Patient-reported Measures: KCCQ and CHF outcomes

Patient-reported Measures:
KCCQ and CHF outcomes
Aanand D. Naik, MD
Houston Health Services Research and
Development Center of Excellence
Patient-Centered Care
• Institute of Medicine Framework
– “Crossing the Quality Chasm”
– Framework for defining quality and safety
• Patient-Centered Care
– Healthcare that established a partnership among
practitioners, patients, and their families (when
appropriate) to ensure that decisions respect patients’
wants, needs, and preferences and that patients have
the education and support they need to make
decisions and participate in their own care.
Standards for PCC
• “Nothing about me without me”
• The right care in the right way at the right
• Providing the care that the patient needs in
the manner the patient desires at the time the
patient desires
• Picker Institute
More than marketing slogan
• Not simply a touchy-feeling endorsement of
• Not about clean offices, short waiting times,
or nicer hospital meals
– More than a marketing slogan
• Patient-centered care
– Improves health outcomes
– Enhances health care quality and safety
How do you make this happen
1. Develop and validate measures
– Take patients’ perspective of illness
– Link that perspective to:
Clinical change
Objective outcomes
2. Allow patients to define the nature and
experience of clinical outcomes
Patient-oriented measures & outcomes
• Scales that define processes of care or clinical
• Subjective in nature
– Patients answer them from their perspective
– Items are understandable, personally meaningful
• Psychometrically reliable and valid
• Correlated to other objective outcomes
Congestive Heart Failure
• CHF is a common clinical syndrome especially among
older adults
– Chronic condition without a cure
– Enormous impact on the prognosis and lifestyle of patients
Furthermore, it is a chronic condition
• Goals of Treatment
– Preventing disease progression (deterioration of heart
function, avoiding hospitalization)
– Alleviating patient suffering
• Patient reported measures can
– Help measure and reduce patients symptoms/suffering
– Correlated with disease progression
Kansas City Cardiomyopathy
• (KCCQ) a self-administered, 23-item
• Describes CHF specific quality of life
• Quantifies (subscales):
– Physical limitation,
– Symptoms (frequency, severity, change over time)
– Subjective QoL
– Social interference and
– Self-efficacy.
KCCQ Psychometrics
• Reliable measure of stable CHF
• Responsive to change in decompensated pts
• Subscales correlated with:
– NYHA classification, SF-36, 6-minute walk scores
– Convergent validation
(JACC 2000)
• Predictive validity
– Predicts 1 year cardiovascular mortality and
hospitalization (Circulation 2004)
Depression and KCCQ
• Multicenter study evaluating baseline
depression with 6 week change in KCCQ scores
– 30% of CHF patients had depression
• MOS-depression scores
– Depression associated with lower KCCQ at
baseline (47.7 vs 67.3, p<.001)
– Depressed patients had an average change score
over 6 weeks of (-7.1, p<.001)
• (JACC 2003)
• KCCQ is a clinically important, patient-report
measure specific to heart failure
• Correlates with disease severity and predictive
of objective, clinical outcomes
• Depression highly linked with CHF outcomes
• Depressed patients have lower KCCQ scores
and depressive predicts worsening of KCCQ

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