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Published on: July 12, 2024
Screening and Initiating Supportive Care in Patients With Heart Failure
Quynh Nguyen1, Kaiming Wang1, Anish Nikhanj1
1Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
Insights
Identifying supportive care needs in heart failure patients is crucial. The KCCQ-12 tool shows promise, but additional assessments are needed for optimal patient support and improved outcomes.
Area of Science:
- Cardiology
- Palliative Care
- Health Services Research
Background:
- Heart failure (HF) patients face significant symptom burden and reduced quality of life.
- Supportive care (SC) is under-utilized in HF management, with identification of patient needs being a key challenge.
- The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a known predictor of SC needs in HF.
Purpose of the Study:
- To evaluate the KCCQ-12 as a screening tool for supportive care needs in ambulatory heart failure patients.
- To characterize patients identified with supportive care needs and assess outcomes following referral to a multidisciplinary SC clinic.
Main Methods:
- Utilized the KCCQ-12 as a screening tool with a summary score cutoff of <29 for identifying SC needs in 456 ambulatory HF patients.
- Established a multidisciplinary SC clinic and evaluated the profile and outcomes of referred patients.
- Assessed patient demographics, medical history, biochemical parameters, echocardiography, and treatment.
Main Results:
- 9% (41/456) of patients screened positive for SC needs using KCCQ-12 <29.
- Patients with KCCQ-12 <29 reported higher symptom burden (NYHA, AHA staging) and depression.
- Of 23 referred patients, 20 received SC, with 11 deaths and 9 currently followed; median survival post-SC clinic initiation was 3 months.
Conclusions:
- A significant unmet need for supportive care exists in heart failure patients.
- The KCCQ-12 is a valuable tool for initial SC needs identification, but serial clinical evaluation is essential.
- Establishing SC clinics and ensuring prompt referrals are critical for managing patients with supportive care needs.
Abstract:
Background: Patients with heart failure (HF) experience a major symptom burden and an overall reduction of quality of life. However, supportive care (SC) remains an under-utilized resource for these patients. Among the many existing barriers to integrating SC into routine care, identifying patients with SC needs remains challenging. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is an important predictor of SC needs in patients with HF. Methods and Results: We used the shortened version KCCQ-12 as a screening tool for SC need in our ambulatory HF patient population using a KCCQ-12 summary score of <29 as the cut-off. Of the 456 patients who completed the KCCQ-12, 41 (9%) were predicted to have SC needs. Demographics, medical history, biochemical parameters, echocardiographic assessment and medical treatment were similar between the two groups of patients. However, patients with KCCQ-12 <29 were more symptomatic based on both New York Heart Association (NYHA) classification and American Heart Association (AHA) staging with a higher prevalence of depression. We established a multidisciplinary SC clinic and the profile and outcomes of patients with SC needs that were referred and followed at our SC clinic were also evaluated. Twenty-three patients were referred to our SC clinic: 2 died before being seen, 1 refused SC and 20 received SC. Of these 20 patients, 11 died and 9 are currently being followed. Median survival after starting the SC clinic is 3 months. In the original SC cohort of 23, 17 patients had available KCCQ-12 summary scores. However, only 6 out of 17 (35%) had KCCQ-12 scores <29, indicating the need for additional assessment tools in this patient population. Conclusions: The magnitude of unmet supportive care needs in patients with HF is significant. While the KCCQ-12 questionnaire is a useful tool to identify patients with SC, serial clinical evaluation, establishment of a SC clinic and prompt referral are essential for patients needing supportive care.
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