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Observational Study
. 2019 Jul;7(7):615-625.
doi: 10.1016/j.jchf.2019.03.020. Epub 2019 Jun 5.

Association of Changes in Heart Failure Treatment With Patients' Health Status: Real-World Evidence From CHAMP-HF

Merrill Thomas  1 , Yevgeniy Khariton  1 , Gregg C Fonarow  2 , Suzanne V Arnold  1 , Larry Hill  3 , Michael E Nassif  4 , Puza P Sharma  5 , Javed Butler  6 , Laine Thomas  3 , Carol I Duffy  5 , Adam D DeVore  7 , Adrian Hernandez  7 , Nancy M Albert  8 , J Herbert Patterson  9 , Fredonia B Williams  10 , Kevin McCague  5 , John A Spertus  11
Affiliations
Observational Study

Association of Changes in Heart Failure Treatment With Patients' Health Status: Real-World Evidence From CHAMP-HF

Merrill Thomas et al. JACC Heart Fail. 2019 Jul.

Abstract

Objectives: The aim of this study was to use a multicenter, observational outpatient registry of patients with heart failure with reduced ejection fraction (HFrEF) to describe the association between changes in patients' medications with changes in health status.

Background: Alleviating symptoms and improving function and quality of life for patients with HFrEF are primary treatment goals and potential indicators of quality. Whether titrating medications in routine clinical care improves patients' health status is unknown.

Methods: The association of any change in HFrEF medications with 3-month change in health status, as measured using the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale, was determined in unadjusted and multivariate-adjusted (25 clinical characteristics, baseline health status) models using hierarchical linear regression.

Results: Among 3,313 outpatients with HFrEF from 140 centers, 21.9% had medication changes. Three months later, 23.7% and 46.4% had clinically meaningfully worse (≥5-point decrease) and improved (≥5-point increase) Kansas City Cardiomyopathy Questionnaire Overall Summary Scale scores. The 3-month median change in Kansas City Cardiomyopathy Questionnaire Overall Summary Scale score for patients whose HFrEF medications were changed was significantly larger (7.3 points; interquartile range: -3.1 to 20.8 points) than in patients whose medications were not changed (3.1 points; interquartile range: -4.7 to 12.5 points) (adjusted difference 3.0 points; 95% confidence interval: 1.4 to 4.6 points; p < 0.001). Among patients whose medications were adjusted, 26% had very large clinical improvement (≥20 points) compared with 14% whose regimens were not changed.

Conclusions: In routine care of patients with HFrEF, changes in HFrEF medications were associated with significant improvements in patients' health status, suggesting that health status-based performance measures can quantify the benefits of titrating medicines in patients with HFrEF.

Keywords: Kansas City Cardiomyopathy Questionnaire; health status; heart failure with reduced ejection fraction; medications; quality.

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Figures

Figure 1:
Figure 1:
Change in KCCQ Scores
Figure 2:
Figure 2:
Change in KCCQ Score by Any Change in Medication
See this image and copyright information in PMC

Comment in

  • PROmises to Keep.
    Brinkley DM, Stevenson LW. Brinkley DM, et al. JACC Heart Fail. 2019 Jul;7(7):626-628. doi: 10.1016/j.jchf.2019.04.013. Epub 2019 Jun 5. JACC Heart Fail. 2019. PMID: 31176673 No abstract available.

References

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