Quality of life in men and women with heart failure: association with outcome, and comparison of the Kansas City Cardiomyopathy Questionnaire and the EuroQol 5 dimensions questionnaire

ObjectivesTo gather insights on the disease experience of patients with heart failure (HF) with reduced ejection fraction (HFrEF), and assess how patients’ experiences and narratives related to the disease complement data collected through standardised patient-reported outcome measures (PROMs). Also, to explore new ways of evaluating the burden experienced by patients and caregivers.DesignObservational, descriptive, multicentre, cross-sectional, mixed-methods study.SettingSecondary care, patient’s homes.ParticipantsTwenty patients with HFrEF (New York Heart Association (NYHA) classification I–III) aged 38–85 years.MeasuresPROMs EuroQoL 5D-5L (EQ-5D-5L) and Kansas City Cardiomyopathy Questionnaire and patient interview and observation.ResultsA total of 20 patients with HFrEF participated in the study. The patients’ mean (SD) age was 72.5 (11.4) years, 65% were male and were classified inNYHA functional classes I (n=4), II (n=7) and III (n=9). The study showed a strong impact of HF in the patients’ quality of life (QoL) and disease experience, as revealed by the standardised PROMs (EQ-5D-5L global index=0.64 (0.36); Kansas City Cardiomyopathy Questionnaire total symptom score=71.56 (20.55)) and the in-depth interviews. Patients and caregivers often disagreed describing and evaluating perceived QoL, as patients downplayed their limitations and caregivers overemphasised the poor QoL of the patients. Patients related current QoL to distant life experiences or to critical moments in their disease, such as hospitalisations. Anxiety over the disease progression is apparent in both patients and caregivers, suggesting that caregiver-specific tools should be developed.ConclusionsPROMs are an effective way of assessing symptoms over the most recent time period. However, especially in chronic diseases such as HFrEF, PROM scores could be complemented with additional tools to gain a better understanding of the patient’s status. New PROMs designed to evaluate and compare specific points in the life of the patient could be clinically more useful to assess changes in health status.

Download Full-text

Habits Heart App for Patient Engagement in Heart Failure Management: Pilot Feasibility Randomized Trial

JMIR mhealth and uhealth ◽

10.2196/19465 ◽

2021 ◽

Vol 9 (1) ◽

pp. e19465

Author(s):

Kevin S Wei ◽

Nasrien E Ibrahim ◽

Ashok A Kumar ◽

Sidhant Jena ◽

Veronica Chew ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Kansas City ◽

Intervention Group ◽

Heart Failure Management ◽

Knowledge Test ◽

Kansas City Cardiomyopathy Questionnaire ◽

Education Material

Background Due to the complexity and chronicity of heart failure, engaging yet simple patient self-management tools are needed. Objective This study aimed to assess the feasibility and patient engagement with a smartphone app designed for heart failure. Methods Patients with heart failure were randomized to intervention (smartphone with the Habits Heart App installed and Bluetooth-linked scale) or control (paper education material) groups. All intervention group patients were interviewed and monitored closely for app feasibility while receiving standard of care heart failure management by cardiologists. The Atlanta Heart Failure Knowledge Test, a quality of life survey (Kansas City Cardiomyopathy Questionnaire), and weight were assessed at baseline and final visits. Results Patients (N=28 patients; intervention: n=15; control: n=13) with heart failure (with reduced ejection fraction: 15/28, 54%; male: 20/28, 71%, female: 8/28, 29%; median age 63 years) were enrolled, and 82% of patients (N=23; intervention: 12/15, 80%; control: 11/13, 85%) completed both baseline and final visits (median follow up 60 days). In the intervention group, 2 out of the 12 patients who completed the study did not use the app after study onboarding due to illnesses and hospitalizations. Of the remaining 10 patients who used the app, 5 patients logged ≥1 interaction with the app per day on average, and 2 patients logged an interaction with the app every other day on average. The intervention group averaged 403 screen views (per patient) in 56 distinct sessions, 5-minute session durations, and 22 weight entries per patient. There was a direct correlation between duration of app use and improvement in heart failure knowledge (Atlanta Heart Failure Knowledge Test score; ρ=0.59, P=.04) and quality of life (Kansas City Cardiomyopathy Questionnaire score; ρ=0.63, P=.03). The correlation between app use and weight change was ρ=–0.40 (P=.19). Only 1 out of 11 patients in the control group retained education material by the follow-up visit. Conclusions The Habits Heart App with a Bluetooth-linked scale is a feasible way to engage patients in heart failure management, and barriers to app engagement were identified. A larger multicenter study may be warranted to evaluate the effectiveness of the app. Trial Registration ClinicalTrials.gov NCT03238729; http://clinicaltrials.gov/ct2/show/NCT03238729

Download Full-text

Habits Heart App for Patient Engagement in Heart Failure Management: Pilot Feasibility Randomized Trial (Preprint)

10.2196/preprints.19465 ◽

2020 ◽

Author(s):

Kevin S Wei ◽

Nasrien E Ibrahim ◽

Ashok A Kumar ◽

Sidhant Jena ◽

Veronica Chew ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Kansas City ◽

Intervention Group ◽

Heart Failure Management ◽

Knowledge Test ◽

Kansas City Cardiomyopathy Questionnaire ◽

Education Material

BACKGROUND Due to the complexity and chronicity of heart failure, engaging yet simple patient self-management tools are needed. OBJECTIVE This study aimed to assess the feasibility and patient engagement with a smartphone app designed for heart failure. METHODS Patients with heart failure were randomized to intervention (smartphone with the Habits Heart App installed and Bluetooth-linked scale) or control (paper education material) groups. All intervention group patients were interviewed and monitored closely for app feasibility while receiving standard of care heart failure management by cardiologists. The Atlanta Heart Failure Knowledge Test, a quality of life survey (Kansas City Cardiomyopathy Questionnaire), and weight were assessed at baseline and final visits. RESULTS Patients (N=28 patients; intervention: n=15; control: n=13) with heart failure (with reduced ejection fraction: 15/28, 54%; male: 20/28, 71%, female: 8/28, 29%; median age 63 years) were enrolled, and 82% of patients (N=23; intervention: 12/15, 80%; control: 11/13, 85%) completed both baseline and final visits (median follow up 60 days). In the intervention group, 2 out of the 12 patients who completed the study did not use the app after study onboarding due to illnesses and hospitalizations. Of the remaining 10 patients who used the app, 5 patients logged ≥1 interaction with the app per day on average, and 2 patients logged an interaction with the app every other day on average. The intervention group averaged 403 screen views (per patient) in 56 distinct sessions, 5-minute session durations, and 22 weight entries per patient. There was a direct correlation between duration of app use and improvement in heart failure knowledge (Atlanta Heart Failure Knowledge Test score; ρ=0.59, P=.04) and quality of life (Kansas City Cardiomyopathy Questionnaire score; ρ=0.63, P=.03). The correlation between app use and weight change was ρ=–0.40 (P=.19). Only 1 out of 11 patients in the control group retained education material by the follow-up visit. CONCLUSIONS The Habits Heart App with a Bluetooth-linked scale is a feasible way to engage patients in heart failure management, and barriers to app engagement were identified. A larger multicenter study may be warranted to evaluate the effectiveness of the app. CLINICALTRIAL ClinicalTrials.gov NCT03238729; http://clinicaltrials.gov/ct2/show/NCT03238729

Download Full-text

Abstract P216: The Utility of Specific Measure for Heart Failure Patient in Web-Based Management: Reliability of Kansas City Cardiomyopathy Questionnaire

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap216 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Ankur Gupta ◽

Abdul Kashem ◽

Jorge Gonzalez ◽

Mohamad Alkhouli ◽

Carol Homko ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Disease Management ◽

Communication System ◽

Kansas City ◽

Control Group ◽

Specific Measure ◽

Web Based ◽

Kansas City Cardiomyopathy Questionnaire

[Background] Internet-based disease management program is known to reduce heart failure (HF) patients' re-hospitalization. Health-related quality of life (QoL) is often omitted in the web-based management of HF patients. We explored whether Kansas city cardiomyopathy questionnaire (KCCQ) can correlate QoL among HF patients while using web-based telemedicine communication system. [Method] 48 HF patients >50 years of age were enrolled into a clinical trial of telemedicine communication system for 12 month. KCCQ was given to the HF patients at the beginning and end of the study at 12 month. [Results] Mean age was 53.2; 72.2% were male; 38.9% were African-Americans; and the mean New York Heart Association class was 2.3. 50% HF patients used telemedicine and 50% served as control. KCCQ symptom stability was reduced in control patients when compared with web-communicated patients (C-28.1%; Web-32.0%; p=0.12). Overall quality of life was reduced in both group and higher in control group (16.3% vs. 2.2%; p=0.02). Overall clinical summary was improved in web-communicated patients (↑0.64% vs. ↓3.47%; p=0.01). [Conclsuion] These cross-sectional data highlight the potential utility of specific measure for HF patients in web-based communication system and disease management. KCCQ has significance of social and behavioral factors in HF-specific QoL.

Download Full-text

MO131THE SHRUNKEN PORE SYNDROME IS ASSOCIATED WITH POOR PROGNOSIS AND LOWER QUALITY OF LIFE IN HEART FAILURE PATIENTS- THE HARVEST-MALMÖ STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.009 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Liana Xhakollari ◽

Anders Grubb ◽

Amra Jujic ◽

Erasmus Bachus ◽

Peter M Nilsson ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Poor Prognosis ◽

Kansas City ◽

Cox Regression ◽

Cardiorenal Syndrome ◽

Risk Of Death ◽

Increased Risk ◽

Health Related Qol

Abstract Background and Aims The cardiorenal syndrome was studied in heart failure (HF) patients with respect to the “Shrunken pore syndrome” (SPS) that is characterized by a difference in renal filtration between cystatin C and creatinine, resulting in a low eGFRcystatin C/eGFRcreatinine-ratio. Method 373 patients hospitalized for HF were retrieved from the HeARt and brain failure inVESTigation trial (HARVEST-Malmö). We used CKD-EPI formulas for estimated glomerular filtration rate (eGFR). Presence of SPS was defined as eGFRcystatinC ≤60% of eGFRcreatinine. In Cox regression multivariate models, associations between SPS, risk of death and risk of 30-day re-hospitalization were studied. Associations between SPS and impaired quality of life (QoL) were studied using multivariate logistic regressions. Results SPS was associated with all-cause mortality (124 events; hazard ratio (HR) 2.35; confidence interval (CI95%) 1.17-4.71; p=0.016 and with 30-day re-hospitalization (70 events; HR 1.82; CI95% 1.04-3.18; p=0.036). Analyses of QoL, based on a Kansas City Cardiomyopathy Questionnaire overall score <50, revealed that SPS was associated with increased risk of low health-related QoL (odds ratios (OR) 2.15 (CI95% 1.03-4.49; p=0.042). Conclusion The results of this observational study show for the first time an association between SPS and poor prognosis in HF. Further studies are needed to confirm the results in HF cohorts and experimental settings to identify pathophysiological mechanisms.

Download Full-text

Quality of life status determinants in hypertrophic cardiomyopathy as evaluated by the Kansas City Cardiomyopathy Questionnaire

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01604-9 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Razvan Capota ◽

Sebastian Militaru ◽

Alin Alexandru Ionescu ◽

Monica Rosca ◽

Cristian Baicus ◽

...

Keyword(s):

Quality Of Life ◽

Hypertrophic Cardiomyopathy ◽

Pulmonary Artery ◽

Kansas City ◽

Nyha Class ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Kansas City Cardiomyopathy Questionnaire ◽

Health Related

Abstract Purpose The present study evaluated how heart failure (HF) negatively impacts health-related quality of life (HRQoL) in hypertrophic cardiomyopathy (HCM) patients and explored the major clinical determinants associated with HRQoL impairment in this population. Methods This was a cross-sectional single-center study of health-related HRQoL that included 91 consecutive patients with HCM. Evaluation was performed based on a comprehensive protocol that included the recommended diagnostic studies, as well as administration of the translated validated version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) (CV Outcomes Inc) as a health status measure. Results The cohort included 52 (57%) males, median age 58 (20–85) years. The median global KCCQ score was 67 (12.5–100) corresponding to a moderate impairment in HRQoL. There was an inverse correlation between the median global KCCQ score and NYHA class (Kendall’s tau b coefficient r − 0.33, p = 0.001). Patients with pulmonary hypertension (PHT), defined as resting pulmonary artery systolic pressure of ≥ 45 mmHg, presented a significantly worse HRQoL as compared to those without PHT (median KCCQ score 56.2 vs 77.5, p = 0.013). The KCCQ score mildly correlated with age (r − 0.18, p = 0.014), history of syncope (r − 0.18, p = 0.045), estimated glomerular filtration rate (eGFR) (r 0.31, p < 0.001), plasmatic creatinine (r − 0.18, p = 0.017) and urea levels (r − 0.27, p < 0.001), left ventricular (LV) end-systolic dimensions (r − 0.18, p = 0.014), maximal provoked intraventricular gradient (r 0.20, p = 0.039), LV ejection fraction (r 0.15, p = 0.04), average E/e′ (r − 0.16, p = 0.039), pulmonary acceleration time (r 0.21, p = 0.007), pulmonary artery systolic pressure (r − 0.20, p = 0.016). In ordinal regression, the independent predictors of HRQoL were NYHA class and eGFR. Conclusions Patients with HCM and HF present a moderate degree of alteration in HRQoL. This is especially true for patients with PHT and more severe functional impairment. Renal failure and NYHA class are potential markers of HRQoL in clinical practice.

Download Full-text

Exercise and Cognitive Training Intervention Improves Self-Care, Quality of Life and Functional Capacity in Persons With Heart Failure

Journal of Applied Gerontology ◽

10.1177/0733464820964338 ◽

2020 ◽

pp. 073346482096433

Author(s):

Rebecca A. Gary ◽

Sudeshna Paul ◽

Elizabeth Corwin ◽

Brittany Butts ◽

Andrew H. Miller ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Cognitive Training ◽

Functional Capacity ◽

Kansas City ◽

Self Care ◽

Optimal Dose ◽

Care Quality ◽

Home Based

This study evaluated a 12-week, home-based combined aerobic exercise (walking) and computerized cognitive training (EX/CCT) program on heart failure (HF) self-care behaviors (Self-care of HF Index [SCHFI]), disease specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]), and functional capacity (6-minute walk distance) compared to exercise only (EX) or a usual care attention control (AC) stretching and flexibility program. Participants ( N = 69) were older, predominately female (54%) and African American (55%). There was significant improvement in self-care management, F(2, 13) = 5.7, p < .016; KCCQ physical limitation subscale, F(2, 52) = 3.4, p < .039; and functional capacity (336 ± 18 vs 388 ± 20 m, p < .05) among the EX/CCT participants. The underlying mechanisms that EX and CCT targets and the optimal dose that leads to improved outcomes are needed to design effective interventions for this rapidly growing population.

Download Full-text

Abstract 27: Impact of Telemonitoring on Health Status in Patients with Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a27 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Natalie Jayaram ◽

Harlan M Krumholz ◽

Sarwat I Chaudhry ◽

Jennifer Mattera ◽

Fengming Tang ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Health Status ◽

Usual Care ◽

Primary Endpoint ◽

Kansas City ◽

Summary Score ◽

Care Group ◽

Patients With Heart Failure

Background: Although telemonitoring in patients with heart failure is not effective in reducing mortality or hospitalizations, less is known regarding its effect on patients’ health status, their symptoms, functioning and quality of life. Methods: The TeleHF study randomized 1,653 patients with recent heart failure hospitalization to telephonic monitoring (n=826) or usual care (n=827). Patients in the telemonitoring arm phoned in daily and responded to a series of automated questions regarding their symptoms and daily weight. Health status information, using the Kansas City Cardiomyopathy Questionnaire (KCCQ), was collected at baseline, 3 months, and at 6 months. The primary endpoint was change in KCCQ score from baseline to 3 and 6 months. Results: The baseline characteristics of the two treatment arms were similar; 42% were female and 39% were black. At baseline, there were no significant differences in KCCQ scores between the telemedicine and the usual care group. Both groups reported significant quality of life limitations with median KCCQ score of 59.9, and median scores of 75.0, 87.5 and 56.3 on the physical limitation, self-efficacy and social limitation subscales respectively. At 3 and 6 month follow-up, there were no significant differences between the two treatment groups with respect to the primary endpoint, change in KCCQ overall summary score or subscale scores from baseline (see table). Conclusion: Telemonitoring in a large group of patients with heart failure did not improve health status when compared to usual care. Failure to improve readmission or mortality rates combined with lack of effect on quality of life suggests that alternative solutions for management of this complex population should be sought.

Download Full-text