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Impact of Tafamidis on Health-Related Quality of Life in Patients With Transthyretin Amyloid Cardiomyopathy (from the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial). Am J Cardiol 2021; 141:98-105. [PMID: 33220323 DOI: 10.1016/j.amjcard.2020.10.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial, tafamidis significantly reduced all-cause mortality and cardiovascular-related hospitalizations in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). ATTR-CM is associated with a significant burden of disease; further analysis of patient-reported quality of life will provide additional data on the efficacy of tafamidis. In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial, 441 adult patients with ATTR-CM were randomized (2:1:2) to tafamidis 80 mg, tafamidis 20 mg, or placebo for 30 months, with pooled tafamidis (80 mg and 20 mg) compared with placebo. Change in Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) domain scores, EQ-5D-3L scores, and patient global assessment, were prespecified exploratory end points. A greater proportion of patients improved KCCQ-OS score at month 30 with tafamidis (41.8%) versus placebo (21.4%). Tafamidis significantly reduced the decline in all 4 KCCQ-OS domains (p <0.0001 for all), and in EQ-5D-3L utility (0.09 [confidence interval 0.05 to 0.12]; p <0.0001) and EQ visual analog scale (9.11 [confidence interval 5.39 to 12.83]; p <0.0001) scores at month 30 versus placebo. A larger proportion of tafamidis-treated patients reported their patient global assessment improved at month 30 (42.3% vs 23.8% with placebo). In conclusion, tafamidis effectively reduced the decline in patient-reported outcomes, providing further insight into its efficacy in health-related quality of life in patients with ATTR-CM.
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Abstract
Heart failure (HF) is a frequent cause of morbidity and mortality worldwide. The prevalence of HF increases, and in high-income countries, 1-2% of total healthcare expenditure is spent on HF. This article gives an overview on the impact of HF on health-related quality of life (HRQoL) and the economic burden of HF. Those suffering from HF are associated with a substantial decrease of HRQoL compared to individuals with most other chronic diseases and to individuals without HF. Therapeutic approaches, which decrease risk factors and lead to an improvement of the clinical status of patients, have a positive effect on HRQoL of the patients. Hospitalization rates have been shown to be correlated with disease severity, mortality, and HRQoL. Inpatient treatments of HF patients are cost intensive and the most important component for the economic burden of HF, responsible for at least half of direct cost. Prevention strategies, diagnostic and therapeutic approaches should focus on avoiding need for hospitalizations, and in particular, readmissions. Outpatient care including medication represents the second largest cost component. The cost of HF varies from less than 1,000 USD per patient in low-income countries to between 5,000 and 15,000 EUR in Europe, and between 17,000 and 30,000 USD in the US. There is a lack of study results on indirect costs. All study results on the socio-economic burden of HF clearly underscore the public health relevance of HF, showing a large economic burden for healthcare systems all over the world and a considerable impact on patients' HRQoL. The results on HRQoL are relatively homogeneous, but there are large differences across countries in respect of the economic burden they have to bear. Despite the large number of studies on the socio-economic consequences of HF further research is necessary, especially on indirect cost and for low- and middle-income countries. Future studies would benefit from a greater standardization of methods and presentation of results.
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Affiliation(s)
- Franz P Hessel
- SRH Berlin University of Applied Science, Berlin, Germany
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Malik AO, Chhatriwalla AK, Saxon J, Hejjaji V, Stebbins A, Jones PG, Cohen DJ, Arnold SV, Vemulapalli S, Wegermann ZK, Kosinski A, Spertus JA. Site-Level Variability in 30-Day Patient Outcomes After Transcatheter Mitral Valve Repair in the United States. Circ Cardiovasc Qual Outcomes 2020; 13:e006878. [PMID: 33280434 DOI: 10.1161/circoutcomes.120.006878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials have demonstrated health status benefit of transcatheter mitral valve repair (TMVr) with MitraClip in patients with mitral valve regurgitation. Real-world site-level variability in health status outcomes for TMVr, and factors associated with this variability, are unknown. METHODS All patients undergoing TMVr procedure with MitraClip between November 2013 and March 2019 in the Transcatheter Valve Therapy Registry were included. Health status was measured at baseline and 30 days with the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) score. Site-level variability in 30-day change in KCCQ-OS was examined by calculating the median odds ratio from a hierarchical logistic regression model, with ≥20-point improvement as the dependent variable. To define the extent to which patient characteristics, procedural characteristics (residual mitral valve regurgitation, periprocedural bleeding), site volume, and patients' baseline health status accounted for variability in outcomes, the proportion of variability (R2) explained by sequentially adding these variables to the model was quantified. RESULTS Across 339 sites, 12 415 patients (mean age 79.0±9.5 years, 46.1%. females, 89.5% White) completed baseline and 30-day health status assessments. Mean KCCQ-OS score was 43.0±24.4 at baseline and 67.0±24.9 at 30-day follow-up. Across sites, the proportion of patients achieving a ≥20-point improvement in KCCQ-OS ranged from 12.5% to 100% and the adjusted median odds ratio was 1.58 (95% CI, 1.46-1.69). The greatest contribution to the variability in health status outcomes was from patients' baseline KCCQ-OS score (R2=25%) with <1% of the variability explained by patient and procedural characteristics, and annual site volume. CONCLUSIONS There is moderate variation across sites in their patients' achievement of health status benefits from TMVr, with patient's baseline health status accounting for the largest proportion of this variation. This underscores the importance of patient selection in supporting more consistent health status benefit from TMVr.
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Affiliation(s)
- Ali O Malik
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Adnan K Chhatriwalla
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - John Saxon
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Vittal Hejjaji
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Amanda Stebbins
- Duke Clinical Research Institute, Durham, NC (A.S., S.V., Z.K.W., A.K.)
| | - Philip G Jones
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - David J Cohen
- University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Suzanne V Arnold
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | | | | | - Andrzej Kosinski
- Duke Clinical Research Institute, Durham, NC (A.S., S.V., Z.K.W., A.K.)
| | - John A Spertus
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
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Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care. J Am Coll Cardiol 2020; 76:2379-2390. [DOI: 10.1016/j.jacc.2020.09.542] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022]
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Greene SJ, Adusumalli S, Albert NM, Hauptman PJ, Rich MW, Heidenreich PA, Butler J. Building a Heart Failure Clinic: A Practical Guide from the Heart Failure Society of America. J Card Fail 2020; 27:2-19. [PMID: 33289664 DOI: 10.1016/j.cardfail.2020.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/13/2020] [Indexed: 01/09/2023]
Abstract
Heart failure (HF) remains a leading cause of mortality and morbidity and a primary driver of health care resource use in the United States. As such, there continues to be much interest in the development and refinement of HF clinics that manage patients with HF in a guideline-directed, technology-enabled, and coordinated approach. Optimization of resource use and maintenance of collaboration with other providers are also important themes when considering implementation of HF clinics. Through this document, the Heart Failure Society of America aims to provide a contemporary, practical guide to creating and sustaining a HF clinic. The guide discusses (1) patient care considerations for delivering guideline-directed and patient-centered care, and (2) operational considerations including development of a HF clinic business plan, setting goals, leadership support, triggers for patient referral and patient follow-up, patient population served, optimal clinic staffing models, relationships with subspecialists, and continuous quality improvement. This document was developed to empower providers and clinicians who wish to build and sustain community-based, successful HF clinics.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio USA
| | - Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Michael W Rich
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA.
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Sepehrvand N, Savu A, Spertus JA, Dyck JRB, Anderson T, Howlett J, Paterson I, Oudit GY, Kaul P, McAlister FA, Ezekowitz JA. Change of Health-Related Quality of Life Over Time and Its Association With Patient Outcomes in Patients With Heart Failure. J Am Heart Assoc 2020; 9:e017278. [PMID: 32812460 PMCID: PMC7660771 DOI: 10.1161/jaha.120.017278] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving health-related quality of life is an important goal in the management of patients with heart failure (HF). Defining health-related quality of life changes over time in patients with HF with preserved (HFpEF) or reduced ejection fraction and showing their association with other important clinical events could support the use of health-related quality of life as a measure of quantifying HF care. Methods and Results In the Alberta HEART (Heart Failure Aetiology and Analysis Team) cohort (n=621), patients were categorized into 4 subgroups: healthy controls (n=98), at risk (n=163), HFpEF (n=191), and HF with reduced ejection fraction (n=169). The change of the Kansas City Cardiomyopathy Questionnaire (KCCQ), EuroQOL 5 dimensions, and Functional Assessment of Cancer Therapy-Anemia over 12 months, and its association with a composite of death or rehospitalization within 3 years were assessed. At baseline, the KCCQ overall summary score was 73 (interquartile range, 53-86) in HFpEF and 78 (interquartile range, 56-90) in HF with reduced ejection fraction (P=0.22). Overall, 30.5% of patients with HF experienced ≥5-point improvements and 32.4% had ≥5-point worsening in KCCQ overall summary score at 12 months, which did not differ between HFpEF and HF with reduced ejection fraction (P=0.23). Clinical events were higher in patients with HF who had a decline in KCCQ over 12 months as compared with those with stable KCCQ scores (70.2% versus 52.0%, P=0.012). The results were similar for the Functional Assessment of Cancer Therapy-Anemia and EuroQOL 5 dimensions. Conclusions In patients with HF, the KCCQ quantified clinically meaningful changes over time, which were associated with important clinical outcomes in patients with HFpEF. Given the observed variability and prognostication in different patient trajectories, health-related quality of life measures could be valuable for quantifying the quality of care in healthcare systems.
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Affiliation(s)
- Nariman Sepehrvand
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Anamaria Savu
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
| | - John A. Spertus
- University of Missouri–Kansas CityKansas CityMO
- Saint Luke’s Mid America Heart InstituteKansas CityMO
| | - Jason R. B. Dyck
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Todd Anderson
- Libin Cardiovascular Institute of AlbertaCalgaryAlbertaCanada
- Department of Cardiac SciencesUniversity of CalgaryAlbertaCanada
| | - Jonathan Howlett
- Libin Cardiovascular Institute of AlbertaCalgaryAlbertaCanada
- Department of Cardiac SciencesUniversity of CalgaryAlbertaCanada
| | - Ian Paterson
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Gavin Y Oudit
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Padma Kaul
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Finlay A. McAlister
- Patient Health Outcomes Research and Clinical Effectiveness UnitUniversity of AlbertaEdmontonAlbertaCanada
- Division of General Internal MedicineDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Justin A. Ezekowitz
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
- Division of CardiologyDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
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Giles L, Freeman C, Field P, Sörstadius E, Kartman B. Humanistic burden and economic impact of heart failure – a systematic review of the literature. F1000Res 2020. [DOI: 10.12688/f1000research.19365.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Heart failure (HF) is increasing in prevalence worldwide. This systematic review was conducted to inform understanding of its humanistic and economic burden. Methods: Electronic databases (Embase, MEDLINE®, and Cochrane Library) were searched in May 2017. Data were extracted from studies reporting health-related quality of life (HRQoL) in 200 patients or more (published 2007–2017), or costs and resource use in 100 patients or more (published 2012–2017). Relevant HRQoL studies were those that used the 12- or 36-item Short-Form Health Surveys, EuroQol Group 5-dimensions measure of health status, Minnesota Living with Heart Failure Questionnaire or Kansas City Cardiomyopathy Questionnaire. Results: In total, 124 studies were identified: 54 for HRQoL and 71 for costs and resource use (Europe: 25/15; North America: 24/50; rest of world/multinational: 5/6). Overall, individuals with HF reported worse HRQoL than the general population and patients with other chronic diseases. Some evidence identified supports a correlation between increasing disease severity and worse HRQoL. Patients with HF incurred higher costs and resource use than the general population and patients with other chronic conditions. Inpatient care and hospitalizations were identified as major cost drivers in HF. Conclusions: Our findings indicate that patients with HF experience worse HRQoL and incur higher costs than individuals without HF or patients with other chronic diseases. Early treatment of HF and careful disease management to slow progression and to limit the requirement for hospital admission are likely to reduce both the humanistic burden and economic impact of HF.
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Abstract
Heart failure is a chronic disease with a multitude of different clinical manifestations. Empowering people living with heart failure requires education, support structure, understanding the needs of patients, and reimaging the care delivery systems currently offered to patients. In this article, the authors discuss practical approaches to activate and empower people with heart failure and enable patient-provider dialogue and shared decision making.
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Affiliation(s)
- Peter Wohlfahrt
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA; Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Irene Z Pan
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA; College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
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Joynt Maddox KE, Bleser WK, Das SR, Desai NR, Ng-Osorio J, O'Brien E, Psotka MA, Wadhera RK, Weintraub WS, Konig M. Value in Healthcare Initiative: Summary and Key Recommendations. Circ Cardiovasc Qual Outcomes 2020; 13:e006612. [PMID: 32683984 DOI: 10.1161/circoutcomes.120.006612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In spring 2018, the American Heart Association convened the Value in Healthcare Summit to begin an important conversation about the challenges patients with cardiovascular disease face in accessing and deriving quality and value from the healthcare system. Following the summit and recognizing the collective momentum it created, the American Heart Association, in collaboration with the Robert J. Margolis Center for Health Policy at Duke University, launched the Value in Healthcare Initiative-Transforming Cardiovascular Care. Four areas of focus were identified, and learning collaboratives were established and proceeded to conduct concrete, actionable problem solving in 4 high-impact areas in cardiovascular care: Value-Based Models, Partnering with Regulators, Predict and Prevent, and Prior Authorization. The deliverables from these groups are being disseminated in 4 stand-alone articles, and their publication will initiate further work to test and evaluate each of these promising areas of reform. This article provides an overview of the initiative's findings and highlights key cross-cutting themes for consideration as the initiative moves forward.
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Affiliation(s)
- Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine and Center for Health Economics and Policy, Institute for Public Health at Washington University, St. Louis, MO (K.E.J.-M.)
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, NC (W.K.B.)
| | | | - Nihar R Desai
- Yale University School of Medicine, New Haven, CT (N.R.D.)
| | | | - Emily O'Brien
- Duke University School of Medicine, Durham, NC (E.O.)
| | | | - Rishi K Wadhera
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W.)
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Schlendorf KH, O’Leary J, Lindenfeld J. Treatment of Secondary Mitral Regurgitation in Heart Failure: A Shifting Paradigm in the Wake of the COAPT Trial. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2020.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Secondary mitral regurgitation (MR) is common in patients with left heart dysfunction and it is associated with poor outcomes. Findings from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial, published in 2018, suggest that in a subset of people with heart failure with secondary MR that persists despite optimization of guideline-directed medical therapies, there is now a role for percutaneous mitral valve repair using the MitraClip device. Defining which patients are most likely to benefit from MitraClip, and when, requires both a multidisciplinary approach centered on heart failure, as well as a recognition of the need for further research in this area.
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Sathananthan J, Green P, Finn M, Wood DA, Lauck S, Crowley A, Alu M, Arnold SV, Cohen D, Kapadia S, Mack M, Thourani VH, Kodali S, Leon M, Webb JG. Prognostic implications of baseline 6‐min walk test performance in intermediate risk patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E154-E160. [DOI: 10.1002/ccd.28981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital University of British Columbia Vancouver Canada
| | - Philip Green
- Columbia University Medical Center New York New York USA
| | - Matthew Finn
- Cardiovascular Research Foundation New York New York USA
| | - David A. Wood
- Centre for Heart Valve Innovation, St Paul's Hospital University of British Columbia Vancouver Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St Paul's Hospital University of British Columbia Vancouver Canada
| | - Aaron Crowley
- Cardiovascular Research Foundation New York New York USA
| | - Maria Alu
- Cardiovascular Research Foundation New York New York USA
| | - Suzanne V. Arnold
- Division of Cardiology Saint Luke's Mid America Heart Institute Kansas City Missouri USA
| | - David Cohen
- Division of Cardiology Saint Luke's Mid America Heart Institute Kansas City Missouri USA
| | | | | | - Vinod H. Thourani
- Marcus Heart and Vascular Center Piedmont Heart Institute Atlanta Georgia USA
| | - Susheel Kodali
- Columbia University Medical Center New York New York USA
| | - Martin Leon
- Columbia University Medical Center New York New York USA
| | - John G. Webb
- Centre for Heart Valve Innovation, St Paul's Hospital University of British Columbia Vancouver Canada
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Cedars AM, Ko JM, John AS, Vittengl J, Stefanescu‐Schmidt AC, Jarrett RB, Kutty S, Spertus JA. Development of a Novel Adult Congenital Heart Disease-Specific Patient-Reported Outcome Metric. J Am Heart Assoc 2020; 9:e015730. [PMID: 32419592 PMCID: PMC7428986 DOI: 10.1161/jaha.119.015730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
Abstract
Background Patient-reported outcome metrics (PROs) quantify important outcomes in clinical trials and can be sensitive measures of patient experience in clinical practice. Currently, there is no validated disease-specific PRO for adults with congenital heart disease (ACHD). Methods and Results We conducted a preliminary psychometric validation of a novel ACHD PRO. ACHD patients were recruited prospectively from 2 institutions and completed a series of questionnaires, a physician health assessment, and a 6-minute walk test. Participants returned to complete the same questionnaires and assessment 3 months±2 weeks later. We tested the internal consistency and test-retest reliability by comparing responses among clinically stable patients at the 2 study visits. We assessed convergent and divergent validity by comparison of ACHD PRO responses to existing validated questionnaires. We assessed responsiveness by comparison with patient-reported clinical change. One hundred three patients completed 1 study visit and 81 completed both. The ACHD PRO demonstrated good internal consistency in each of its 5 domains (Cronbach's α: 0.87; 0.74; 0.74; 0.90; and 0.89, respectively) and in the overall summary score (0.92). Test-retest reliability was good with an intraclass correlation ≥0.73 for all domains and 0.78 for the Summary Score. The ACHD PRO accurately assessed domain concepts based on comparison with validated standards. Preliminary estimates of responsiveness suggest sensitivity to clinical status. Conclusions These studies provide initial support for the validity and reliability of the ACHD PRO. Further studies are needed to assess its sensitivity to changes in clinical status.
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Affiliation(s)
- Ari M. Cedars
- Division of CardiologyDepartment of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Jong Mi Ko
- Division of CardiologyDepartment of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Anitha S. John
- Department of CardiologyChildren’s National Medical CenterWashingtonDC
| | | | | | - Robin B. Jarrett
- Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTX
| | - Shelby Kutty
- Department of Pediatric CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - John A. Spertus
- Department of CardiologyMid‐America Heart InstituteKansas CityKS
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Singh M, Spertus JA, Gharacholou SM, Arora RC, Widmer RJ, Kanwar A, Sanjanwala RM, Welle GA, Al-Hijji MA. Comprehensive Geriatric Assessment in the Management of Older Patients With Cardiovascular Disease. Mayo Clin Proc 2020; 95:1231-1252. [PMID: 32498778 DOI: 10.1016/j.mayocp.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022]
Abstract
Cardiovascular disease (CVD) disproportionately affects older adults. It is expected that by 2030, one in five people in the United States will be older than 65 years. Individuals with CVD now live longer due, in part, to current prevention and treatment approaches. Addressing the needs of older individuals requires inclusion and assessment of frailty, multimorbidity, depression, quality of life, and cognition. Despite the conceptual relevance and prognostic importance of these factors, they are seldom formally evaluated in clinical practice. Further, although these constructs coexist with traditional cardiovascular risk factors, their exact prevalence and prognostic impact remain largely unknown. Development of the right decision tools, which include these variables, can facilitate patient-centered care for older adults. These gaps in knowledge hinder optimal care use and underscore the need to rigorously evaluate the optimal constructs for providing care to older adults. In this review, we describe available tools to examine the prognostic role of age-related factors in patients with CVD.
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Affiliation(s)
- Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO
| | | | - Rakesh C Arora
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Amrit Kanwar
- University of Iowa Carver College of Medicine, Iowa City, IA
| | - Rohan M Sanjanwala
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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64
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Health Status Changes and Outcomes in Patients With Heart Failure and Mitral Regurgitation. J Am Coll Cardiol 2020; 75:2099-2106. [DOI: 10.1016/j.jacc.2020.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 11/17/2022]
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65
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Butler J, Khan MS, Mori C, Filippatos GS, Ponikowski P, Comin-Colet J, Roubert B, Spertus JA, Anker SD. Minimal clinically important difference in quality of life scores for patients with heart failure and reduced ejection fraction. Eur J Heart Fail 2020; 22:999-1005. [PMID: 32239794 DOI: 10.1002/ejhf.1810] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/25/2020] [Accepted: 06/07/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS While the associations of health-related quality of life scores in heart failure (HF) [e.g. the Kansas City Cardiomyopathy Questionnaire (KCCQ)] with clinical outcomes are well established, their interpretation in the context of what magnitudes of change are clinically important to patients is less clear. The main objective of this study was to correlate the changes in the KCCQ and Patient Global Assessment (PGA) in patients with HF with reduced ejection fraction (HFrEF) to determine minimal clinically important difference (MCID). METHODS AND RESULTS We analysed data from 459 patients of the FAIR-HF trial. Both KCCQ and PGA were assessed at 4 and 24 weeks after enrolment. An anchor-based approach was used to calculate MCID at week 4 and 24. PGA was chosen as the clinical anchor against which changes in the KCCQ scores were calibrated. For each category of change in PGA, the corresponding differences were calculated by the mean scores of various domains of KCCQ along with 95% confidence intervals (CIs). There was fair correlation between PGA and changes in overall summary scores (OSS) (r = 0.31; P < 0.001), clinical summary scores (CSS) (r = 0.36; P < 0.001) and physical limitation scores (PLS) (r = 0.31; P < 0.001) from baseline to week 4. KCCQ OSS, CSS and PLS MCID for 'little improvement' at week 4 were 3.6 (1.0-6.2), 4.5 (1.8-7.2) and 4.7 (1.4-8.0) points, respectively. OSS, CSS and PLS MCID for 'little improvement' at week 24 were 4.3 (0.2-8.4), 4.5 (0.5-8.5) and 4.0 (-0.9-9.0) points, respectively. CONCLUSION The MCID threshold for KCCQ score was generally consistent and numerically lower than the threshold of 5-point change considered for clinical outcome prognosis and were stable between 4 and 24 weeks. This suggests that even changes smaller than the traditional 5-point improvements in KCCQ may be clinically meaningful. Also, these results can aid in the clinical interpretation of patient-reported outcomes, and better endpoint selection in future studies.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MO, USA
| | | | | | - Gerasimos S Filippatos
- Medical School, University of Cyprus, Nicosia, Cyprus.,National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | | | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital and IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | | | - John A Spertus
- Department of Cardiology, University of Missouri-Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany
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66
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Wohlfahrt P, Zickmund SL, Slager S, Allen LA, Nicolau JN, Kfoury AG, Felker GM, Conte J, Flint K, DeVore AD, Selzman CH, Hess R, Spertus JA, Stehlik J. Provider Perspectives on the Feasibility and Utility of Routine Patient-Reported Outcomes Assessment in Heart Failure: A Qualitative Analysis. J Am Heart Assoc 2020; 9:e013047. [PMID: 31937195 PMCID: PMC7033831 DOI: 10.1161/jaha.119.013047] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Patient‐reported outcomes (PROs) objectively measure health‐related quality of life and provide prognostic information. Advances in technology now allow for rapid, patient‐friendly PRO assessment and scoring, yet the adoption of PROs in clinic has been slow. We conducted a multicenter qualitative study of diverse providers to describe the barriers and facilitators of routine PRO use in heart failure clinics. Methods and Results Sixty heart failure providers from 5 institutions participated in 8 focus groups to explore provider perspectives on the use of heart failure‐specific and generic PROs in clinical practice. A qualitative editing approach was used to analyze the data, whereby a coding dictionary was iteratively developed and applied using the qualitative software program Altas.ti. Three main themes, supporting and impeding PRO use, emerged: (1) data collection; (2) presentation and interpretation; and (3) utility and value. For each construct, we identified perspectives that highlighted both barriers and facilitators. Providers identified burden, survey fatigue, and language/health literacy barriers as potentially impeding data collection. Optimal workflow, PRO frequency and length, use of PRO translations, and assistance of a patient's proxy were suggested as facilitators. Focus group discussions provided insight on how to display PROs to support its interpretability and sharing. Furthermore, the need to educate providers on the utility and value PROs over and above current clinical approaches emerged. Conclusions Overcoming the barriers and supporting facilitators of PRO adoption could potentially lead to more successful adoption of PROs in heart failure clinics.
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Affiliation(s)
| | | | - Stacey Slager
- University of Utah School of Medicine Salt Lake City UT
| | - Larry A Allen
- University of Colorado Anschutz Medical Campus Aurora CO
| | | | | | | | - Jorge Conte
- University of Utah School of Medicine Salt Lake City UT
| | - Kelsey Flint
- University of Colorado Anschutz Medical Campus Aurora CO.,Rocky Mountain Regional VA Medical Center Aurora CO
| | - Adam D DeVore
- Division of Cardiology Duke University Medical Center Durham NC
| | | | - Rachel Hess
- University of Utah School of Medicine Salt Lake City UT
| | | | - Josef Stehlik
- University of Utah School of Medicine Salt Lake City UT
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67
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Malik AO, Omer M, Pflederer MC, Almomani A, Gosch KL, Jones PG, Peri-Okonny PA, Al Badarin F, Brandt HA, Arnold SV, Main ML, Cohen DJ, Spertus JA, Chhatriwalla AK. Association Between Diastolic Dysfunction and Health Status Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2476-2484. [PMID: 31786216 DOI: 10.1016/j.jcin.2019.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to assess the association of baseline left ventricular diastolic dysfunction (LVDD) with health status outcomes of patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Although LVDD in patients with aortic stenosis is associated with higher mortality after TAVR, it is unknown if it is also associated with health status recovery. METHODS In a cohort of 304 patients with interpretable echocardiograms, undergoing TAVR, LVDD was categorized at baseline as absent (grade 0), mild (grade 1), moderate (grade 2), or severe (grade 3). Disease-specific health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) at baseline and at 1-month and 12-month follow-up. Association of baseline LVDD with health status at baseline and follow-up after TAVR was assessed using a linear trend test, and association with health status recovery (change in KCCQ-OS) was examined using a linear mixed model adjusting for baseline KCCQ-OS. RESULTS Twenty-four (7.9%), 54 (17.8%), 186 (61.2%), and 40 (13.2%) patients had LVDD grades of 0, 1, 2, and 3, respectively. Baseline KCCQ-OS was 61.3 ± 22.7, 51.0 ± 26.1, 44.7 ± 25.7, and 44.4 ± 21.9 (p = 0.004) in patients with LVDD grades of 0, 1,2 and 3. At 1 and 12 months after TAVR, LVDD was not associated with KCCQ-OS. Recovery in KCCQ-OS after TAVR was substantial and similar in patients across all severities of LVDD. CONCLUSIONS Although LVDD is associated with health status prior to TAVR, patients across all severities of LVDD have similar recovery in health status after TAVR.
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Affiliation(s)
- Ali O Malik
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
| | - Mohamed Omer
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Mathew C Pflederer
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Ahmed Almomani
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Poghni A Peri-Okonny
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Firas Al Badarin
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Hunter A Brandt
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Suzanne V Arnold
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael L Main
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - David J Cohen
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
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68
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Selvaraj S, Claggett B, Pozzi A, McMurray JJ, Jhund PS, Packer M, Desai AS, Lewis EF, Vaduganathan M, Lefkowitz MP, Rouleau JL, Shi VC, Zile MR, Swedberg K, Solomon SD. Prognostic Implications of Congestion on Physical Examination Among Contemporary Patients With Heart Failure and Reduced Ejection Fraction. Circulation 2019; 140:1369-1379. [DOI: 10.1161/circulationaha.119.039920] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The contemporary prognostic value of the physical examination— beyond traditional risk factors including natriuretic peptides, risk scores, and symptoms—in heart failure (HF) with reduced ejection fraction is unknown. We aimed to determine the association between physical signs of congestion at baseline and during study follow-up with quality of life and clinical outcomes and to assess the treatment effects of sacubitril/valsartan on congestion.
Methods:
We analyzed participants from PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in HF) with an available physical examination at baseline. We examined the association of the number of signs of congestion (jugular venous distention, edema, rales, and third heart sound) with the primary outcome (cardiovascular death or HF hospitalization), its individual components, and all-cause mortality using time-updated, multivariable-adjusted Cox regression. We further evaluated whether sacubitril/valsartan reduced congestion during follow-up and whether improvement in congestion is related to changes in clinical outcomes and quality of life, assessed by Kansas City Cardiomyopathy Questionnaire overall summary scores.
Results:
Among 8380 participants, 0, 1, 2, and 3+ signs of congestion were present in 70%, 21%, 7%, and 2% of patients, respectively. Patients with baseline congestion were older, more often female, had higher MAGGIC risk scores (Meta-Analysis Global Group in Chronic Heart Failure) and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (
P
<0.05). After adjusting for baseline natriuretic peptides, time-updated Meta-Analysis Global Group in Chronic Heart Failure score, and time-updated New York Heart Association class, increasing time-updated congestion was associated with all outcomes (
P
<0.001). Sacubitril/valsartan reduced the risk of the primary outcome irrespective of clinical signs of congestion at baseline (
P
=0.16 for interaction), and treatment with the drug improved congestion to a greater extent than did enalapril (
P
=0.011). Each 1-sign reduction was independently associated with a 5.1 (95% CI, 4.7–5.5) point improvement in Kansas City Cardiomyopathy Questionnaire overall summary scores. Change in congestion strongly predicted outcomes even after adjusting for baseline congestion (
P
<0.001).
Conclusions:
In HF with reduced ejection fraction, the physical exam continues to provide significant independent prognostic value even beyond symptoms, natriuretic peptides, and Meta-Analysis Global Group in Chronic Heart Failure risk score. Sacubitril/valsartan improved congestion to a greater extent than did enalapril. Reducing congestion in the outpatient setting is independently associated with improved quality of life and reduced cardiovascular events, including mortality.
Clinical Trial Registration:
https://www.clinicaltrials.gov
. Unique identifier: NCT01035255.
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Affiliation(s)
- Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (S.S.)
| | - Brian Claggett
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., E.F.L, M.V., S.D.S.)
| | - Andrea Pozzi
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (A.P., J.J.V.M., P.S.J.)
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (A.P., J.J.V.M., P.S.J.)
| | - Pardeep S. Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (A.P., J.J.V.M., P.S.J.)
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.)
- Imperial College, London, United Kingdom (M.P.)
| | - Akshay S. Desai
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., E.F.L, M.V., S.D.S.)
| | - Eldrin F. Lewis
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., E.F.L, M.V., S.D.S.)
| | - Muthiah Vaduganathan
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., E.F.L, M.V., S.D.S.)
| | | | - Jean L. Rouleau
- Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.)
| | | | - Michael R. Zile
- Medical University of South Carolina and Ralph H. Johnson Department of Veterans Administration Medical Center, Charleston (M.R.Z.)
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.)
- National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.)
| | - Scott D. Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., E.F.L, M.V., S.D.S.)
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69
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Heidenreich PA. Patient-Reported Outcomes. JACC-HEART FAILURE 2019; 7:875-877. [DOI: 10.1016/j.jchf.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 11/16/2022]
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Khariton Y, Fonarow GC, Arnold SV, Hellkamp A, Nassif ME, Sharma PP, Butler J, Thomas L, Duffy CI, DeVore AD, Albert NM, Patterson JH, Williams FB, McCague K, Spertus JA. Association Between Sacubitril/Valsartan Initiation and Health Status Outcomes in Heart Failure With Reduced Ejection Fraction. JACC-HEART FAILURE 2019; 7:933-941. [PMID: 31521679 DOI: 10.1016/j.jchf.2019.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to describe the short-term health status benefits of angiotensin-neprilysin inhibitor (ARNI) therapy in patients with heart failure and reduced ejection fraction (HFrEF). BACKGROUND Although therapy with sacubitril/valsartan, a neprilysin inhibitor, improved patients' health status (compared with enalapril) at 8 months in the PARADIGM-HF (Prospective Comparison of ARNI with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) study, the early impact of ARNI on patients' symptoms, functions, and quality of life is unknown. METHODS Health status was assessed by using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ) in 3,918 outpatients with HFrEF and left ventricular ejection fraction ≤40% across 140 U.S. centers in the CHAMP-HF (Change the Management of Patients with Heart Failure) registry. ARNI therapy was initiated in 508 patients who were matched 1:2 to 1,016 patients who were not initiated on ARNI (no-ARNI), using a nonparsimonious time-dependent propensity score (6 sociodemographic factors, 23 clinical characteristics), prior KCCQ overall summary (KCCQ-OS) score, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker status. RESULTS Multivariate linear regression demonstrated a greater mean improvement in KCCQ-OS in patients initiated on ARNI therapy (5.3 ± 19 vs. 2.5 ± 17.4, respectively; p < 0.001) over a median (interquartile range [IQR]) of 57 (32 to 104) days. The proportions of ARNI versus no-ARNI groups with ≥10-point (large) and ≥20-point (very large) improvements in KCCQ-OS were 32.7% versus 26.9%, respectively, and 20.5% versus 12.1%, respectively, consistent with numbers needed to treat of 18 and 12, respectively. CONCLUSIONS In routine clinical care, ARNI therapy was associated with early improvements in health status, with 20% experiencing a very large health status benefit compared with 12% who were not started on ARNI therapy. These findings support the use of ARNI to improve patients' symptoms, functions, and quality of life.
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Affiliation(s)
- Yevgeniy Khariton
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri.
| | - Gregg C Fonarow
- Department of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California
| | - Suzanne V Arnold
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Ann Hellkamp
- Duke Clinical Research Institute, Durham, North Carolina
| | - Michael E Nassif
- Department of Cardiology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - Puza P Sharma
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, North Carolina
| | - Carol I Duffy
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - Adam D DeVore
- Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | | | - Kevin McCague
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - John A Spertus
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
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71
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Spertus JV, Hatfield LA, Cohen DJ, Arnold SV, Ho M, Jones PG, Leon M, Zuckerman B, Spertus JA. Integrating Quality of Life and Survival Outcomes in Cardiovascular Clinical Trials. Circ Cardiovasc Qual Outcomes 2019; 12:e005420. [PMID: 31189406 DOI: 10.1161/circoutcomes.118.005420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Survival and health status (eg, symptoms and quality of life) are key outcomes in clinical trials of heart failure treatment. However, health status can only be recorded on survivors, potentially biasing treatment effect estimates when there is differential survival across treatment groups. Joint modeling of survival and health status can address this bias. Methods and Results We analyzed patient-level data from the PARTNER 1B trial (Placement of Aortic Transcatheter Valves) of transcatheter aortic valve replacement versus standard care. Health status was quantified with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at randomization, 1, 6, and 12 months. We compared hazard ratios for survival and mean differences in KCCQ scores at 12 months using several models: the original growth curve model for KCCQ scores (ignoring death), separate Bayesian models for survival and KCCQ scores, and a Bayesian joint longitudinal-survival model fit to either 12 or 30 months of survival follow-up. The benefit of transcatheter aortic valve replacement on 12-month KCCQ scores was greatest in the joint-model fit to all survival data (mean difference, 33.7 points; 95% credible intervals [CrI], 24.2-42.4), followed by the joint-model fit to 12 months of survival follow-up (32.3 points; 95% CrI, 22.5-41.5), a Bayesian model without integrating death (30.4 points; 95% CrI, 21.4-39.3), and the original growth curve model (26.0 points; 95% CI, 18.7-33.3). At 12 months, the survival benefit of transcatheter aortic valve replacement was also greater in the joint model (hazard ratio, 0.50; 95% CrI, 0.32-0.73) than in the nonjoint Bayesian model (0.54; 95% CrI, 0.37-0.75) or the original Kaplan-Meier estimate (0.55; 95% CI, 0.40-0.74). Conclusions In patients with severe symptomatic aortic stenosis and prohibitive surgical risk, the estimated benefits of transcatheter aortic valve replacement on survival and health status compared with standard care were greater in joint Bayesian models than other approaches.
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Affiliation(s)
- Jacob V Spertus
- Department of Statistics, University of California, Berkeley (J.V.S.)
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H.)
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
| | - Martin Ho
- Center for Devices and Radiologic Health, Food and Drug Administration, Bethesda MD (M.H., B.Z.)
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.)
| | - Martin Leon
- Division of Cardiology, Columbia University, New York, NY (M.L.)
| | - Bram Zuckerman
- Center for Devices and Radiologic Health, Food and Drug Administration, Bethesda MD (M.H., B.Z.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
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72
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Thomas M, Khariton Y, Fonarow GC, Arnold SV, Hill L, Nassif ME, Sharma PP, Butler J, Thomas L, Duffy CI, DeVore AD, Hernandez A, Albert NM, Patterson JH, Williams FB, McCague K, Spertus JA. Association of Changes in Heart Failure Treatment With Patients' Health Status: Real-World Evidence From CHAMP-HF. JACC-HEART FAILURE 2019; 7:615-625. [PMID: 31176672 DOI: 10.1016/j.jchf.2019.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to use a multicenter, observational outpatient registry of patients with heart failure with reduced ejection fraction (HFrEF) to describe the association between changes in patients' medications with changes in health status. BACKGROUND Alleviating symptoms and improving function and quality of life for patients with HFrEF are primary treatment goals and potential indicators of quality. Whether titrating medications in routine clinical care improves patients' health status is unknown. METHODS The association of any change in HFrEF medications with 3-month change in health status, as measured using the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale, was determined in unadjusted and multivariate-adjusted (25 clinical characteristics, baseline health status) models using hierarchical linear regression. RESULTS Among 3,313 outpatients with HFrEF from 140 centers, 21.9% had medication changes. Three months later, 23.7% and 46.4% had clinically meaningfully worse (≥5-point decrease) and improved (≥5-point increase) Kansas City Cardiomyopathy Questionnaire Overall Summary Scale scores. The 3-month median change in Kansas City Cardiomyopathy Questionnaire Overall Summary Scale score for patients whose HFrEF medications were changed was significantly larger (7.3 points; interquartile range: -3.1 to 20.8 points) than in patients whose medications were not changed (3.1 points; interquartile range: -4.7 to 12.5 points) (adjusted difference 3.0 points; 95% confidence interval: 1.4 to 4.6 points; p < 0.001). Among patients whose medications were adjusted, 26% had very large clinical improvement (≥20 points) compared with 14% whose regimens were not changed. CONCLUSIONS In routine care of patients with HFrEF, changes in HFrEF medications were associated with significant improvements in patients' health status, suggesting that health status-based performance measures can quantify the benefits of titrating medicines in patients with HFrEF.
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Affiliation(s)
- Merrill Thomas
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Yevgeniy Khariton
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Larry Hill
- Duke Clinical Research Institute, Durham, North Carolina
| | - Michael E Nassif
- Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - Puza P Sharma
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Laine Thomas
- Duke Clinical Research Institute, Durham, North Carolina
| | - Carol I Duffy
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Adrian Hernandez
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | | | - Kevin McCague
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri.
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Baron SJ, Arnold SV, Wang K, Magnuson EA, Chinnakondepali K, Makkar R, Herrmann HC, Kodali S, Thourani VH, Kapadia S, Svensson L, Brown DL, Mack MJ, Smith CR, Leon MB, Cohen DJ. Health Status Benefits of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Surgical Risk: Results From the PARTNER 2 Randomized Clinical Trial. JAMA Cardiol 2019; 2:837-845. [PMID: 28658491 DOI: 10.1001/jamacardio.2017.2039] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance In patients with severe aortic stenosis (AS) at intermediate surgical risk, treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) results in similar 2-year survival. The effect of TAVR vs SAVR on health status in patients at intermediate surgical risk is unknown. Objective To compare health-related quality of life among intermediate-risk patients with severe AS treated with either TAVR or SAVR. Design, Setting, and Participants Between December 2011 and November 2013, 2032 intermediate-risk patients with severe AS were randomized to TAVR with the Sapien XT valve or SAVR in the Placement of Aortic Transcatheter Valve 2 Trial and were followed up for 2 years. Data analysis was conducted between March 1, 2016, to April 30, 2017. Main Outcomes and Measures Health status was assessed at baseline, 1 month, 1 year, and 2 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ) (23 items covering physical function, social function, symptoms, self-efficacy and knowledge, and quality of life on a 0- to 100-point scale; higher scores indicate better quality of life), Medical Outcomes Study Short Form-36 (36 items covering 8 dimensions of health status as well as physical and mental summary scores; higher scores represent better health status), and EuroQOL-5D (assesses 5 dimensions of general health on a 3-level scale, with utility scores ranging from 0 [death] to 1 [ideal health]). Analysis of covariance was used to examine changes in health status over time, adjusting for baseline status. Results Of the 2032 randomized patients, baseline health status was available for 1833 individuals (950 TAVR, 883 SAVR) who formed the primary analytic cohort. A total of 1006 (54.9%) of the population were men; mean (SD) age was 81.4 (6.8) years. Over 2 years, both TAVR and SAVR were associated with significant improvements in both disease specific (16-22 points on the KCCQ-OS scale) and generic health status (3.9-5.1 points on the SF-36 physical summary scale). At 1 month, TAVR was associated with better health status than SAVR, but this difference was restricted to patients treated via transfemoral access (mean difference in the KCCQ overall summary [KCCQ-OS] score, 14.1 points; 95% CI, 11.7 to 16.4; P < .01) and was not seen in patients treated via transthoracic access (mean difference in KCCQ-OS, 3.5 points; 95% CI, -1.4 to 8.4; P < .01 for interaction). There were no significant differences between TAVR and SAVR in any health status measures at 1 or 2 years. Conclusions and Relevance Among intermediate-risk patients with severe AS, health status improved significantly with both TAVR and SAVR through 2 years of follow up. Early health status improvement was greater with TAVR, but only among patients treated via transfemoral access. Longer term follow-up is needed to assess the durability of quality-of-life improvement with TAVR vs SAVR in this population. Trial Registration clinicaltrials.gov Identifier: NCT01314313.
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Affiliation(s)
- Suzanne J Baron
- Saint Luke's Mid America Heart Institute, School of Medicine, University of Missouri, Kansas City
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, School of Medicine, University of Missouri, Kansas City
| | - Kaijun Wang
- Saint Luke's Mid America Heart Institute, School of Medicine, University of Missouri, Kansas City
| | - Elizabeth A Magnuson
- Saint Luke's Mid America Heart Institute, School of Medicine, University of Missouri, Kansas City
| | - Khaja Chinnakondepali
- Saint Luke's Mid America Heart Institute, School of Medicine, University of Missouri, Kansas City
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | | | | | | | | | - Craig R Smith
- Columbia University Medical Center, New York, New York
| | - Martin B Leon
- Columbia University Medical Center, New York, New York
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, School of Medicine, University of Missouri, Kansas City
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McMurray JJ, DeMets DL, Inzucchi SE, Køber L, Kosiborod MN, Langkilde AM, Martinez FA, Bengtsson O, Ponikowski P, Sabatine MS, Sjöstrand M, Solomon SD. A trial to evaluate the effect of the sodium-glucose co-transporter 2 inhibitor dapagliflozin on morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction (DAPA-HF). Eur J Heart Fail 2019; 21:665-675. [PMID: 30895697 PMCID: PMC6607736 DOI: 10.1002/ejhf.1432] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce the risk of incident heart failure hospitalization in individuals with type 2 diabetes who have, or are at high risk of, cardiovascular disease. Most patients in these trials did not have heart failure at baseline and the effect of SGLT2 inhibitors on outcomes in individuals with established heart failure (with or without diabetes) is unknown. DESIGN AND METHODS The Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) is an international, multicentre, parallel group, randomized, double-blind, study in patients with chronic heart failure, evaluating the effect of dapagliflozin 10 mg, compared with placebo, given once daily, in addition to standard care, on the primary composite outcome of a worsening heart failure event (hospitalization or equivalent event, i.e. an urgent heart failure visit) or cardiovascular death. Patients with and without diabetes are eligible and must have a left ventricular ejection fraction ≤ 40%, a moderately elevated N-terminal pro B-type natriuretic peptide level, and an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2 . The trial is event-driven, with a target of 844 primary outcomes. Secondary outcomes include the composite of total heart failure hospitalizations (including repeat episodes), and cardiovascular death and patient-reported outcomes. A total of 4744 patients have been randomized. CONCLUSIONS DAPA-HF will determine the efficacy and safety of the SGLT2 inhibitor dapagliflozin, added to conventional therapy, in a broad spectrum of patients with heart failure and reduced ejection fraction.
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Affiliation(s)
| | - David L. DeMets
- Department of Biostatistics and Medical Informatics, School of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Silvio E. Inzucchi
- Section of EndocrinologyYale University School of MedicineNew HavenCTUSA
| | - Lars Køber
- Rigshospitalet Copenhagen University HospitalCopenhagenDenmark
| | - Mikhail N. Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri‐Kansas CityKansas CityMOUSA
- The George Institute for Global HealthSydneyAustralia
| | | | | | | | | | - Marc S. Sabatine
- TIMI Study Group, Division of Cardiovascular MedicineBrigham and Women's Hospital, and Harvard Medical SchoolBostonMAUSA
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75
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Arnold SV, Chinnakondepalli KM, Spertus JA, Magnuson EA, Baron SJ, Kar S, Lim DS, Mishell JM, Abraham WT, Lindenfeld JA, Mack MJ, Stone GW, Cohen DJ. Health Status After Transcatheter Mitral-Valve Repair in Heart Failure and Secondary Mitral Regurgitation: COAPT Trial. J Am Coll Cardiol 2019; 73:2123-2132. [PMID: 30894288 DOI: 10.1016/j.jacc.2019.02.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) led to reduced heart failure (HF) hospitalizations and improved survival in patients with symptomatic HF and 3+ to 4+ secondary mitral regurgitation (MR) on maximally-tolerated medical therapy. Given the advanced age and comorbidities of these patients, improvement in health status is also an important treatment goal. OBJECTIVES The purpose of this study was to understand the health status outcomes of patients with HF and 3+ to 4+ secondary MR treated with TMVr versus standard care. METHODS The COAPT trial randomized patients with HF and 3+ to 4+ secondary MR to TMVr (n = 302) or standard care (n = 312). Health status was assessed at baseline and at 1, 6, 12, and 24 months with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the SF-36 health status survey. The primary health status endpoint was the KCCQ overall summary score (KCCQ-OS; range 0 to 100; higher = better; minimum clinically important difference = 5 points). RESULTS At baseline, patients had substantially impaired health status (mean KCCQ-OS 52.4 ± 23.0). While health status was unchanged over time in the standard care arm, patients randomized to TMVr demonstrated substantial improvement in the KCCQ-OS at 1 month (mean between-group difference 15.9 points; 95% confidence interval [CI]: 12.3 to 19.5 points), with only slight attenuation of this benefit through 24 months (mean between-group difference 12.8 points; 95% CI: 7.5 to 18.2 points). At 24 months, 36.4% of TMVr patients were alive with a moderately large (≥10-point) improvement versus 16.6% of standard care patients (p < 0.001), for a number needed to treat of 5.1 patients (95% CI: 3.6 to 8.7 patients). TMVr patients also reported better generic health status at each timepoint (24-month mean difference in SF-36 summary scores: physical 3.6 points; 95% CI: 1.4 to 5.8 points; mental 3.6 points; 95% CI: 0.8 to 6.4 points). CONCLUSIONS Among patients with symptomatic HF and 3+ to 4+ secondary MR receiving maximally-tolerated medical therapy, edge-to-edge TMVr resulted in substantial early and sustained health status improvement compared with medical therapy alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] [COAPT]; NCT01626079).
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - Khaja M Chinnakondepalli
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - Elizabeth A Magnuson
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - Suzanne J Baron
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - Saibal Kar
- Cedars-Sinai Medical Center, Los Angeles, California
| | - D Scott Lim
- University of Virginia, Charlottesville, Virginia
| | - Jacob M Mishell
- Kaiser Permanente-San Francisco Hospital, San Francisco, California
| | | | | | | | - Gregg W Stone
- New York-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri.
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76
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Gallagher AM, Lucas R, Cowie MR. Assessing health-related quality of life in heart failure patients attending an outpatient clinic: a pragmatic approach. ESC Heart Fail 2018; 6:3-9. [PMID: 30311454 PMCID: PMC6352889 DOI: 10.1002/ehf2.12363] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/13/2018] [Accepted: 08/30/2018] [Indexed: 12/28/2022] Open
Abstract
Aims Improving quality of life (QoL) in heart failure patients is a key management objective. Validated health‐related QoL (HR‐QoL) measurement tools have been incorporated into clinical trials but not routinely into daily practice. The aims of this study were to investigate the acceptability and feasibility of implementing validated HR‐QoL instruments into heart failure clinics and to examine the impact of patient characteristics on HR‐QoL. Methods and results One hundred and sixty‐three patients attending heart failure clinics at a UK tertiary centre were invited to complete three HR‐QoL assessments: the Minnesota Living with Heart Failure Questionnaire (MLHFQ); the EuroQoL 5D‐3L (EQ‐5D‐3L); and the Kansas City Cardiomyopathy Questionnaire (KCCQ) in that order. Data on patient demographics, co‐morbidities, New York Heart Association (NYHA) class, plasma B‐type natriuretic peptide (BNP), renal function, and left ventricular ejection fraction were recorded. 94% of patients attending clinic were willing to participate. The EQ‐5D‐3L had all questions answered by 92% of patients, compared with 86% and 51% for the MLHFQ and KCCQ, respectively. HR‐QoL significantly correlated with NYHA class using each tool (MLHFQ, r = 0.59; KCCQ, r = −0.61; EQ‐5D‐3L, r = −0.44, all P < 0.01). However, within each NYHA class, there was a widespread of HR‐QoL scores. There was no association between patient demographics, left ventricular ejection fraction, plasma B‐type natriuretic peptide, or renal function with HR‐QoL using any tool. Conclusions Health‐related QoL assessment by validated questionnaire was acceptable to patients and feasible to perform in routine practice. Although NYHA class correlated significantly with HR‐QoL scores, there was high variability in HR‐QoL within each NYHA class, highlighting its limitation as the sole assessment of HR‐QoL. Clinicians should encourage the assessment of HR‐QoL to facilitate patient‐centred care and make more specific use of HR‐QoL measurement tools.
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Affiliation(s)
| | | | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), London, UK
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77
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Luo N, O'Connor CM, Cooper LB, Sun JL, Coles A, Reed SD, Whellan DJ, Piña IL, Kraus WE, Mentz RJ. Relationship between changing patient-reported outcomes and subsequent clinical events in patients with chronic heart failure: insights from HF-ACTION. Eur J Heart Fail 2018; 21:63-70. [PMID: 30168635 DOI: 10.1002/ejhf.1299] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/20/2018] [Accepted: 07/08/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS A 5-point change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) is commonly considered to be a clinically significant difference in health status in patients with heart failure. We evaluated how the magnitude of change relates to subsequent clinical outcomes. METHODS AND RESULTS Using data from the HF-ACTION trial of exercise training in chronic heart failure (n = 2331), we used multivariable Cox regression with piecewise linear splines to examine the relationship between change in KCCQ overall summary score from baseline to 3 months (range 0-100; higher scores reflect better health status) and subsequent all-cause mortality/hospitalization. Among 2038 patients with KCCQ data at the 3-month visit, KCCQ scores increased from baseline by ≥5 points for 45%, scores decreased by ≥5 points for 23%, and scores changed by <5 points for the remaining 32% of patients. There was a non-linear relationship between change in KCCQ and outcomes. Worsening health status was associated with increased all-cause mortality/hospitalization (adjusted hazard ratio 1.07 per 5-point KCCQ decline; 95% confidence interval 1.03-1.12; P < 0.001). In contrast, improving health status, up to an 8-point increase in KCCQ, was associated with decreased all-cause mortality/hospitalization (adjusted hazard ratio 0.93 per 5-point increase; 95% confidence interval 0.90-0.97; P < 0.001). Additional improvements in health status beyond an 8-point increase in KCCQ was not associated with all-cause death or hospitalization (P = 0.42). CONCLUSION In patients with heart failure, small changes in KCCQ are associated with changing future risk, but more research will be necessary to understand how different magnitudes of improving health status affect outcomes.
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Affiliation(s)
- Nancy Luo
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Christopher M O'Connor
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Lauren B Cooper
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Durham, NC, USA
| | - Adrian Coles
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Ileana L Piña
- Montefiore-Einstein Medical Center, New York, NY, USA
| | - William E Kraus
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
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78
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Symptom patterns and clinical outcomes in women versus men with systolic heart failure and depression. Clin Res Cardiol 2018; 108:244-253. [PMID: 30097684 DOI: 10.1007/s00392-018-1348-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Depression is more common in females than in males and is 3-5 times more prevalent in patients with heart failure (HF) than in the general population. The 9-item Patient Health Questionnaire (PHQ-9) is a validated depression screening instrument; higher sum-scores predict adverse clinical outcomes. Sex- and gender differences in PHQ-9 symptom profile, diagnostic and prognostic properties, and impact on health-related quality of life (HRQOL) have not been comprehensively studied in HF patients. METHODS AND RESULTS This post hoc analysis from the Interdisciplinary Network Heart Failure program enrolled 852/1022 participants (67 ± 13 years, 28% female) who completed the PHQ-9 at hospital discharge after cardiac decompensation. All had a left ventricular ejection fraction ≤ 40%. Women had a higher mean PHQ-9 sum-score than men (8.4 ± 5.6 vs. 7.4 ± 5.5; p = 0.027), and higher proportions rated the following items ≥ 2 (i.e., present on ≥ 50% of days): 'feeling down, hopeless' (25.8 vs. 18.0%; p = 0.011); 'fatigue' (51.9 vs. 37.2%; p < 0.001); and 'trouble concentrating' (21.6 vs. 15.4%; p = 0.032). A PHQ-9 sum-score ≥ 10 predicted increased mortality in women [hazard ratio 1.91 (95% confidence interval 1.06-3.43); p = 0.030] and men [2.10 (1.43-3.09); p < 0.001] and was associated with worse HRQOL (p < 0.001 for all comparisons). Sum-scores ≥ 10 predicted higher re-hospitalization rates in men only [1.35 (1.08-1.69); p = 0.008]. CONCLUSIONS Differences in several PHQ-9 items indicated sex- or gender-specific depression symptomatology in HF. For both sexes, HRQOL and survival were worse when PHQ-9 sum-score was ≥ 10, but higher sum-scores predicted higher re-hospitalization rates in men only. Considering these specific aspects might help optimize care strategies in HF.
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79
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Hummel SL, Karmally W, Gillespie BW, Helmke S, Teruya S, Wells J, Trumble E, Jimenez O, Marolt C, Wessler JD, Cornellier M, Maurer MS. Home-Delivered Meals Postdischarge From Heart Failure Hospitalization. Circ Heart Fail 2018; 11:e004886. [PMID: 30354562 PMCID: PMC6205816 DOI: 10.1161/circheartfailure.117.004886] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background In patients with heart failure (HF), malnutrition and dietary sodium excess are common and may worsen outcomes. No prior studies have provided low-sodium, nutritionally complete meals following HF hospitalization. Methods and Results The GOURMET-HF study (Geriatric Out-of-Hospital Randomized Meal Trial in Heart Failure) randomized patients discharged from HF hospitalization to 4 weeks of home-delivered sodium-restricted Dietary Approaches to Stop Hypertension meals (DASH/SRD; 1500 mg sodium/d) versus usual care. The primary outcome was the between-group change in the Kansas City Cardiomyopathy Questionnaire summary score from discharge to 4 weeks postdischarge. Additional outcomes included changes in the Kansas City Cardiomyopathy Questionnaire clinical summary score and cardiac biomarkers. All patients were followed 12 weeks for death/all-cause readmission and potential diet-related adverse events (symptomatic hypotension, hyperkalemia, acute kidney injury). Sixty-six patients were randomized 1:1 at discharge to DASH/SRD versus usual care (age, 71±8 years; 30% female; ejection fraction, 39±18%). The Kansas City Cardiomyopathy Questionnaire summary score increased similarly between groups (DASH/SRD 46±23-59±20 versus usual care 43±19-53±24; P=0.38), but the Kansas City Cardiomyopathy Questionnaire clinical summary score increase tended to be greater in DASH/SRD participants (47±22-65±19 versus 45±20-55±26; P=0.053). Potentially diet-related adverse events were uncommon; 30-day HF readmissions (11% versus 27%; P=0.06) and days rehospitalized within that timeframe (17 versus 55; P=0.055) trended lower in DASH/SRD participants. Conclusions Home-delivered DASH/SRD after HF hospitalization appeared safe in selected patients and had directionally favorable effects on HF clinical status and 30-day readmissions. Larger studies are warranted to clarify the effects of postdischarge nutritional support in patients with HF. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02148679.
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Affiliation(s)
- Scott L. Hummel
- University of Michigan, Ann Arbor, MI
- Ann Arbor Veterans Affairs Health System, Ann Arbor, MI
| | | | | | | | | | | | - Erika Trumble
- Ann Arbor Veterans Affairs Health System, Ann Arbor, MI
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Napier R, McNulty SE, Eton DT, Redfield MM, AbouEzzeddine O, Dunlay SM. Comparing Measures to Assess Health-Related Quality of Life in Heart Failure With Preserved Ejection Fraction. JACC-HEART FAILURE 2018; 6:552-560. [PMID: 29885952 DOI: 10.1016/j.jchf.2018.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 02/15/2018] [Accepted: 02/18/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This study sought to compare the performance of 2 health-related quality of life (HRQOL) questionnaires in patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND The ability to accurately assess HRQOL over time is important in the care of patients with heart failure. The validity and reliability of HRQOL tools including the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) has not been fully determined or compared in patients with HFpEF. METHODS Among patients with stable chronic HFpEF enrolled in the NEAT (Nitrate Effect on Activity Tolerance in Heart Failure) trial (n = 110), the study evaluated and compared reliability, validity, and responsiveness to change of the MLHFQ and KCCQ at baseline, 6 weeks, and 12 weeks. RESULTS Internal consistency was good and comparable for MLHFQ and KCCQ domains measuring similar aspects of HRQOL at baseline including the MLHFQ physical (Cronbach's α = 0.93) compared with the KCCQ clinical summary (α = 0.91), and the MLHFQ emotional (α = 0.92) compared with the KCCQ quality of life (α = 0.87). Correlations with New York Heart Association functional class (Spearman rho; rs= -0.37 vs. 0.30) and 6-min walk test (6MWT) (rs = 0.38 vs. -0.23) at baseline were slightly stronger for the KCCQ overall summary score than for the MLHFQ total score. The MLHFQ was more responsive to change in 6MWT based on responsiveness statistics. CONCLUSIONS These data suggest that both the MLHFQ and KCCQ are reliable and valid tools to assess HRQOL in HFpEF. The KCCQ was more strongly correlated with baseline functional status parameters, while the MLHFQ was more responsive to improvement in 6MWT.
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Affiliation(s)
- Rebecca Napier
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - David T Eton
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Omar AbouEzzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
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81
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Baron SJ, Thourani VH, Kodali S, Arnold SV, Wang K, Magnuson EA, Pichard AD, Babaliaros V, George I, Miller DC, Tuzcu EM, Greason K, Herrmann HC, Smith CR, Leon MB, Cohen DJ. Effect of SAPIEN 3 Transcatheter Valve Implantation on Health Status in Patients With Severe Aortic Stenosis at Intermediate Surgical Risk: Results From the PARTNER S3i Trial. JACC Cardiovasc Interv 2018; 11:1188-1198. [PMID: 29860075 DOI: 10.1016/j.jcin.2018.02.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve (S3-TAVR) results in improved quality of life (QoL) compared with previous-generation TAVR devices or surgical aortic valve replacement (SAVR). BACKGROUND In patients with severe aortic stenosis at intermediate surgical risk, TAVR using the SAPIEN XT valve (XT-TAVR) results in similar QoL compared with SAVR. Compared with SAPIEN XT, the SAPIEN 3 valve offers a lower delivery profile and modifications to reduce paravalvular regurgitation. METHODS Between February and December 2014, 1,078 patients at intermediate surgical risk with severe aortic stenosis were treated with S3-TAVR in the PARTNER S3i (Placement of Aortic Transcatheter Valve) trial. QoL was assessed at baseline, 1 month, and 1 year using the Kansas City Cardiomyopathy Questionnaire, Medical Outcomes Study Short Form-36, and EQ-5D. QoL outcomes of S3-TAVR patients were compared with those in the SAVR and XT-TAVR arms of the PARTNER 2A trial using propensity score stratification to adjust for differences between the treatment groups. RESULTS Over 1 year, S3-TAVR was associated with substantial improvements in QoL compared with baseline. At 1 month, S3-TAVR was associated with better QoL than either SAVR or XT-TAVR (adjusted differences in Kansas City Cardiomyopathy Questionnaire overall summary score 15.6 and 3.7 points, respectively; p < 0.001). At 1 year, the differences in QoL between S3-TAVR and both SAVR and XT-TAVR were reduced but remained statistically significant (adjusted differences 2.0 and 2.2 points, respectively; p < 0.05). Similar results were seen for generic QoL outcomes. CONCLUSIONS Among patients at intermediate surgical risk with severe aortic stenosis, S3-TAVR resulted in improved QoL at both 1 month and 1 year compared with both XT-TAVR and SAVR.
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Affiliation(s)
- Suzanne J Baron
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
| | | | - Susheel Kodali
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Kaijun Wang
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | | | | | - Isaac George
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - D Craig Miller
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - E Murat Tuzcu
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kevin Greason
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Craig R Smith
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Martin B Leon
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
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Informal Caregivers' Experiences and Needs When Caring for a Relative With Heart Failure: An Interview Study. J Cardiovasc Nurs 2018; 31:E1-8. [PMID: 25419945 DOI: 10.1097/jcn.0000000000000210] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden. OBJECTIVE The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home. METHODS The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis. RESULTS Two themes emerged: "living in a changed existence" and "struggling and sharing with healthcare." The first theme describes informal caregivers' experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative's symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative's healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by healthcare professionals. CONCLUSIONS Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of "self" and of "us." Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative.
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83
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Goh VJ, Tromp J, Teng THK, Tay WT, Van Der Meer P, Ling LH, Siswanto BB, Hung CL, Shimizu W, Zhang S, Narasimhan C, Yu CM, Park SW, Ngarmukos T, Liew HB, Reyes E, Yap J, MacDonald M, Richards MA, Anand I, Lam CSP. Prevalence, clinical correlates, and outcomes of anaemia in multi-ethnic Asian patients with heart failure with reduced ejection fraction. ESC Heart Fail 2018; 5:570-578. [PMID: 29604185 PMCID: PMC6073031 DOI: 10.1002/ehf2.12279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022] Open
Abstract
Aims Recent international heart failure (HF) guidelines recognize anaemia as an important comorbidity contributing to poor outcomes in HF, based on data mainly from Western populations. We sought to determine the prevalence, clinical correlates, and prognostic impact of anaemia in patients with HF with reduced ejection fraction across Asia. Methods and results We prospectively studied 3886 Asian patients (60 ± 13 years, 21% women) with HF (ejection fraction ≤40%) from 11 regions in the Asian Sudden Cardiac Death in Heart Failure study. Anaemia was defined as haemoglobin <13 g/dL (men) and <12 g/dL (women). Ethnic groups included Chinese (33.0%), Indian (26.2%), Malay (15.1%), Japanese/Korean (20.2%), and others (5.6%). Overall, anaemia was present in 41%, with a wide range across ethnicities (33–54%). Indian ethnicity, older age, diabetes, and chronic kidney disease were independently associated with higher odds of anaemia (all P < 0.001). Ethnicity modified the association of chronic kidney disease with anaemia (Pinteraction = 0.045), with the highest adjusted odds among Japanese/Koreans [2.86; 95% confidence interval (CI) 1.96–4.20]. Anaemic patients had lower Kansas City Cardiomyopathy Questionnaire scores (P < 0.001) and higher risk of all‐cause mortality and HF hospitalization at 1 year (hazard ratio = 1.28, 95% CI 1.08–1.50) compared with non‐anaemic patients. The prognostic impact of anaemia was modified by ethnicity (Pinteraction = 0.02), with the greatest hazard ratio in Japanese/Koreans (1.82; 95% CI 1.14–2.91). Conclusions Anaemia is present in a third to more than half of Asian patients with HF and adversely impacts quality of life and survival. Ethnic differences exist wherein prevalence is highest among Indians, and survival is most severely impacted by anaemia in Japanese/Koreans.
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Affiliation(s)
| | - Jasper Tromp
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Peter Van Der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bambang B Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shu Zhang
- Fuwai Cardiovascular Hospital, Beijing, China
| | | | | | | | | | - Houng Bang Liew
- Queen Elizabeth II Hospital, Clinical Research Center, Sabah, Malaysia
| | | | | | | | - Mark A Richards
- National University Heart Centre, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Carolyn S P Lam
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.,National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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84
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Filippatos G, Maggioni AP, Lam CSP, Pieske-Kraigher E, Butler J, Spertus J, Ponikowski P, Shah SJ, Solomon SD, Scalise AV, Mueller K, Roessig L, Bamber L, Gheorghiade M, Pieske B. Patient-reported outcomes in the SOluble guanylate Cyclase stimulatoR in heArT failurE patientS with PRESERVED ejection fraction (SOCRATES-PRESERVED) study. Eur J Heart Fail 2018; 19:782-791. [PMID: 28586537 DOI: 10.1002/ejhf.800] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 12/13/2022] Open
Abstract
AIMS Exploratory assessment of the potential benefits of the novel soluble guanylate cyclase stimulator vericiguat on health status in patients with heart failure (HF) with preserved ejection fraction. METHODS AND RESULTS The SOCRATES-PRESERVED trial randomized patients with chronic HF and ejection fraction ≥ 45% within 4 weeks of decompensation to 12 weeks of treatment with titrated doses of vericiguat (1.25, 2.5, 5, and 10 mg once daily) or placebo. Health status was assessed with the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) and the generic health-related quality of life measure EQ-5D. In total, 477 patients were randomized 12.9 ± 9.0 days after hospitalization or if requiring outpatient treatment with intravenous diuretics for HF. Baseline KCCQ clinical summary score (CSS), a combination of symptom and physical function domains, was 52.3 ± 20.4 in the 10 mg arm and 54.1 ± 23.0 in placebo, and EQ-5D US index score was 0.74 ± 0.2 and 0.73 ± 0.2, respectively. A larger proportion of patients treated with vericiguat in the 10 mg arm, compared with placebo, achieved clinically meaningful improvements in KCCQ-CSS (82.0% vs. 59.0%, number needed to treat = 4.35, P = 0.0052). Important domains of the KCCQ as well as EQ-5D scores demonstrated a dose-dependent relationship with vericiguat. In the 10 mg arm, the mean physical limitations domain increased by +17.2 ± 19.1 at 12 weeks, compared with +4.5 ± 21.6 in placebo (P = 0.0009). The EQ-5D US index score increased by +0.064 ± 0.167 in the 10 mg arm, compared with a decrease of -0.009 ± 0.195 in placebo (P = 0.0461). Improvements in KCCQ and EQ-5D scores paralleled physician-assessed NYHA class and clinical congestion. CONCLUSION Vericiguat, in exploratory hypothesis-generating analyses, was associated with clinically important improvements in patients' health status, as assessed by the KCCQ and EQ-5D. Further studies should be conducted to test the hypothesis that vericiguat improves physical functioning and health-related quality of life in patients with HF with preserved ejection fraction.
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Affiliation(s)
- Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Aldo P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore and Duke-National University of Singapore, Singapore
| | - Elisabeth Pieske-Kraigher
- Charité Universitätsmedizin, Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Germany
| | - Javed Butler
- Division of Cardiology, Stony Brook University, Stony Brook, NY, USA
| | - John Spertus
- Mid America Heart Institute of Saint Luke's Hospital, Kansas City, MO, USA
| | | | | | - Scott D Solomon
- Brigham and Women's Hospital, Cardiovascular Division, Boston, MA, USA
| | | | | | | | | | - Mihai Gheorghiade
- Northwestern University Feinberg School of Medicine, Center for Cardiovascular Innovation, Chicago, IL, USA
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum; Charité University Medicine Berlin, and Department of Internal Medicine and Cardiology, German Heart Center Berlin, and DZHK (German Center for Cardiovascular Research), Berlin, Germany
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85
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Pokharel Y, Khariton Y, Tang Y, Nassif ME, Chan PS, Arnold SV, Jones PG, Spertus JA. Association of Serial Kansas City Cardiomyopathy Questionnaire Assessments With Death and Hospitalization in Patients With Heart Failure With Preserved and Reduced Ejection Fraction: A Secondary Analysis of 2 Randomized Clinical Trials. JAMA Cardiol 2017; 2:1315-1321. [PMID: 29094152 PMCID: PMC5814994 DOI: 10.1001/jamacardio.2017.3983] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/12/2017] [Indexed: 12/21/2022]
Abstract
Importance While there is increasing emphasis on incorporating patient-reported outcome measures in routine care for patients with heart failure (HF), how best to interpret longitudinally collected patient-reported outcome measures is unknown. Objective To examine the strength of association between prior, current, or a change in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores with death and hospitalization in patients with HF with preserved (HFpEF) and reduced (HFrEF) ejection fractions. Design, Setting, and Participants Secondary analyses of the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial of 1372 patients with HFpEF, conducted between August 2006 and January 2012, and the HF-ACTION trial that included 1669 patients with HFrEF, conducted between April 2003 and February 2007. Exposures Prior, current, and change in KCCQ Overall Summary scores (KCCQ-os) in 5-point increments (higher scores indicate better health status). Main Outcomes and Measures Time to cardiovascular death/first HF hospitalization (primary outcome) and all-cause death (secondary outcome). Results Of 1767 eligible TOPCAT participants, 882 were women (49.9%), and the mean (SD) age was 71.5 (9.7) years. Of 2130 eligible HF-ACTION participants, 599 were women (28.1%), and the mean age was 58.6 (12.7) years. Each 5-point difference in prior or current KCCQ-os scores was associated with a 6% (95% CI, 4%-8%; P < .001) to 9% (95% CI, 7%-11%; P < .001) lower risk for subsequent cardiovascular death/first HF hospitalization in patients with HFpEF and 6% (95% CI, 4%-9%; P < .001) to 8% (95% CI, 5%-10%; P < .001) lower risk for subsequent cardiovascular death/first HF hospitalization in patients with HRpEF and HFrEF in unadjusted analyses. Results were similar for change in KCCQ-os. In models with the prior and current KCCQ-os, only the current KCCQ-os was significantly associated with 10% (95% CI, 7%-12%; P < .001) and 7% (95% CI, 3%-11%; P < .001) lower risk for subsequent cardiovascular death/first HF hospitalization in patients with HFpEF and HFrEF, respectively. Similar results were observed when the current and Δ KCCQ-os were considered together, when adjusted for important patient and treatment characteristics, when including 3 sequential KCCQ-os scores, and when examining all-cause death as the outcome. Conclusions and Relevance In serial health status evaluations of patients with HF, the most recent KCCQ score was most strongly associated with subsequent death and cardiovascular hospitalization in HFpEF and HFrEF. Measuring serial patient-reported outcome measures in the clinical care of patients with HF can provide an updated assessment of prognosis. Trial Registration clinicaltrials.gov Identifier: NCT00094302 (TOPCAT) and NCT00047437 (HF-ACTION).
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Affiliation(s)
- Yashashwi Pokharel
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Yevgeniy Khariton
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Yuanyuan Tang
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Michael E. Nassif
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Paul S. Chan
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Suzanne V. Arnold
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Philip G. Jones
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - John A. Spertus
- University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
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86
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Raffel J, Wallace A, Gveric D, Reynolds R, Friede T, Nicholas R. Patient-reported outcomes and survival in multiple sclerosis: A 10-year retrospective cohort study using the Multiple Sclerosis Impact Scale-29. PLoS Med 2017; 14:e1002346. [PMID: 28692670 PMCID: PMC5503162 DOI: 10.1371/journal.pmed.1002346] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/07/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is increasing emphasis on using patient-reported outcomes (PROs) to complement traditional clinical outcomes in medical research, including in multiple sclerosis (MS). Research, particularly in oncology and heart failure, has shown that PROs can be prognostic of hard clinical endpoints such as survival time (time from study entry until death). However, unlike in oncology or cardiology, it is unknown whether PROs are associated with survival time in neurological diseases. The Multiple Sclerosis Impact Scale-29 (MSIS-29) is a PRO sensitive to short-term change in MS, with questions covering both physical and psychological quality of life. This study aimed to investigate whether MSIS-29 scores can be prognostic for survival time in MS, using a large observational cohort of people with MS. METHODS AND FINDINGS From 15 July 2004 onwards, MSIS-29 questionnaires were completed by people with MS registered with the MS Society Tissue Bank (n = 2,126, repeated 1 year later with n = 872 of the original respondents). By 2014, 264 participants (12.4%) had died. Higher baseline MSIS-29 physical (MSIS-29-PHYS) score was associated with reduced survival time (subgroup with highest scores versus subgroup with lowest scores: hazard ratio [HR] 5.7, 95% CI 3.1-10.5, p < 0.001). Higher baseline MSIS-29 psychological score was also associated with reduced survival time (subgroup with highest scores versus subgroup with lowest scores: HR 2.8, 95% CI 1.8-4.4, p < 0.001). In those with high baseline MSIS-29 scores, mortality risk was even greater if the MSIS-29 score worsened over 1 year (HR 2.3, 95% CI 1.2-4.4, p = 0.02). MSIS-29-PHYS scores were associated with survival time independent of age, sex, and patient-reported Expanded Disability Status Scale score in a Cox regression analysis (per 1-SD increase in MSIS-29-PHYS score: HR 1.8, 95% CI 1.1-2.9, p = 0.03). A limitation of the study is that this cohort had high baseline age and disability levels; the prognostic value of MSIS-29 for survival time at earlier disease stages requires further investigation. CONCLUSIONS This study reports that PROs can be prognostic for hard clinical outcomes in neurological disease, and supports PROs as a meaningful clinical outcome for use in research and clinical settings.
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Affiliation(s)
- Joel Raffel
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alison Wallace
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Djordje Gveric
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Richard Reynolds
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Richard Nicholas
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
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87
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Van Beek MH, Roest AM, Wardenaar KJ, Van Balkom AJ, Speckens AE, Oude Voshaar RC, Zuidersma M. The Prognostic Effect of Physical Health Complaints With New Cardiac Events and Mortality in Patients With a Myocardial Infarction. PSYCHOSOMATICS 2017; 58:121-131. [DOI: 10.1016/j.psym.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
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Flint KM, Schmiege SJ, Allen LA, Fendler TJ, Rumsfeld J, Bekelman D. Health Status Trajectories Among Outpatients With Heart Failure. J Pain Symptom Manage 2017; 53:224-231. [PMID: 27756621 DOI: 10.1016/j.jpainsymman.2016.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT Health status (i.e., symptoms, function, and quality of life) is an important palliative care outcome in patients with heart failure; however, patterns of health status over time (i.e., trajectories) are not well described. OBJECTIVES The objective of this study was to identify health status trajectories in outpatients with heart failure and assess whether depression, symptom burden, or sense of peace predict health status trajectory. METHODS This is an observational study utilizing data from the Patient-Centered Disease Management for Heart Failure trial. Participants completed Kansas City Cardiomyopathy Questionnaires at baseline, three, six, and 12 months. Latent class growth analysis identified health status trajectories; multinomial logistic regression models identified predictors of trajectory membership. RESULTS Patients (n = 384) were primarily men (97%) and older (mean age 67.6 ± 10.1). Three health status trajectories were identified. All three trajectories improved at three months; however, the marked improvement health status trajectory (n = 19) showed progressive improvement over one year, whereas the poor (n = 119) and moderate (n = 246) health status trajectories had little change after three months. In adjusted analyses, worse baseline depression (odds ratio 1.10; 95% confidence interval 1.01-1.20), symptom burden (1.45; 1.15-1.83), and sense of peace (0.41; 0.22-0.75) predicted membership in the poor vs. moderate health status trajectory. CONCLUSION We identified three one-year health status trajectories in patients with heart failure, with the two most common trajectories characterized by early improvement followed by limited change. Future research should assess these findings in nonveterans and women and explore whether treatment of depression, high symptom burden, and low sense of peace leads to improved long-term heart failure health status trajectory.
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Affiliation(s)
- Kelsey M Flint
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA.
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Larry A Allen
- Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA; Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA
| | - Timothy J Fendler
- Division of Cardiovascular Diseases, St. Luke's Mid-American Heart Institute, University of Missouri, Kansas City, Missouri, USA
| | - John Rumsfeld
- American College of Cardiology, Washington, District of Columbia, USA
| | - David Bekelman
- Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA; VA Eastern Colorado Health Care System, Denver, Colorado, USA; Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA
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Gusdal AK, Josefsson K, Thors Adolfsson E, Martin L. Registered Nurses' Perceptions about the Situation of Family Caregivers to Patients with Heart Failure - A Focus Group Interview Study. PLoS One 2016; 11:e0160302. [PMID: 27505287 PMCID: PMC4978469 DOI: 10.1371/journal.pone.0160302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 07/18/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Heart failure is a growing public health problem associated with poor quality of life and significant morbidity and mortality. The majority of heart failure care is provided by family caregivers, and is associated with caregiver burden and reduced quality of life. Research emphasizes that future nursing interventions should recognize the importance of involving family caregivers to achieve optimal outcomes. Aims The aims of this study are to explore registered nurses’ perceptions about the situation of family caregivers to patients with heart failure, and registered nurses’ interventions, in order to improve family caregivers’ situation. Methods The study has a qualitative design with an inductive approach. Six focus group interviews were held with 23 registered nurses in three hospitals and three primary health care centres. Data were analysed using qualitative content analysis. Results Two content areas were identified by the a priori study aims. Four categories and nine sub-categories emerged in the analysis process. The content area “Family caregivers' situation” includes two categories: “To be unburdened” and “To comprehend the heart failure condition and its consequences”. The content area “Interventions to improve family caregivers' situation” includes two categories: “Individualized support and information” and “Bridging contact”. Conclusions Registered nurses perceive family caregivers' situation as burdensome, characterized by worry and uncertainty. In the PHCCs, the continuity and security of an RN as a permanent health care contact was considered an important and sustainable intervention to better care for family caregivers' worry and uncertainty. In the nurse-led heart failure clinics in hospitals, registered nurses can provide family caregivers with the opportunity of involvement in their relative's health care and address congruence and relationship quality within the family through the use of "Shared care" and or Family-centred care. Registered nurses consider it necessary to have a coordinated individual care plan as a basis for collaboration between the county council and the municipality.
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Affiliation(s)
- Annelie K. Gusdal
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
- * E-mail:
| | - Karin Josefsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Eva Thors Adolfsson
- Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västerås, Sweden
- Department of Primary Health Care, Västmanland County Hospital, Västerås, Sweden
| | - Lene Martin
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
- School of Health Sciences, City University, London, United Kingdom
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Psotka MA, von Maltzahn R, Anatchkova M, Agodoa I, Chau D, Malik FI, Patrick DL, Spertus JA, Wiklund I, Teerlink JR. Patient-Reported Outcomes in Chronic Heart Failure: Applicability for Regulatory Approval. JACC-HEART FAILURE 2016; 4:791-804. [PMID: 27395351 DOI: 10.1016/j.jchf.2016.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/14/2016] [Accepted: 04/27/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The study sought to review the characteristics of existing patient-reported outcome (PRO) instruments used with chronic heart failure (HF) patients and evaluate their potential to support an approved U.S. Food and Drug Administration (FDA) product label claim. BACKGROUND PROs, including symptoms and their associated functional limitations, contribute substantially to HF patient morbidity. PRO measurements capture the patient perspective and can be systematically assessed with structured questionnaires, however rigorous recommendations have been set by the FDA regarding the acceptability of PRO measures as a basis for product label claims. METHODS Extensive searches of databases and specialty guidelines identified PRO instruments used in patients with chronic HF. Information on critical properties recommended by the FDA guidance were systematically extracted and used to evaluate the selected PRO instruments. RESULTS Nineteen PRO instruments used with chronic HF patients were identified. The Kansas City Cardiomyopathy Questionnaire and Minnesota Living with Heart Failure Questionnaire were the most extensively evaluated and validated in studies of this population. However, judged by criteria listed in the FDA PRO guidance, no existing PRO measure met all of the criteria to support a product label claim in the United States. CONCLUSIONS Currently available chronic HF PRO measures do not fulfill all the recommendations provided in the FDA PRO guidance and therefore may not support an FDA-approved product label claim. Future investigations are merited to develop a PRO measure for use in patients with chronic HF in accordance with the FDA guidance.
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Affiliation(s)
- Mitchell A Psotka
- School of Medicine, University of California San Francisco and Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | | | | | - Dina Chau
- Amgen Inc., Thousand Oaks, California
| | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, California
| | - Donald L Patrick
- Department of Health Services, University of Washington, Seattle, Washington
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and Department of Biomedical and Health Informatics, University of Missouri, Kansas City, Missouri
| | | | - John R Teerlink
- School of Medicine, University of California San Francisco and Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California.
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Utility of Patient-Reported Outcome Instruments in Heart Failure. JACC-HEART FAILURE 2016; 4:165-75. [DOI: 10.1016/j.jchf.2015.10.015] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
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Versteeg H, Denollet J, Meine M, Pedersen SS. Patient-reported health status prior to cardiac resynchronisation therapy identifies patients at risk for poor survival and prolonged hospital stays. Neth Heart J 2015; 24:18-24. [PMID: 26645709 PMCID: PMC4692829 DOI: 10.1007/s12471-015-0775-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Patient-reported factors have largely been neglected in search of predictors of response to cardiac resynchronisation therapy (CRT). The current study aimed to examine the independent value of pre-implantation patient-reported health status in predicting four-year survival and cardiac-related hospitalisation of CRT patients. Methods Consecutive patients (N = 139) indicated to receive a first-time CRT-defibrillator at the University Medical Center Utrecht were asked to complete a set of questionnaires prior to implantation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess heart failure-specific health status. Data on patients’ demographic, clinical and psychological characteristics at baseline, and on cardiac-related hospitalisations and all-cause deaths during a median follow-up of 3.9 years were obtained from purpose-designed questionnaires and patients’ medical records. Results Results of multivariable Cox regression analyses showed that poor patient-reported health status (KCCQ score < 50) prior to implantation was associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death, independent of sociodemographic, clinical and psychological risk factors (adjusted hazard ratio 2.46, 95 % confidence interval (CI) 1.30–4.65). Poor health status was not significantly associated with the absolute number of cardiac-related hospital admissions, but with the total number of days spent in hospital during follow-up (adjusted incidence rate ratio 3.20, 95 % CI 1.88–5.44). Conclusions Patient-reported health status assessed prior to CRT identifies patients at risk for poor survival and prolonged hospital stays, independent of traditional risk factors. These results emphasise the importance of incorporating health status measures in cardiovascular research and patient management. Heart failure patients reporting poor health status should be identified and offered appropriate additional treatment programs.
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Affiliation(s)
- H Versteeg
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
| | - J Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - M Meine
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - S S Pedersen
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Spertus JA, Jones PG. Development and Validation of a Short Version of the Kansas City Cardiomyopathy Questionnaire. Circ Cardiovasc Qual Outcomes 2015; 8:469-76. [PMID: 26307129 PMCID: PMC4885562 DOI: 10.1161/circoutcomes.115.001958] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a growing demand to collect patients' experiences of their health status (their symptoms, function, and quality of life) in clinical trials, quality assessment initiatives, and in routine clinical care. In heart failure, the 23-item, disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) has been shown to be valid, reliable, sensitive to clinical change, and prognostic of both clinical events and costs. However, its use has been limited, in part, by its length. We sought to develop a shortened version of the instrument that maintains the psychometric properties of the full KCCQ. METHODS AND RESULTS Using data from 3 clinical studies incorporating 4168 patients, we derived and validated a 12-item KCCQ, the KCCQ-12, to capture symptom frequency, physical and social limitations, and quality of life impairment as a result of heart failure, as well as an overall summary score. The KCCQ-12 scores had high correlations with the original scales (>0.93 for all scales in all clinical settings), high test–retest reliability (>0.76 for all domains), high responsiveness (16–31 point improvements after discharge from hospitalization; standardized response mean =0.61–1.12), and comparable prognostic significance and interpretation of clinically important differences as compared with the full KCCQ. CONCLUSIONS The KCCQ-12 is a shorter version of the original 23-item instrument that should be more feasible to implement while preserving the psychometric properties of the full instrument.
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Affiliation(s)
- Nariman Sepehrvand
- From the Canadian VIGOUR Centre (N.S., J.A.E.) and Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada (J.A.E.)
| | - Justin A. Ezekowitz
- From the Canadian VIGOUR Centre (N.S., J.A.E.) and Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada (J.A.E.)
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Masoudi FA. Health Status and Incident Heart Failure in Chronic Kidney Disease: Accumulating Evidence to Use Patient-Reported Measures in Clinical Care. Circ Heart Fail 2015. [PMID: 26199307 DOI: 10.1161/circheartfailure.115.002360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Frederick A Masoudi
- From the Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus and the Colorado Cardiovascular Outcomes Research Consortium (CCOR), Aurora.
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96
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Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, Delville C, Davila A. Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure. J Cardiovasc Nurs 2015; 30:S3-13. [PMID: 24978157 PMCID: PMC4276559 DOI: 10.1097/jcn.0000000000000169] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. OBJECTIVE The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention. METHODS This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. RESULTS The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). CONCLUSIONS An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.
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Affiliation(s)
- Angela P Clark
- Angela P. Clark, PhD, RN, ACNS-BC, FAAN, FAHA Associate Professor of Nursing Emerita, The University of Texas at Austin. Graham McDougall, PhD, RN, FAAN, FGSA Professor of Nursing, The University of Alabama at Tuscaloosa. Barbara Riegel, PhD, RN, FAHA, FAAN Professor of Nursing, School of Nursing, The University of Pennsylvania, Philadelphia. Glenda Joiner-Rogers, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Sheri Innerarity, PhD, RN, ACNS-BC, FNP Associate Professor of Clinical Nursing, The University of Texas at Austin. Martha Meraviglia, PhD, RN, ACNS-BC Associate Professor of Clinical Nursing, The University of Texas at Austin. Carol Delville, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Ashley Davila, MSN, ACNS-BC Clinical Nurse Specialist, Texas Diabetes and Endocrinology, Austin
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97
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Mishra RK, Yang W, Roy J, Anderson AH, Bansal N, Chen J, DeFilippi C, Delafontaine P, Feldman HI, Kallem R, Kusek JW, Lora CM, Rosas SE, Go AS, Shlipak MG. Kansas City Cardiomyopathy Questionnaire Score Is Associated With Incident Heart Failure Hospitalization in Patients With Chronic Kidney Disease Without Previously Diagnosed Heart Failure: Chronic Renal Insufficiency Cohort Study. Circ Heart Fail 2015; 8:702-8. [PMID: 25985796 DOI: 10.1161/circheartfailure.115.002097] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 05/15/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Chronic kidney disease is a risk factor for heart failure (HF). Patients with chronic kidney disease without diagnosed HF have an increased burden of symptoms characteristic of HF. It is not known whether these symptoms are associated with occurrence of new onset HF. METHODS AND RESULTS We studied the association of a modified Kansas City Cardiomyopathy Questionnaire with newly identified cases of hospitalized HF among 3093 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study who did not report HF at baseline. The annually updated Kansas City Cardiomyopathy Questionnaire score was categorized into quartiles (Q1-4) with the lower scores representing the worse symptoms. Multivariable-adjusted repeated measure logistic regression models were adjusted for demographic characteristics, clinical risk factors for HF, N-terminal probrain natriuretic peptide level and left ventricular hypertrophy, left ventricular systolic and diastolic dysfunction. Over a mean (±SD) follow-up period of 4.3±1.6 years, there were 211 new cases of HF hospitalizations. The risk of HF hospitalization increased with increasing symptom quartiles; 2.62, 1.85, 1.14, and 0.74 events per 100 person-years, respectively. The median number of annual Kansas City Cardiomyopathy Questionnaire assessments per participant was 5 (interquartile range, 3-6). The annually updated Kansas City Cardiomyopathy Questionnaire score was independently associated with higher risk of incident HF hospitalization in multivariable-adjusted models (odds ratio, 3.30 [1.66-6.52]; P=0.001 for Q1 compared with Q4). CONCLUSIONS Symptoms characteristic of HF are common in patients with chronic kidney disease and are associated with higher short-term risk for new hospitalization for HF, independent of level of kidney function, and other known HF risk factors.
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Affiliation(s)
- Rakesh K Mishra
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Wei Yang
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Jason Roy
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Amanda H Anderson
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Nisha Bansal
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Jing Chen
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Christopher DeFilippi
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Patrice Delafontaine
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Harold I Feldman
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Radhakrishna Kallem
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - John W Kusek
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Claudia M Lora
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Sylvia E Rosas
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Alan S Go
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Michael G Shlipak
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
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Campbell RT, Jackson CE, Wright A, Gardner RS, Ford I, Davidson PM, Denvir MA, Hogg KJ, Johnson MJ, Petrie MC, McMurray JJV. Palliative care needs in patients hospitalized with heart failure (PCHF) study: rationale and design. ESC Heart Fail 2015; 2:25-36. [PMID: 27347426 PMCID: PMC4864752 DOI: 10.1002/ehf2.12027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 01/29/2023] Open
Abstract
Aims The primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes. Methods An unselected, prospective, near‐consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2‐year period. All potential participants will be screened using B‐type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease‐specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed. Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF.
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Affiliation(s)
- Ross T Campbell
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
| | | | - Ann Wright
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics University of Glasgow UK
| | | | | | | | | | - Mark C Petrie
- Robertson Centre for Biostatistics University of Glasgow UK
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
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Wessler JD, Maurer MS, Hummel SL. Evaluating the safety and efficacy of sodium-restricted/Dietary Approaches to Stop Hypertension diet after acute decompensated heart failure hospitalization: design and rationale for the Geriatric OUt of hospital Randomized MEal Trial in Heart Failure (GOURMET-HF). Am Heart J 2015; 169:342-348.e4. [PMID: 25728723 DOI: 10.1016/j.ahj.2014.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/21/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) is a major public health problem affecting predominantly older adults. Nonadherence to diet remains a significant contributor to acute decompensated HF (ADHF). The sodium-restricted Dietary Approaches to Stop Hypertension (DASH/SRD) eating plan reduces cardiovascular dysfunction that can lead to ADHF and is consistent with current HF guidelines. We propose that an intervention that promotes adherence to the DASH/SRD by home-delivering meals will be safe and improve health-related quality of life (QOL) in older adults after hospitalization for ADHF. METHODS/DESIGN This is a 3-center, randomized, single-blind, controlled trial of 12-week duration designed to determine the safety and efficacy of home-delivered DASH/SRD-compliant meals in older adults after discharge from ADHF hospitalization. Sixty-six subjects will be randomized in a 1:1 stratified fashion by gender and left ventricular ejection fraction (<50% vs ≥50%). Study subjects will receive either preprepared, home-delivered DASH/SRD-compliant meals or usual dietary advice for 4weeks after hospital discharge. Investigators will be blinded to group assignment, food diaries, and urinary electrolyte measurements until study completion. The primary efficacy end point is the change in the Kansas City Cardiomyopathy Questionnaire summary scores for health-related QOL from study enrollment to 4weeks postdischarge. Safety evaluation will focus on hypotension, renal insufficiency, and hyperkalemia. Exploratory end points include echocardiography, noninvasive vascular testing, markers of oxidative stress, and salt taste sensitivity. CONCLUSION This randomized controlled trial will test the efficacy, feasibility, and safety of 4weeks of DASH/SRD after ADHF hospitalization. By testing a novel dietary intervention supported by multiple levels of evidence including preliminary data in outpatients with stable HF, we will address a critical evidence gap in the care of older patients with ADHF. If effective and safe, this intervention could be scaled to assess effects on readmission and healthcare costs in older adults after ADHF.
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Affiliation(s)
- Jeffrey D Wessler
- Department of Medicine/Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Mathew S Maurer
- Department of Medicine/Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Scott L Hummel
- Department of Medicine/Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI; Ann Arbor Veterans Affairs Health System, Ann Arbor, MI.
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Thompson LE, Bekelman DB, Allen LA, Peterson PN. Patient-Reported Outcomes in Heart Failure: Existing Measures and Future Uses. Curr Heart Fail Rep 2015; 12:236-46. [DOI: 10.1007/s11897-015-0253-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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