Summary health status measures in advanced heart failure: relationship to clinical variables and outcome.
BACKGROUND
Patient-centered health status measures are important because they capture the patient's perspective on their heart failure, but it is unclear which of these have independent prognostic significance.


RESULTS
A total of 142 consecutive subjects from a specialty heart failure clinic were assessed at baseline with a broad array of clinical, laboratory, and self-report measures including four summary measures of health status. The relationships between these measures and their association with the combined end point of transplantation or death over a mean follow-up of 3 years were examined. In unadjusted analyses, the Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score had the strongest association with the combined end point (HR [for each unit score difference] = 0.98 [0.96-0.99], P = .002). In the adjusted Cox proportional hazards model including all 4 summary measures, the Seattle Heart Failure Score, V0(2,) systolic blood pressure, and medical comorbidity, only the Standard Gamble utility remained significantly associated with time to the combined end point (HR [for each 0.01 utility score difference] = 0.98 [0.97-0.99], P = .007).


CONCLUSIONS
Our study suggests that summary health status measures are simple and significant indicators of prognosis in advanced heart failure patients. The KCCQ summary score summarizes a wide range of clinical variables from the patient's point of view, whereas the standard gamble utility contains important prognostic information not captured in usual clinical variables.
Sullivan
Mark D
MD
Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
Levy
Wayne C
WC
Russo
Joan E
JE
Crane
Barbara
B
Spertus
John A
JA
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires