College of Cardiology, 47(4), 752–756.

    Article  Google Scholar 

  9. Sullivan, M. D., Wayne, W. C., Russo, J. E., Crane, B., & Spertus, J. A. (2007). Summary health status measures in advanced heart failure: relationship to clinical variables and outcome. Journal of Cardiac Failure, 13(7), 560–568.

    Article  PubMed  Google Scholar 

  10. Chan, P. S., Soto, G., Jones, P. G., Brahmajee, K., Nallamothu, K., Zhang, Z., et al. (2009). Patient health status and costs in heart failure. Insights from the Eplenorone post-acute myocardial infarction Heart Failure Efficacy and Survival Study (EPHESUS). Circulation, 119(3), 398–407.

    Article  PubMed  Google Scholar 

  11. Mommersteeg, P. M. C., Denollet, J., Spertus, J., & Pedersen, S. S. (2009). Health status as a risk factor in cardiovascular disease: A systematic review of current evidences. American Heart Journal, 157(2), 201–218.

    Article  Google Scholar 

  12. Parissis, J. T., Nikolau, M., Farmakis, D., Paraskevaidis, I. A., Bistola, V., Venetsanou, K., et al. (2009). Self assessment of health status is associated with inflammatory activation and predicts long term outcomes in chronic heart failure. Heart Failure Reviews, 11(4), 163–169.

    Google Scholar 

  13. Garin, O., Ferrer, M., Pont, A., Rué, M., Kotzeva, A., Wiklund, I., et al. (2009). Disease specific health-related quality of life questionnaires for heart failure: A systematic review and meta-analyses. Quality of Life Research, 18(1), 71–85.

    Article  PubMed  Google Scholar 

  14. Investigators, G. I. S. S. I.-H. F., Tavazzi, L., Maggioni, A. P., Marchioli, R., Barlera, S., Franzosi, M. G., et al. (2008). Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): A randomised, double-blind, placebo-controlled trial. The Lancet, 372(9645), 1223–1230.

    Article  Google Scholar 

  15. Miani, D., Rozbowsky, P., Gregori, D., Pilotto, L., Albanese, M. C., Fresco, C., et al. (2003). The Kansas City Cardiomyopathy Questionnaire: Italian translation and validation. Italian Heart Journal, 4(9), 620–626.

    PubMed  Google Scholar 

  16. Green, C. P., Porter, C. B., Bresnahan, D. R., & Spertus, J. A. (2000). Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: A new health status measure for heart failure. Journal of the American College of Cardiology, 35(5), 1245–1255.

    Article  CAS  PubMed  Google Scholar 

  17. Spertus, J., Peterson, E., Conard, M. W., Heidenreich, P. A., Krumholz, H. M., Jones, P., et al. (2005). Monitoring clinical changes in patients with heart failure: A comparison of methods. American Heart Journal, 150(4), 707–715.

    Article  PubMed  Google Scholar 

  18. Tavazzi, L., Tognoni, G., Franzosi, M. G., Latini, R., Maggioni, A. P. M., Marchioli, R., et al. (2004). Rationale and design of the GISSI heart failure trial: A large trial to assess the effects of n-3 polyunsaturated fatty acids and rosuvastatin in symptomatic congestive heart failure. The European Journal of Heart Failure, 6(5), 635–641.

    Article  CAS  Google Scholar 

  19. Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.

    Google Scholar 

  20. Ghali, W. A., Quan, H., Brant, R., van Melle, G., Norris, C. M., Faris, P. D., et al. (2001). Comparison of 2 methods for calculating adjusted survival curves from proportional hazard models. Journal of the American Medical Association, 286(12), 1494–1497.

    Article  CAS  PubMed  Google Scholar 

  21. Kosiborod, M., Soto, G. E., Jones, P. G., Krumholz, H. M., Weintraub, W. S., Deedwania, P., et al. (2007). Identifying heart failure patients at high risk for near term cardiovascular events with serial health status assessments. Circulation, 115(15), 1975–1981.

    Article  PubMed  Google Scholar 

  22. Raphael, C., Briscoe, C., Davies, J., Ian Whinnett, Z., Mainsty, C., Sutton, R., et al. (2007). Limitations of the New York Heart Association functional classification system and self reported walking distances in chronic heart failure. Heart, 93(4), 476–482.

    Article  PubMed  Google Scholar 

  23. Tengs, T. O., & Wallace, A. (2000). One thousands health related quality of life estimates. Medical Care, 38(6), 583–637.

    Article  CAS  PubMed  Google Scholar 

  24. Rahimi, K., Malholtra, A., Banning, A. P., & Jenkinson, C. (2010). Outcome selection and role of patients reported outcomes in contemporary cardiovascular trials: Systematic review. BMJ, 314, c5750. doi:10.1136/bmj.c507.

    Google Scholar 

  25. Guyatt, G. H., Oxman, A. D., Kunz, R., Vist, J. E., Falk-Ytter, Y., & Schünemann, H. J. (2008). What is quality of evidence and why is it important to clinicians? British Medical Journal, 336(7650), 995–998.

    Article  PubMed  Google Scholar 

  26. McAlister, F. A., Stewart, S., Ferrua, S., & McMurray, J. J. (2004). Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials. Journal of the American College of Cardiology, 44(4), 810–819.

    PubMed  Google Scholar 

  27. Investigators, Gesica. (2005). Randomised trial of telephone intervention in chronic heart failure: DIAL trial. British Medical Journal, 331(7514), 425–429.

    Article  Google Scholar 

  28. Ferrante, D., Varini, S., Macchia, A., Soifer, S., Badra, R., Nul, D., et al. (2010). Long-term results after a telephone interview intervention in chronic heart failure. Journal of the American College of Cardiology, 56(5), 372–378.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The QDF is a companion study of the GISSI-HF trial, promoted and coordinated by ANMCO (Associazione Nazionale Medici Cardiologi Ospedalieri), Mario Negri Institute and Mario Negri Sud Consortium, S. Maria Imbaro (CH). Steering Committee: Luigi Tavazzi (Chairman), Gianni Tognoni (Co-Chairman), Maria Grazia Franzosi, Roberto Latini, Aldo P. Maggioni, Roberto Marchioli, Gian Luigi Nicolosi and Maurizio Porcu. We are grateful to Judith Baggott for language assistance.

Conflict of interests

All Authors declare they have no competing interests.

Author information

Authors and Affiliations

  1. IRCCS - Mario Negri Pharmacological Research Institute and Turin University, Via La Masa 19, 20156, Milan, Italy

    Paola Di Giulio

Authors
  1. Paola Di Giulio
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Network of Nurses of GISSI-HF

Corresponding author

Correspondence to Paola Di Giulio.

Appendix

Appendix

Network of Nurses of GISSI-HF

Steering committee

Paola Di Giulio, RN, MSc (IRCCS-Istituto Mario Negri and Turin University), Maria Grazia Danesi, RN (Ospedale di San Bonifacio VR), Anna Iadevaio, RN (Ospedale S. Luigi, Orbassano), Lorena Partemi, RN (Ospedale di Ascoli Piceno), Daniela Miani, MD (Ospedale S. Maria della Misericordia, Udine), Vito Lepore, MD (Consorzio Mario Negri Sud, S. Maria Imbaro),  Luigi Tavazzi, MD (GVM Hospitals of Care and Research, Cotignola), Gianni Tognoni, MD (Consorzio Mario Negri Sud, S. Maria Imbaro)

Database management and statistics

Roberto Marchioli, Marco Scarano and Rosa Maria Marfisi (Consorzio Mario Negri Sud, S. Maria Imbaro)

Secretariat

Carla Pera and Barbara Ferri (coordination), (Consorzio Mario Negri Sud, S. Maria Imbaro)

Participating centres and investigators

Agordo (BL), Valeria Rosson, Carmen Serafini; Acqui Terme (AL), Maria Teresa Zunino; Ascoli Piceno, Lorena Partemi, Maria Luigia Falleroni, Luciano Moretti; Asti, Liliana Porta; Bari-Carbonara (BA), Antonia Santorsola, Teresa Tenerelli; Bentivoglio (BO), Beatrice Bertoncelli, Graziana Mengoli; Bologna (S. Orsola), Maddalena Stagnitto, Giovanni M.Puddu; Bovolone (VR), Eleonora Masini, A. Pasini, S. Boni; Borgomanero (NO), Elena Valsesia; Bussolengo (VR), Giovanna Cornacini; Cagliari (Ospedale Marino), Daniela Melis, Antonella Mulana; Catanzaro (Policlinico), Antonio Giurlanda; Catanzaro (Pugliese), Maria Fava; Carrara (MS), Patrizia Bellini, Sandro Vallucci; Castellammare di Stabia (NA), Aniello Cuomo; Cassano delle Murge (BA), Saba Campanale; Castiglione delle Stiviere (MN), Greta Bonatti; Cerignola (FG), Teresa Bianco; Città di Castello (PG), Valeria Milli; Colleferro (RM), Luigina Antonelli; Conegliano Veneto (TV), Lauretta Fanin, Laura Faiola; Cosenza, Rosa Stefanizzi; Cremona, Miriam Mariani; Empoli (FI), Antonella Rossi; Fidenza (PR), Sandra Teresa Regnani, Federica Loreni; Frascati (RM), Rosaria Cianfrocca; Genova-Sestri Ponente (GE), Alessandra Pisani, Viviana Faraolfi; Gorizia, Patrizia Ponzalli, Tatiana Savli; Lagonegro (PZ), Mario Cresci; Legnano (VR), Stefania Guardalben, BarbaraBelluzzo; Lido di Camaiore (LU), Rossana Ruberti; Martina Franca (TA), Maria Zizzi; Mestre (VE),Caterina Tonda; Milano (Niguarda), Maria GraziaCadrobbi, Rossella Gilardi; Milazzo (ME), Antonino Mondì, Antonio Costa; Mirano (VE), Sabrina Milan, Alessandra Zottarelli; Moncalieri (TO), Barbara Parodi; Monza (Policlinico), Nadia Sartorio, Barbara Rossin; Monza (S. Gerardo), Antonella Santi, Paola Cagnan; Mormanno (CS), Elvio Maradei, Antonella Cauteruccio,  Carmine Carpino;  Napoli (Fondazione Pascale), Rosaria Addeo; Napoli (Cardarelli), Alessandra Izzo; Napoli (Federico II), Giampiero Amendola, Pasquale Perrone Filardi,  Nicosia (EN), Arcangela Mancuso Prizzitano, Grazia Maria Piluso; Orbassano (TO), Anna Lina Iadevaio; Palermo (Villa Sofia), Maria Teresa Cinà, Vincenzo Cirrincione;  Palermo (Ospedale Ingrassia), Santo Gumina; Palmanova (UD), Giancarlo Codato; Paola (CS), Francesca Raimondo; Passirana-Rho (MI), Maria Grazia Cappiello; Passignana sul Trasimeno, Francesca Creta; Pavia, Milena Barbieri; Penne (PE), Lia Chiarella, Liliana Abbondio; Pieve di Cadore (BL), Maurizia Piccin; Ragusa, Vittoria Scillone; Reggio Calabria, Giovanni Cutrupi, Albarosa Ruggeri;  Rogliano (CS), Giuliana Sicilia, Antonio Provenzano;  Rieti, Paolo Marcari; Rimini, Stefania Ricci, Ersilia Pazzagli, Monica La Grotteria; Rivolta d’Adda (CR), Rosella Orsini; Roma (Campus Biomedico), Luisella Leandri; Roma (S. Eugenio), Nicola Antonio Vetere; Rovigo, Elisa Braggion; Saluzzo (CN), Sofia Giordanino, Sandra Armando; San Bonifacio (VR), Elide Zampieri, Maria Cristina Danese, Arianna Valentini; Sassuolo (MO), Maria Grazia Ferrante; Scilla (RC), Caterina Santacroce; Scorrano (LE), Ivana Crocetti; Somma Lombardo (VA), Franca Macchi, Massimiliana Bernacchi; Sondalo (SO), Dina Pini; Soriano Calabro (VV), Marianna Varì, Maria Lucente; Sorrento (NA), Francesco Scaramastra; Torino (Valdese), Sabine Reichardt; Torino (Gradenigo), Sergio Gabasio,  Cristina Zocchi;  Trento (TN) (Villa Bianca), Monika Studnika, Ewa Buczowska; Treviso (TV), Maria Cescon, Daniela Lazzari, Antonio Prizzon; Udine (S. Maria della Misericordia), Paola De Biaggio; Vasto (CH), Concetta Buda; Venosa (PZ), Valentino Mastrangelo, Marisa Avigliano; Verona (Osp. Maggiore), Lucia Dell’Aquila; Veruno (NO), Elena Bonanomi, Alessandro Mezzani; Varese (AO Universitaria), Franca Porrini; Vigevano (PV), Giuseppina Girardi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Network of Nurses of GISSI-HF., Di Giulio, P. Should patients perception of health status be integrated in the prognostic assessment of heart failure patients? A prospective study. Qual Life Res 23, 49–56 (2014). https://doi.org/10.1007/s11136-013-0468-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-013-0468-8

Keywords

Search

Navigation