title: Comparable performance of the Kansas City Cardiomyopathy Questionnaire in patients with heart failure with preserved and reduced ejection fraction.
abstract: BACKGROUND
  Despite the growing epidemic of heart failure with preserved ejection fraction (HFpEF), no valid measure of patients' health status (symptoms, function, and quality of life) exists. We evaluated the Kansas City Cardiomyopathy Questionnaire (KCCQ), a validated measure of HF with reduced EF, in patients with HFpEF.
  
  
  RESULTS
  Using a prospective HF registry, we dichotomized patients into HF with reduced EF (EF≤ 40) and HFpEF (EF≥50). The associations between New York Heart Association class, a commonly used criterion standard, and KCCQ Overall Summary and Total Symptom domains were evaluated using Spearman correlations and 2-way ANOVA with differences between patients with HF with reduced EF and HFpEF tested with interaction terms. Predictive validity of the KCCQ Overall Summary scores was assessed with Kaplan-Meier curves for death and all-cause hospitalization. Covariate adjustment was made using Cox proportional hazards models. Internal reliability was assessed with Cronbach's α. Among 849 patients, 200 (24%) had HFpEF. KCCQ summary scores were strongly associated with New York Heart Association class in both patients with HFpEF (r=-0.62; P<0.001) and HF with reduced EF (r=-0.55; P=0.27 for interaction). One-year event-free rates by KCCQ category among patients with HFpEF were 0 to 25=13.8%, 26 to 50=59.1%, 51 to 75=73.8%, and 76 to 100=77.8% (log rank P<0.001), with no significant interaction by EF (P=0.37). The KCCQ domains demonstrated high internal consistency among patients with HFpEF (Cronbach's α=0.96 for overall summary and ≥0.69 in all subdomains).
  
  
  CONCLUSIONS
  Among patients with HFpEF, the KCCQ seems to be a valid and reliable measure of health status and offers excellent prognostic ability. Future studies should extend and replicate our findings, including the establishment of its responsiveness to clinical change.
authors.affiliation: Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Joseph
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.forename: Philip G
authors.initials: PG
authors.lastname: Jones
authors.forename: Himad
authors.initials: H
authors.lastname: Khattak
authors.forename: Anne E
authors.initials: AE
authors.lastname: Platts
authors.forename: Victor G
authors.initials: VG
authors.lastname: Dávila-Román
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Mann
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: health status; heart failure, diastolic; quality of life