亚洲心力衰竭患者报告的与医生评估的射血分数降低和保留的心力衰竭健康状况

IF 6.9 2区医学

Circulation. Cardiovascular Quality and Outcomes Pub Date : 2023-01-01 DOI:10.1161/CIRCOUTCOMES.122.009134

Kanako Teramoto, Wan Ting Tay, Jasper Tromp, Tiew-Hwa Katherine Teng, Chanchal Chandramouli, Wouter Ouwerkerk, Claire A Lawson, Weiting Huang, Chung-Lieh Hung, Vijay Chopra, Inder Anand, Arthur Mark Richards, Carolyn S P Lam

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引用次数: 0

摘要

背景:我们旨在评估患者报告的堪萨斯城心肌病问卷(KCCQ)-总体总结(os)评分与医生评估的纽约心脏协会(NYHA)分级之间的不一致是否在射血分数降低或保留的心力衰竭(HF)患者中普遍存在，并确定其与预后的关系。方法:将4818例HF患者按KCCQ-os评分(范围0 ~ 100，按中位数71.9分为高[好]对低[差])和NYHA分级(I/II[好]或III/IV[差])分为和谐良好(低NYHA分级，高KCCQ-os评分)、和谐不良(高NYHA分级，低KCCQ-os评分)、不和谐较差NYHA分级(高NYHA分级，高KCCQ-os评分)、不和谐较差KCCQ-os评分(低NYHA分级，低KCCQ-os评分)。比较两组间1年HF住院或死亡的综合情况。结果:良好2070例(43.0%)，不良1099例(22.8%)，较差NYHA评分331例(6.9%)，较差KCCQ-os评分1318例(27.4%)。与良好患者相比，不良患者不良结局最高(HR, 2.7 [95% CI, 2.2-3.5])，其次是KCCQ-os评分不一致(HR, 1.8 [95% CI, 1.4-2.2])和NYHA评分不一致(HR, 1.5 [95% CI, 1.0-2.3]);无HF表型改变(保留与减少射血分数，相互作用p =0.52)。6个月时，1403例(48%)患者KCCQ-os评分有临床显著改善(6个月增加≥5分)。6个月时KCCQ-os改善的患者(HR, 0.65 [95% CI, 0.47-0.92])有更好的预后，且相关性不受HF表型的影响(p交互作用=0.40)。结论:三分之一的心衰患者报告的健康状况与临床评估的不一致，主要是由于患者报告的预后较差。这种不一致，特别是在KCCQ不一致的患者中，应该提醒医生注意HF住院和死亡的风险增加，并提示进一步评估患者报告的结果相对于医生评估更差的潜在驱动因素。

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Patient-Reported Versus Physician-Assessed Health Status in Heart Failure With Reduced and Preserved Ejection Fraction From ASIAN-HF Registry.

Background: We aimed to assess if discordance between patient-reported Kansas City Cardiomyopathy Questionnaire (KCCQ)-overall summary (os) score and physician-assessed New York Heart Association (NYHA) class is common among patients with heart failure (HF) with reduced or preserved ejection fraction, and determine its association with outcomes.

Methods: A total of 4818 patients with HF were classified according to KCCQ-os score (range 0-100, dichotomized by median value 71.9 into high [good] versus low [bad]) and NYHA class (I/II [good] or III/IV [bad]) as concordant good (low NYHA class, high KCCQ-os score), concordant bad (high NYHA class, low KCCQ-os score), discordant worse NYHA class (high NYHA class, high KCCQ-os score), and discordant worse KCCQ-os score (low NYHA class, low-KCCQ-os score). The composite of HF hospitalization or death at 1 year was compared across groups.

Results: There were 2070 (43.0%) concordant good, 1099 (22.8%) concordant bad, 331 (6.9%) discordant worse NYHA class, and 1318 (27.4%) discordant worse KCCQ-os score patients. Compared with concordant good, adverse outcomes were the highest in concordant bad (HR, 2.7 [95% CI, 2.2-3.5]) followed by discordant worse KCCQ-os score (HR, 1.8 [95% CI, 1.4-2.2]) and discordant worse NYHA class (HR, 1.5 [95% CI, 1.0-2.3]); with no modification by HF phenotype (preserved versus reduced ejection fraction, P_interaction=0.52). At 6 months, 1403 (48%) experienced clinically significant improvement in KCCQ-os score (≥5 points increase over 6 months). Patients with improved KCCQ-os at 6 months (HR, 0.65 [95% CI, 0.47-0.92]) had better outcomes and the association was not modified by HF phenotype (P_interaction=0.40).

Conclusions: One-third of patients with HF had discordance between patient-reported and clinician-assessed health status, largely attributable to worse patient-reported outcomes. Such discordance, particularly in those with discordantly worse KCCQ, should alert physicians to an increased risk of HF hospitalization and death, and prompt further assessment for potential drivers of worse patient-reported outcomes relative to physicians' assessment.

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来源期刊

Circulation. Cardiovascular Quality and Outcomes Medicine-Cardiology and Cardiovascular Medicine

CiteScore

9.80

自引率

2.90%

发文量

357

期刊介绍： Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.