Elsevier

JACC: Heart Failure

Volume 7, Issue 7, July 2019, Pages 615-625
JACC: Heart Failure

Clinical Research
Association of Changes in Heart Failure Treatment With Patients’ Health Status: Real-World Evidence From CHAMP-HF

https://doi.org/10.1016/j.jchf.2019.03.020Get rights and content
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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.

Key Words

health status
heart failure with reduced ejection fraction
Kansas City Cardiomyopathy Questionnaire
medications
quality

Abbreviations and Acronyms

CI
confidence interval
GDMT
guideline-directed medical therapy
HF
heart failure
HFrEF
heart failure with reduced ejection fraction
KCCQ
Kansas City Cardiomyopathy Questionnaire
MRA
mineralocorticoid antagonist
PRO
patient-reported outcome

Cited by (0)

Dr. Khariton is supported by the National Heart, Lung, and Blood Institute under award T32HL110837 (the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health). Dr. Fonarow has received research support from the National Institutes of Health; is a consultant for Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical; and has served on the Get With the Guidelines Steering Committee. Dr. Butler has received research support from the National Institutes of Health and the European Union; and serves as a consultant for Amgen, Bayer, Boehringer Ingelheim, Cardiocell, CVRx, Gilead, Janssen, Medtronic, Merck, Novartis, Relypsa, and ZS Pharma. Dr. Thomas has received research funding from Novartis Pharmaceuticals. Dr. DeVore has received research support from the American Heart Association, Amgen, the National Institutes of Health, and Novartis; and provides consulting services for Novartis. Dr. Hernandez has received research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, and Novartis; and has received honoraria from Bayer, Boston Scientific, and Novartis. Dr. Albert is a consultant for Novartis and Boston Scientific; and has received honoraria from Novartis. Dr. Spertus has received grant funding from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, Novartis, and Abbott Vascular; serves on a Scientific Advisory Board for United Healthcare; is a consultant for Novartis, Bayer, V-Wave, AstraZeneca, Janssen, Corvia, and Bayer; has intellectual property rights for the Kansas City Cardiomyopathy Questionnaire; and has an equity interest in Health Outcomes Science. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.