title: Should patients perception of health status be integrated in the prognostic assessment of heart failure patients? A prospective study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Paola
authors.initials: P
authors.lastname: Di Giulio
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
references.citation: BMJ. 2010 Nov 01;341:c5707
references.pmid: 21041324
references.citation: Ital Heart J. 2003 Sep;4(9):620-6
references.pmid: 14635380
references.citation: J Am Coll Cardiol. 2004 Aug 18;44(4):810-9
references.pmid: 15312864
references.citation: Circulation. 2007 Apr 17;115(15):1975-81
references.pmid: 17420346
references.citation: Heart. 2007 Apr;93(4):476-82
references.pmid: 17005715
references.citation: Lancet. 2008 Oct 4;372(9645):1223-30
references.pmid: 18757090
references.citation: Qual Life Res. 2009 Feb;18(1):115-23
references.pmid: 19105048
references.citation: Med Care. 2000 Jun;38(6):583-637
references.pmid: 10843310
references.citation: JAMA. 2001 Sep 26;286(12):1494-7
references.pmid: 11572743
references.citation: BMJ. 2009 Jan 12;338:a2597
references.pmid: 19139137
references.citation: Am Heart J. 2009 Feb;157(2):208-18
references.pmid: 19185627
references.citation: Circulation. 2008 Nov 11;118(20):2103-10
references.pmid: 19001034
references.citation: Am Heart J. 2005 Oct;150(4):707-15
references.pmid: 16209970
references.citation: Eur J Heart Fail. 2004 Aug;6(5):635-41
references.pmid: 15302013
references.citation: J Am Coll Cardiol. 2010 Jul 27;56(5):372-8
references.pmid: 20650358
references.citation: Circulation. 2009 Jan 27;119(3):398-407
references.pmid: 19139382
references.citation: Eur J Heart Fail. 2009 Feb;11(2):163-9
references.pmid: 19168514
references.citation: J Am Coll Cardiol. 2000 Apr;35(5):1245-55
references.pmid: 10758967
references.citation: BMJ. 2005 Aug 20;331(7514):425
references.pmid: 16061499
references.citation: J Am Coll Cardiol. 2006 Feb 21;47(4):752-6
references.pmid: 16487840
references.citation: Qual Life Res. 2009 Feb;18(1):71-85
references.pmid: 19052916
references.citation: Am J Cardiol. 1996 Oct 15;78(8):890-5
references.pmid: 8888661
references.citation: Circulation. 2002 Jul 2;106(1):5-7
references.pmid: 12093759
references.citation: J Card Fail. 2007 Sep;13(7):560-8
references.pmid: 17826647
references.citation: BMJ. 2008 May 3;336(7651):995-8
references.pmid: 18456631
references.citation: Arch Intern Med. 2005 Jun 13;165(11):1274-9
references.pmid: 15956007
references.citation: Circulation. 2004 Aug 3;110(5):546-51
references.pmid: 15262843