Patient-Reported Versus Physician-Assessed Health Status in Heart Failure With Reduced and Preserved Ejection...

Area of Science:

• Cardiology
• Clinical Outcomes Research
• Patient-Reported Outcomes

Background:

• Heart failure (HF) management relies on both patient-reported symptoms and physician assessments.
• Discrepancies between patient perception (Kansas City Cardiomyopathy Questionnaire - KCCQ) and clinical assessment (New York Heart Association - NYHA class) may impact outcomes.
• Understanding this discordance is crucial for optimizing HF care.

Purpose of the Study:

• To evaluate the prevalence of discordance between KCCQ overall summary (os) scores and NYHA class in patients with HF.
• To determine the association of this discordance with adverse outcomes, including HF hospitalization and mortality.
• To examine if HF phenotype (preserved vs. reduced ejection fraction) modifies these associations.

Main Methods:

• A cohort of 4818 HF patients was analyzed.
• Patients were categorized into four groups: concordant good, concordant bad, discordant worse NYHA class, and discordant worse KCCQ-os score.
• Outcomes (HF hospitalization or death at 1 year) were compared across these groups using hazard ratios (HR).

Main Results:

• Discordance was observed in 34.3% of patients, primarily with worse KCCQ-os scores (27.4%).
• Compared to concordant good status, adverse outcomes were highest in concordant bad (HR 2.7) and discordant worse KCCQ-os score (HR 1.8) groups.
• Clinically significant KCCQ-os score improvement at 6 months (≥5 points) was associated with better outcomes (HR 0.65).

Conclusions:

• One-third of HF patients exhibit discordance between patient-reported and physician-assessed health status, often driven by worse patient-reported outcomes.
• Discordance, particularly worse KCCQ scores, indicates an elevated risk of HF hospitalization and death.
• Physicians should consider this discordance to prompt further assessment and management.