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

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. 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. 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. 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.