Improvement in Kansas City Cardiomyopathy Questionnaire Scores After a Self-Care Intervention in Patients With Acute Heart Failure Discharged From the Emergency Department

Abstract

Background: We conducted a secondary analysis of changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 over 30 days in a randomized trial of self-care coaching versus structured usual care in patients with acute heart failure who were discharged from the emergency department.

Methods: Patients in 15 emergency departments completed the KCCQ-12 at emergency department discharge and at 30 days. We compared change in KCCQ-12 scores between the intervention and usual care arms, adjusted for enrollment KCCQ-12 and demographic characteristics. We used linear regression to describe changes in KCCQ-12 summary scores and logistic regression to characterize clinically meaningful KCCQ-12 subdomain changes at 30 days.

Results: There were 350 patients with both enrollment and 30-day KCCQ summary scores available; 166 allocated to usual care and 184 to the intervention arm. Median age was 64 years (interquartile range, 55-70), 37% were female participants, 63% were Black, median KCCQ-12 summary score at enrollment was 47 (interquartile range, 33-64). Self-care coaching resulted in significantly greater improvement in health status compared with structured usual care (5.4-point greater improvement, 95% CI, 1.12-9.68; P=0.01). Improvements in health status in the intervention arm were driven by improvements within the symptom frequency (adjusted odds ratio, 1.62 [95% CI, 1.01-2.59]) and quality of life (adjusted odds ratio, 2.39 [95% CI, 1.46-3.90]) subdomains.

Conclusions: In this secondary analysis, patients with acute heart failure who received a tailored, self-care intervention after emergency department discharge had clinically significant improvements in health status at 30 days compared with structured usual care largely due to improvements within the symptom frequency and quality of life subdomains of the KCCQ-12. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02519283.

Keywords: emergencies; health status; heart failure; quality of life.

Conflict of interest statement

Potential Conflicts of interest:

Dr. Stubblefield reports no COI.

Dr. Storrow reports no COI.

Dr. Spertus reports that, relevant to this work, he owns the copyright to the Kansas City Cardiomyopathy Questionnaire. He also serves as a consultant for Bayer, AstraZeneca, Myokardia, Merck, Amgen, Novartis, United Healthcare and Janssen; has equity in Health Outcomes Sciences and serves on the Board of Directors for Blue Cross-Blue Shield of Kansas City.

Dr. Pang is a consultant for Baxter, BMS, and Merck. He has received research or other support from: BMS, Roche, Novartis, PCORI, AHA, NHLBI, AHRQ, OrthoDiagnostics, Abbott, and Beckman Coulter.

Dr. Levy received grant/research support from NIH/NHLBI, NIH/NIMHD, PCORI, AHRQ, EMF, BCBSMF, MDHHS, and MHEF and consultant support/other from Apex Innovations, AstraZeneca, BMS, Mespere, Novartis, Cardionomics, Baim Institute, Ortho Clinical Diagnostics, Roche Diagnostics, Siemens, and the Hospital Quality Foundation. Dr. Levy is also Chair of the Accreditation Oversight Committee for the American College of Cardiology (ACC) and a member of the ACC’s National Cardiovascular Data Registry Oversight Committee.

Dr. Butler is a consultant for Abbott, Amgen, Applied Therapeutics, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squib, CVRx, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Relypsa, Vifor.

Dr. Chang reports no COI.

Dr. Char reports no COI.

Dr. Diercks reports research funding from Abbott, Ortho Clinical Diagnostics, Roche, and Siemens. Her stock/ownership interests are Emergencies in Medicine, LLC.

Dr. Fermann reports research funding from Siemens, Ortho Diagnostics, NIH (NHLBI/NINDS/NIMH). Speaker’s Bureau for Portola and Janssen. Advisory Board for Portola and Janssen.

Dr. Han is supported by the National Institutes of Health (NIH) under award number

R21AG06312, R56HL141567 and R01AG065249. Dr. Han also receives research funding from Bristol Myers Squibb, Boehringer Ingelheim, and Merck.

Dr. Hiestand reports research funding from Siemens.

Dr. Hogan reports no COI.

Dr. Kahn reports no COI.

Dr. Lindenfeld is a consultant for Abbott, AstraZeneca, CVRx, Boehringer Ingelheim, Edwards LifeSciences, Impulse Dynamics, VWave. She receives funding from Astra Zeneca, Volumetric, Sensible Medical.

Dr. McNaughton reports no COI relevant to this work. She receives research support from the NHLBI, the VA, and Pfizer.

Ms. Miller reports no COI.

Dr. Peacock reports grants from Abbott, Brainbox, Calcimedica, CSL Behring, Ortho Clinical Diagnostics, Relypsa, Roche, Salix, Siemens. He is a consultant for Abbott, Astra-Zeneca, Beckman, Bosch, Fast Biomedical, Forrest Devices, Ischemia Care, Dx, Instrument Labs, Janssen, Nabriva, Ortho Clinical Diagnostics, Osler, Relypsa, Roche, Quidel, Salix, Siemens. His Stock/Ownership Interests are AseptiScope Inc, Brainbox Inc, Comprehensive Research Associates LLC, Emergencies in Medicine LLC, Forrest Devices, Ischemia DX LLC.

Dr. Schrock reports no COI.

Dr. Self reports no COI.

Dr. Singer reports research funding or consulting fees from Alexion Pharmaceutical, Janssen, Pfizer, BMS, Mallinckrodt.

Dr. Sterling is partially supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 1U54GM115428.

Dr. Collins received grant research support from NIH/NHLBI, PCORI, AHRQ, Beckman Colter and consultant support/other from Ortho Clinical, Boehringer Ingelheim, Vixiar, BMS.

Figures

Fig 1.. Effect size between intervention and usual care from enrollment to 30 days.

Linear regression analyses show 5.4-point greater improvements in KCCQ-12 summary scores at 30 days and similar associations in the symptom frequency and quality of life sub-domains.

Fig 2.. Responder analysis of change in KCCQ-12 summary score at 30 days with self-care intervention versus usual care.

Unadjusted small, moderate, and large changes in KCCQ-12 Summary Scores in self-care intervention versus usual care at 30 days (A). Associated small, moderate, and large changes in KCCQ-12 summary scores using adjusted regression analyses (B). Abbreviations: KCCQ-12, 12 item Kansas City Cardiomyopathy Questionnaire; OR, odds ratio; CI, confidence interval.

Fig 3.. Responder analysis of change in KCCQ-12 subdomain scores at 30 days with self-care intervention versus usual care.

Unadjusted small, moderate, and large changes in KCCQ-12 Physical Limitation Score (A), Symptom Frequency Score (C), Quality of Life Score (E), and Social Limitation Score (G) with self-care intervention versus usual care at 30 days. Associated small, moderate, and large changes in KCCQ-12 Physical Limitation Score (B), Symptom Frequency Score (D), Quality of Life Score (F), and Social Limitation Score (H) using adjusted regression analyses. Abbreviations: KCCQ-12, 12 item Kansas City Cardiomyopathy Questionnaire; OR, odds ratio; CI, confidence interval.