Objective:
Heart Failure Shared Medical Appointments (HF SMAs) are group visits in which several HF patients are treated by a clinician(s) at the same time. This intervention is a system redesign that addresses growing health system and patient care burdens in chronic HF management. Group visits have been associated with greater adherence to select HF medications and hospitalization-free survival during the intervention. However, there is little data on patient-reported outcomes such as HF-specific health status, an important outcome that quantifies the impact of the patient’s HF on his or her life. The objective of this pilot study is to determine whether HF SMA is associated with a change in HF-specific health status. The short version Kansas City Cardiomyopathy Questionnaire (KCCQ-12) measures HF-specific health status, including symptoms, physical and social function, and quality of life.
Methods:
We retrospectively collected patient characteristics by review of medical records for all patients in a VA hospital that completed the full HF SMA intervention (4 visits across 8 weeks). Each patient completed the KCCQ-12 at the beginning of each clinic visit. The primary outcome was change in KCCQ Summary Score(range 0 to 100; higher scores indicate better health status; 5 points is a clinically meaningful change). The secondary outcome was change in KCCQ subscales.
Results:
Twenty-eight patients (median age 64, median LVEF 35%) completed all four HF SMA visits. The mean KCCQ at baseline was 51. From pre- to post-SMA, the average change in KCCQ-12 Summary Score was +8 (p=0.001). The Quality of Life Subscale was associated with the greatest change (average change,+15, p=0.0003), followed by Symptom Scale (average change +10, p=0.002). There was no significant change in Social Limitation (average change +6, p=0.08) or Physical Function (average change +2, p=0.48).
Conclusions:
Preliminary findings suggest that a novel group intervention in patients with HF is associated with mild to moderate clinically significant changes in HF-specific health status. Further, HF SMA appears to specifically improve quality of life and symptoms more than physical function. Future clinical trials will be required to determine how these improvements compare to usual care.
Shared Medical Appointments and Prediabetes: The Power of the Group
