title: Comparison Between the Kansas City Cardiomyopathy Questionnaire and New York Heart Association in Assessing Functional Capacity and Clinical Outcomes.
abstract: OBJECTIVE
  The Kansas City Cardiomyopathy Questionnaire (KCCQ) has emerged as a patient-centered heart failure-specific health status measure. It currently lacks routine and widespread use in clinical practice and trials. The purpose of this study was to examine the correlation between KCCQ and cardiopulmonary exercise testing (CPET) parameters and clinical outcomes, compared with the New York Heart Association functional classification (NYHA).
  
  
  RESULTS
  We performed a single-centered observational analysis of 432 patients who presented to the Heart Failure Department, completed the KCCQ, and underwent CPET. The 1-year clinical outcome assessed was a composite of mortality, heart failure hospitalization, and need for heart transplantation or left ventricular assist device. In the KCCQ, the physical limitation domain had a correlation with peak VO2similar to NYHA (r = 0.48; P < .001; and r = -0.48; P < .001; respectively), and slightly better correlation with ventilatory threshold (r = 0.42; P < .001; and r = -0.40; P < .001; respectively). According to model validation, the KCCQ physical limitation domain and NYHA were similar predictors of peak VO2(r2= 0.229; and r2= 0.227; respectively). KCCQ predicted the specified 1-year clinical outcome (hazard ratio 0.75, 95% confidence interval 0.69-0.82; P < .001) and provided incremental predictive ability when added to a model that included NYHA, with a net reclassification index of 76.1% (P < .001).
  
  
  CONCLUSIONS
  KCCQ and NYHA provide similar assessment of functional capacity. KCCQ predicts 1-year clinical outcomes, providing incremental value over NYHA. These findings support its routine use in clinical care, as well as its potential to serve as a measure in clinical trials.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nael
authors.initials: N
authors.lastname: Hawwa
authors.affiliation: Division of Cardiology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Vest
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rony
authors.initials: R
authors.lastname: Lahoud
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.affiliation: Department of Mathematics, Cleveland State University, Cleveland, Ohio.
authors.forename: Yuping
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eiran Z
authors.initials: EZ
authors.lastname: Gorodeski
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: chol@ccf.org.
authors.forename: Leslie
authors.initials: L
authors.lastname: Cho
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis; D017079:Exercise Tolerance; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010346:Patient Care Management / Q000379:methods / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000379:methods; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Heart failure; KCCQ; NYHA; functional capacity; peak VO(2)