Elsevier

JACC: Heart Failure

Volume 9, Issue 12, December 2021, Pages 861-873
JACC: Heart Failure

Mini-focus Issue: Acute Decompensated Heart Failure
Clinical Research
Health Status Predicts Short- and Long-Term Risk of Composite Clinical Outcomes in Acute Heart Failure

https://doi.org/10.1016/j.jchf.2021.06.015Get rights and content
Under a Creative Commons license
open access

Abstract

Objectives

This study aims to examine the association between the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score and the 30-day and 1-year rates of composite events of cardiovascular death and heart failure (HF) rehospitalization in patients with acute HF.

Background

Few studies reported the prognostic effects of KCCQ in acute HF.

Methods

This study prospectively enrolled adult patients hospitalized for HF from 52 hospitals in China and collected the KCCQ-12 score within 48 hour of index admission. The study used multivariable Cox regression to examine the association between KCCQ-12 score and 30-day and 1-year composite events and was further stratified by new-onset HF and acutely decompensated chronic heart failure (ADCHF). Subgroup analyses were performed to explore the potential heterogeneity. The study evaluated the incremental prognostic value of KCCQ-12 score over N-terminal pro−B-type natriuretic peptide (NT-proBNP) levels and established risk scores by C-statistics, net reclassification improvement, and integrated discrimination improvement.

Results

Among 4,898 patients, 29.4% had new-onset HF. After adjustment, each 10-point decrease in the KCCQ-12 score was associated with a 13% increase in 30-day risk and a 7% increase in 1-year risk. The associations were consistent regardless of new-onset HF or ADCHF, age, sex, left ventricular ejection fraction, New York Heart Association functional class, NT-proBNP level, comorbidities, and renal function. Adding KCCQ-12 score to NT-proBNP and established risk scores significantly improved prognostic capabilities measured by C-statistics, net reclassification improvement, and integrated discrimination improvement.

Conclusions

In acute HF, a poor KCCQ-12 score predicted short- and long-term risks of cardiovascular death and HF rehospitalization. KCCQ-12 could serve as a convenient tool for rapid initial risk stratification and provide additional prognostic value over NT-proBNP and established risk scores.

Key Words

acute heart failure
cardiovascular death
health status
KCCQ
prognosis
rehospitalization

Abbreviations and Acronyms

ADCHF
acutely decompensated chronic heart failure
AF
atrial fibrillation
CAD
coronary artery disease
HF
acute heart failure
IQR
interquartile range
KCCQ
Kansas City Cardiomyopathy Questionnaire
LVEF
left ventricular heart failure
NT-proBNP
N-terminal pro-B-type natriuretic peptide
NYHA
New York Heart Association

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