title: Patient-reported health status prior to cardiac resynchronisation therapy identifies patients at risk for poor survival and prolonged hospital stays.
abstract: BACKGROUND
  Patient-reported factors have largely been neglected in search of predictors of response to cardiac resynchronisation therapy (CRT). The current study aimed to examine the independent value of pre-implantation patient-reported health status in predicting four-year survival and cardiac-related hospitalisation of CRT patients.
  
  
  METHODS
  Consecutive patients (N = 139) indicated to receive a first-time CRT-defibrillator at the University Medical Center Utrecht were asked to complete a set of questionnaires prior to implantation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess heart failure-specific health status. Data on patients' demographic, clinical and psychological characteristics at baseline, and on cardiac-related hospitalisations and all-cause deaths during a median follow-up of 3.9 years were obtained from purpose-designed questionnaires and patients' medical records.
  
  
  RESULTS
  Results of multivariable Cox regression analyses showed that poor patient-reported health status (KCCQ score < 50) prior to implantation was associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death, independent of sociodemographic, clinical and psychological risk factors (adjusted hazard ratio 2.46, 95 % confidence interval (CI) 1.30-4.65). Poor health status was not significantly associated with the absolute number of cardiac-related hospital admissions, but with the total number of days spent in hospital during follow-up (adjusted incidence rate ratio 3.20, 95 % CI 1.88-5.44).
  
  
  CONCLUSIONS
  Patient-reported health status assessed prior to CRT identifies patients at risk for poor survival and prolonged hospital stays, independent of traditional risk factors. These results emphasise the importance of incorporating health status measures in cardiovascular research and patient management. Heart failure patients reporting poor health status should be identified and offered appropriate additional treatment programs.
authors.affiliation: Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. h.versteeg-4@umcutrecht.nl.|CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. h.versteeg-4@umcutrecht.nl.
authors.forename: H
authors.initials: H
authors.lastname: Versteeg
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Denollet
authors.affiliation: Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Meine
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.|Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.|Department of Cardiology, Odense University Hospital, Odense, Denmark.|Department of Psychology, University of Southern Denmark, Odense, Denmark.
authors.forename: S S
authors.initials: SS
authors.lastname: Pedersen
keywords: Cardiac resynchronisation therapy; Health status; Heart failure; KCCQ; Prognosis