Cited by 192Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsHeart rate and cardiovascular health

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Comparable Performance of the Kansas City Cardiomyopathy Questionnaire in Patients With Heart Failure With Preserved and Reduced Ejection Fraction

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Joseph, Susan M., Novak, Eric, Arnold, Suzanne V., Jones, Philip G., Khattak, Himad, Platts, Anne E., Dávila-Román, Victor G., Mann, Douglas L., Spertus, John A.·2013·Circulation: Heart Failure

DOI 10.1161/circheartfailure.113.000359PMC PMC4545244

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Abstract

Background—: Despite the growing epidemic of heart failure with preserved ejection fraction (HFpEF), no valid measure of patients’ health status (symptoms, function, and quality of life) exists. We evaluated the Kansas City Cardiomyopathy Questionnaire (KCCQ), a validated measure of HF with reduced EF, in patients with HFpEF. Methods and Results—: Using a prospective HF registry, we dichotomized patients into HF with reduced EF (EF≤ 40) and HFpEF (EF≥50). The associations between New York Heart Association class, a commonly used criterion standard, and KCCQ Overall Summary and Total Symptom domains were evaluated using Spearman correlations and 2-way ANOVA with differences between patients with HF with reduced EF and HFpEF tested with interaction terms. Predictive validity of the KCCQ Overall Summary scores was assessed with Kaplan–Meier curves for death and all-cause hospitalization. Covariate adjustment was made using Cox proportional hazards models. Internal reliability was assessed with Cronbach’s α. Among 849 patients, 200 (24%) had HFpEF. KCCQ summary scores were strongly associated with New York Heart Association class in both patients with HFpEF ( r =−0.62; P <0.001) and HF with reduced EF ( r =−0.55; P =0.27 for interaction). One-year event-free rates by KCCQ category among patients with HFpEF were 0 to 25=13.8%, 26 to 50=59.1%, 51 to 75=73.8%, and 76 to 100=77.8% (log rank P <0.001), with no significant interaction by EF ( P =0.37). The KCCQ domains demonstrated high internal consistency among patients with HFpEF (Cronbach’s α=0.96 for overall summary and ≥0.69 in all subdomains). Conclusions—: Among patients with HFpEF, the KCCQ seems to be a valid and reliable measure of health status and offers excellent prognostic ability. Future studies should extend and replicate our findings, including the establishment of its responsiveness to clinical change.

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Statistics notes: Cronbach's alpha: Table 1
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Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure
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“Scores were divided into ranges of 0 to 25, 26 to 50, 51 to 75, and 76 to 100, which corresponds to severe, moderate, fair, and little-to-no disability, respectively.(7,11,20) New York Heart Association Functional Class, a physician-assigned assessment of patients’ symptoms and function, was also recorded for each pat…”
BackgroundSelf-citation
HFSA 2010 Comprehensive Heart Failure Practice Guideline
Heart Failure Society of America (2010) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2010.04.004 · Cited by 1,304
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“The availability of a tool to measure health status in patients with HFpEF is important in light of increasing evidence suggesting that QOL may be of equally great, or even greater, importance to some patients than decreased mortality, particularly in older patients with HF.35–37 As such, QOL is increasingly recognize…”
BackgroundInfluential
Heart failure with preserved left ventricular systolic function
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“25 The KCCQ has undergone extensive reliability and validity testing in various HF populations 26–28 and is used to measure health status in LVAD studies.”
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Adekunle, O. A., Schommer, J. C., Wang, Y. S., Yunusa, I. U., Fleming, M. L., Seoane-Vazquez, E. C., & Brown, L. M. (2024) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2024.100457 · Cited by 1
Platelet and Leukocyte Mitochondrial Function With Cardiac Function and Self-Reported Health Status Among Obese Patients With Heart Failure
Shen, Q., Cintron, S. A., & Pierce, J. D. (2024) · Nursing Research · doi:10.1097/nnr.0000000000000723 · Cited by 1
“The KCCQ is a reliable and valid tool used for patients with HF (Joseph et al., 2013; Pokharel et al., 2017).”
Method
SHengXIaN-QuYu DEcoction in the Treatment of Heart Failure with Reduced and Mildly-Reduced Ejection Fraction (SHINE-HF): rationale and design for a multicenter randomized controlled trial
Feng, L., Chen, S., Liu, J., Li, C., Cao, H.-S., Tao, L., Fang, F., Huo, F., Liu, L., Wubu'er, P., et al. (2025) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2025.101497 · Cited by 1
“For each domain, the validity, reproducibility, responsiveness, and interpretability have been independently established [15].”
Interatrial shunt devices in heart failure with preserved ejection fraction: A meta-analysis of randomized trials
Prata, A. A., Coan, A. C. C., Coylewright, M. J., Fernandes, J. M., Katsuyama, E. S., Fukunaga, C. K., Barbosa, G. S., Scardini, P. G., & Gioli‐Pereira, L. (2025) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2025.103154 · Cited by 1
Racial representation in heart failure clinical trials and registries: A systematic review and meta-analysis
Green, C. L., Aladesanmi, O., Chery, G. S., Jackson, L. R., & Thomas, K. L. (2025) · Journal of the National Medical Association · doi:10.1016/j.jnma.2025.11.005 · Cited by 1
Health status trajectories using Markov modeling in patients with heart failure with preserved ejection fraction
Kim, W., Yoon, M., Park, J. J., Kook, W., & Greenberg, B. (2026) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2026.01.003 · Cited by 1
Non-Cardiac Comorbidities in Acute Heart Failure: Phenotype-Specific Insights from Sub-Saharan Africa
Adamu, U. G., Nel, S., Makgoro, C., Maseko, M. J., & Tsabedze, N. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15062202 · Cited by 1
“This is consistent with prior studies showing that reduced KCCQ scores predict increased rehospitalization and mortality [37].”
Cost-Effectiveness and Budget-Impact Analysis of Semaglutide in Heart Failure with Preserved Ejection Fraction and Obesity in the German Health-Care System
Estler, B., Fröhlich, H., Täger, T., Frey, N., & Frankenstein, L. (2026) · PharmacoEconomics · doi:10.1007/s40273-026-01621-4 · Cited by 1
LCZ696 (sacubitril/valsartan) for patients with heart failure
Hernández, A. V., Pasupuleti, V., Banach, M., & Bielecka-Dabrowa, A. M. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013517 · Cited by 1
Diagnostic and therapeutic challenges for PCPs regarding heart failure with preserved ejection fraction and obesity: results of an online internet-based survey
Campos, C., MAGWIRE, M. L., Butler, J., Hoovler, A., Sabharwal, A. K., & Shah, S. J. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02549-4 · Cited by 1
“The health status (symptoms, physical limitations, and quality of life) of patients with HFpEF is as poor or worse than that of patients with HFrEF [9–11].”
Background
Health-related Quality of Life and Mortality in Incident Heart Failure from the Cardiovascular Health Study (CHS)
Woltz, P. C. (n.d.) · ProQuest Demo Repository
Economic outcomes from telecardiology services
Kaladjurdjevic, M., & Antonicelli, R. (2017) · Digital Medicine · doi:10.4103/digm.digm_9_17
Zusammenhang von gesundheitsbezogener Lebensqualität mit dem Outcome bei Patienten mit Risikofaktoren für die Entwicklung einer Herzinsuffizienz mit erhaltener Ejektionsfraktion
Beismann, C. (2019) · doi:10.53846/goediss-7743
Systems-Based Patient Work Analyses of Older Adults with Heart Failure
Mickelson, R. S. (2017)
Die Bedeutung gesundheitsbezogener Lebensqualität für die Vorhersage des ereignisfreien Überlebens bei Patienten mit kardiovaskulärem Risikoprofil
Beismann, C., Nolte, K., Wachter, R., Hashemi, D., Trippel, T. D., Edelmann, F., & Meyer, T. (2021) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2021.67.4.361
Empagliflozin (Jardiance)
CADTH (2023) · Canadian Journal of Health Technologies · doi:10.51731/cjht.2023.547
Addressing Comorbidities in Heart Failure: When Feeling Better and Living Longer go in the Same Direction
Chioncel, O., Tomasoni, D., & Metra, M. (2023) · European Journal of Heart Failure · doi:10.1002/ejhf.2998
Validação do questionário Kansas City Cardiomyopathy Questionnaire - versão reduzida, para o português do Brasil
dos Reis, M. C. (2023) · doi:10.11606/d.5.2023.tde-04082023-165103
MID-RANGE HEART FAILURE: A NEW KID ON THE BLOCK?
Mitić, V., Stojanović, D. R., Petrović, D., Stojanović, M., Šarić, S., Stojanović, S., & Deljanin-Ilić, M. (2019) · Acta Medica Medianae · doi:10.5633/amm.2019.0419
Particularities of rhythm and conduction disorders in heart failure patients with preserved ejection fraction admitted to a rehabilitation hospital
Mihăilă, M.-D., & Pop, D. (2024) · Balneo and PRM Research Journal · doi:10.12680/balneo.2024.712
“%) presented NYHA severity classes III or IV [6].”
Background
Predisposing, enabling, and need factors influencing health-related quality of life among people with metabolic syndrome
Adekunle, O. A., Wang, Y. S., Yunusa, I. U., Fleming, M. L., Seoane-Vazquez, E. C., & Brown, L. M. (2024) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2024.102255
Heart Failure with Preserved Ejection Fraction in Egypt: An Expert Opinion
Abdelhamid, M., Salem, A. Z., Kabil, H., Ragy, H. I., Hasan‐Ali, H., Elnoamany, M. F., Elsetiha, M., & Shaheen, S. M. (2025) · Global Heart · doi:10.5334/gh.1411
Is Simpler Better? The Psychometric Performance of the Kansas City Cardiomyopathy Questionnaire-12 in Symptomatic Obstructive Cardiomyopathy
Gamero, M. T., Soles, E. O., & Brailovsky, Y. (2025) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2025.03.007 · Cited by 1
Cost-utility analysis of dapagliflozin for the treatment of symptomatic chronic heart failure in Spain
Escobar, C., Pascual-Figal, D. A., Segura, J. M. G., Capel, M., Pomares, E., & Caudron, C. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13089-7
Construct and Predictive Validity of the Kansas City Cardiomyopathy Questionnaire in Adult Congenital Heart Disease
Byrne, R. D., Nair, A. P., Dolgner, S. J., Choudhry, S., Hickey, E. J., Wood, A. C., Fedson, S., Bozkurt, B., & Broda, C. R. (2025) · JACC Advances · doi:10.1016/j.jacadv.2025.102020
Health-Related Quality-of-Life Measures in Patients with Heart Failure Cardiogenic Shock Following Axillary Mechanical Circulatory Support
Mautong, H., Desai, A., Sharma, S., Ruiz, J. R., Leoni, J., & GOSWAMI, R. M. (2025) · Medical Sciences · doi:10.3390/medsci13030146
“The association of KCCQ-12 scores with prognosis has been demonstrated at the time of discharge from hospitalization for ADHF [16].”
Independent contributions of functional class, comorbidity, and frailty to health status in elderly adults with heart failurePreprint
Nguyen, H. L. H., Pham, A. T. N., Trinh, T. C., Than, T. H. N., Nguyen, T. N. H. M., & Pham, T. H. (2025) · medRxiv · doi:10.1101/2025.10.21.25337981
Impact of Atrial Fibrillation Type on Quality of Life and Clinical Parameters in Patients with Diabetes Mellitus
Ciubotaru, P. G., Kundnani, N. R., Marin-Bancila, L., Nisulescu, D. D., Albulescu, N., Sharma, A., Ivan, V. S., Buzaș, R., Ciocan, V., & Lighezan, D. (2025) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd12120453
“This result is consistent with earlier research that indicates KCCQ can distinguish between patients with varying cardiac functions, even those who are not part of traditional heart failure cohorts [24].”
Additional file 1 of A cultural and gender-based approach to understanding patient adjustment to chronic heart failure
Surikova, J., Payne, A. Y. M., Miller, K.-L., Ravaei, A., & Nolan, R. P. (2020) · Figshare · doi:10.6084/m9.figshare.12672507
Estimating the Placebo Effect on Patient-Reported Outcomes in Sham-Controlled Device Trials: Insights From REDUCE LAP-HF II
Girard, A. A., Mylavarapu, U., Komtebedde, J., Arnold, S. V., Solomon, S. D., Leon, M. B., van Veldhuisen, D. J., Cutlip, D. E., Čikeš, M., Zile, M. R., et al. (2026) · Circulation Population Health and Outcomes · doi:10.1161/circoutcomes.125.012676
Self-citation
Terminale Herzinsuffizienz: Therapie mit „Kunstherz“
Wiedemann, D., & Riebandt, J. (2026) · Wiener klinisches Magazin · doi:10.1007/s00740-025-00581-3
“[KCCQ]) belegen eine deutliche Verbes-serung gegenüber dem präoperativen Zustand (z.B. NYHA IV, KCCQ ∅ 29 Punkte) und das auch stabil über den Unterstüt-zungszeitraum hinweg [23, 24].”
An Evidence-Based Quality Improvement Project of the Impact of a Nurse Practitioner-Led Heart Failure, Self-Care-Focused, Patient Education on Health Care-Related Quality of Life
Sraboyants, T. (2026) · Journal of Doctoral Nursing Practice · doi:10.1891/jdnp-2021-0023
Trayectorias del estado de salud mediante el modelo de Markov en pacientes con insuficiencia cardiaca con fracción de eyección conservada
Kim, W., Yoon, M., Park, J. J., Kook, W., & Greenberg, B. (2026) · Revista Española de Cardiología · doi:10.1016/j.recesp.2026.01.005
Mavacamten in Chinese Patients with Obstructive Hypertrophic Cardiomyopathy: Patient-Reported Health Status Analysis up to 78 Weeks in the EXPLORER-CN Study
Tian, Z., Li, X., Li, L., Zhang, Q., Wang, J., Shi, Y. Q., Peng, D. Q., Ma, W., Yang, P., Cheng, X., et al. (2026) · Cardiology and Therapy · doi:10.1007/s40119-026-00449-5
Trajectories of symptom scores and risk of cardiovascular events in the vulnerable phase of heart failure: an analysis using a latent class trajectory model
Xiao, D., Xu, Y., Jiang, Y., Xiong, Z., Shen, Q., Sun, X., Xiong, X., & Hu, B. (2026) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2026.1841870
Defining Clinically Meaningful Within-Patient Changes in Heart Failure
Yehya, A., Hahn, R. T., Borlaug, B., Delgado, V., Ambrosy, A. P., Arena, R. A., Reza, N., Lewis, G. D., Tapaskar, N., Carbone, S., et al. (2026) · JACC Heart Failure · doi:10.1016/j.jchf.2026.103310
Self-citation
Patient‐Reported Quality of Life‐Based Machine Learning Model Predicting Sudden Cardiac Death in Heart Failure With Preserved Ejection Fraction: Kansas City Cardiomyopathy Questionnaire‐Based Sudden Cardiac Death Score
Liu, X., Zhang, Z., Cui, M., Shu, C., Yu, W., Pan, H., Abudukeremu, A., Zhao, K., Zheng, M., Cao, Z., et al. (2026) · Medicine Advances · doi:10.1002/med4.70081
Using dapagliflozin to reduce symptoms in transthyretin cardiac amyloidosis: An n-of-1 trial series pilot study
Håkansson, E., Anan, I., Brunström, M., Ängerud, K. H., Lindqvist, P., Pilebro, B., Wixner, J., & Lindmark, K. (2026) · PLoS ONE · doi:10.1371/journal.pone.0346065
“Answers are transformed into several sub scores, including total symptom score (TSS), overall summary score (OSS) and clinical summary score (CSS), each ranging from 0–100 points with a higher score meaning less symptoms [8,26,27].”

Authors: Joseph, S. M., Novak, E., Arnold, S. V., Jones, P. G., Khattak, H., Platts, A. E., Dávila-Román, V. G., Mann, D. L., & Spertus, J. A.
Affiliations: Washington University in St. Louis (US)
From the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, MO (S.M.J., E.N., H.K., A.E.P., V.G.D.-R., D.L.M.); and Saint Luke’s Mid-America Heart Institute, University of Missouri, Kansas City (S.V.A., P.G.J., J.A.S.).
ORCID: Joseph, Susan M.
Arnold, Suzanne V.
Jones, Philip G.
Mann, Douglas L.
Spertus, John A.
Venue: Circulation: Heart Failure
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-11
Volume: 6
Issue: 6
Pages: 1139-1146
ISSN: 1941-3289 (ISSN-L)
1941-3297
DOI: 10.1161/circheartfailure.113.000359
PMC: PMC4545244
OpenAlex: W2547126679
Cited by: 192
References: 50
Citations by year: 2026: 12 · 2025: 18 · 2024: 28 · 2023: 24 · 2022: 16 · 2021: 24 · 2020: 20 · 2019: 13 · 2018: 10 · 2017: 11 · 2016: 6 · 2015: 7 · 2014: 3
FWCI: 3.63
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Circulation Heart Failure (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders: National Heart, Lung, and Blood Institute (U10HL110309, RC2HL102222)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
Keywords: Kansas City Cardiomyopathy Questionnaire, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, health status measurement, quality of life, symptom burden, NYHA functional class, prognostic validity, mortality, hospitalization, internal consistency
MeSH terms: Female, Follow-Up Studies, Health Status, Heart Failure, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Stroke Volume, United States, Reproducibility of Results, Incidence, Disease Progression

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Comparable Performance of the Kansas City Cardiomyopathy Questionnaire in Patients With Heart Failure With Preserved and Reduced Ejection Fraction

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