TY - JOUR
T1 - Monitoring clinical changes in patients with heart failure
T2 - A comparison of methods
AU - Spertus, John
AU - Peterson, Eric
AU - Conard, Mark W.
AU - Heidenreich, Paul A.
AU - Krumholz, Harlan M.
AU - Jones, Philip
AU - McCullough, Peter A.
AU - Pina, Ileana
AU - Tooley, Joseph
AU - Weintraub, William S.
AU - Rumsfeld, John S.
N1 - Funding Information:
Project support was from an unrestricted grant by Pharmacia, Inc; Biosite, Inc, donated supplies to measure B-type natriuretic peptide. Doctors Rumsfeld and Heidenreich are supported by VA Health Services Research Career Development Awards. Doctor Spertus owns the copyright to the KCCQ.
PY - 2005/10
Y1 - 2005/10
N2 - Background: Although monitoring the clinical status of patients with heart failure rests at the core of clinical medicine, the ability of different techniques to reflect clinical change has not been evaluated. This study sought to describe changes in various measures of disease status associated with gradations of clinical change. Methods: A prospective, 14-center cohort of 476 outpatients was assessed at baseline and 6 ± 2 weeks to compare changes in 7 heart failure measures with clinically observed change. Measures included health status instruments (the Kansas City Cardiomyopathy Questionnaire [KCCQ], Short Form-12, and EQ-5D), physician-assessed functional class (New York Heart Association [NYHA]), an exercise test (6-minute walk), patient weight, and a biomarker (B-type natriuretic peptide). Cardiologists, blinded to all measures except weight and NYHA, categorized clinical change ranging from large deterioration to large improvement. Results: The KCCQ, NYHA, and 6-minute walk test were most sensitive to clinical change. For patients with large, moderate, and small deteriorations, the KCCQ decreased by 25 ± 16, 17 ± 14, and 5.3 ± 11 points, respectively. For patients with small, moderate, and large improvements, the KCCQ increased by 5.7 ± 16, 10.5 ± 16, and 22.3 ± 16 points, respectively (P < .01 for all compared with the no change group). New York Heart Association and 6-minute walk distance were significantly different for those with moderate and large changes (P < .05) but neither revealed a difference between those with small versus no clinical deterioration. The KCCQ had the highest c statistic for monitoring individual patients, followed by NYHA and 6-minute walk. Conclusion: The KCCQ, followed by the NYHA and the 6-minute walk test, most accurately reflected clinical change in patients with heart failure.
AB - Background: Although monitoring the clinical status of patients with heart failure rests at the core of clinical medicine, the ability of different techniques to reflect clinical change has not been evaluated. This study sought to describe changes in various measures of disease status associated with gradations of clinical change. Methods: A prospective, 14-center cohort of 476 outpatients was assessed at baseline and 6 ± 2 weeks to compare changes in 7 heart failure measures with clinically observed change. Measures included health status instruments (the Kansas City Cardiomyopathy Questionnaire [KCCQ], Short Form-12, and EQ-5D), physician-assessed functional class (New York Heart Association [NYHA]), an exercise test (6-minute walk), patient weight, and a biomarker (B-type natriuretic peptide). Cardiologists, blinded to all measures except weight and NYHA, categorized clinical change ranging from large deterioration to large improvement. Results: The KCCQ, NYHA, and 6-minute walk test were most sensitive to clinical change. For patients with large, moderate, and small deteriorations, the KCCQ decreased by 25 ± 16, 17 ± 14, and 5.3 ± 11 points, respectively. For patients with small, moderate, and large improvements, the KCCQ increased by 5.7 ± 16, 10.5 ± 16, and 22.3 ± 16 points, respectively (P < .01 for all compared with the no change group). New York Heart Association and 6-minute walk distance were significantly different for those with moderate and large changes (P < .05) but neither revealed a difference between those with small versus no clinical deterioration. The KCCQ had the highest c statistic for monitoring individual patients, followed by NYHA and 6-minute walk. Conclusion: The KCCQ, followed by the NYHA and the 6-minute walk test, most accurately reflected clinical change in patients with heart failure.
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U2 - 10.1016/j.ahj.2004.12.010
DO - 10.1016/j.ahj.2004.12.010
M3 - Article
C2 - 16209970
AN - SCOPUS:25844437142
SN - 0002-8703
VL - 150
SP - 707
EP - 715
JO - American heart journal
JF - American heart journal
IS - 4
ER -