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Comparable Performance of the Kansas City Cardiomyopathy Questionnaire in Patients With Heart Failure With Preserved and Reduced Ejection Fraction
Open accessAbstract
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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“The KCCQ is a standardized, 23-item, participant-administered instrument that quantifies heart failurerelated symptoms (frequency, severity, and recent changes), physical function, quality of life, and social function. 16-18 For each domain, the validity, reproducibility, responsiveness, and interpretability have been independently established. 16-18”
From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [17]
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Cites
Statistics notes: Cronbach's alpha: Table 1
Bland, J. M., & Altman, D. G. (1997) · BMJ · doi:10.1136/bmj.314.7080.572 · Cited by 5,300
Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction
Owan, T., Hodge, D. O., Herges, R. M., Jacobsen, S. J., Roger, V. L., & Redfield, M. M. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa052256 · Cited by 4,209
Green, C. P., Porter, C. B., Bresnahan, D. R., & Spertus, J. A. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00531-3 · Cited by 1,827 · cited 1×
“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-citationHFSA 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
Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment
Borlaug, B. A., & Paulus, W. J. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq426 · Cited by 1,136 · cited 5×
“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…”
BackgroundInfluentialHeart failure with preserved left ventricular systolic function
Hogg, K. J., Swedberg, K. B., & McMurray, J. J. V. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.07.046 · Cited by 927
Systolic and Diastolic Heart Failure in the Community
Bursi, F., Weston, S. A., Redfield, M. M., Jacobsen, S. J., Pakhomov, S., Nkomo, V. T., Meverden, R. A., & Roger, V. L. (2006) · JAMA · doi:10.1001/jama.296.18.2209 · Cited by 891
Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr254 · Cited by 760
Aurigemma, G. P., & Gaasch, W. H. (2004) · New England Journal of Medicine · doi:10.1056/nejmcp022709 · Cited by 759
Flynn, K. E., Piña, I. L., Whellan, D. J., Lin, L., Blumenthal, J. A., Ellis, S. J., Fine, L. J., Howlett, J. G., Keteyian, S. J., Kitzman, D. W., et al. (2009) · JAMA · doi:10.1001/jama.2009.457 · Cited by 737
Self-citationLam, C. S. P., Roger, V. L., Rodeheffer, R. J., Bursi, F., Borlaug, B. A., Ommen, S. R., Kass, D. A., & Redfield, M. M. (2007) · Circulation · doi:10.1161/circulationaha.106.659763 · Cited by 544
Diastolic and Systolic Heart Failure Are Distinct Phenotypes Within the Heart Failure Spectrum
Borlaug, B. A., & Redfield, M. M. (2011) · Circulation · doi:10.1161/circulationaha.110.954388 · Cited by 451
Preferences for quality of life or survival expressed by patients with heart failure
Lewis, E. F., Johnson, P. A., Johnson, W., Collins, C., Griffin, L., & Stevenson, L. W. (2001) · The Journal of Heart and Lung Transplantation · doi:10.1016/s1053-2498(01)00298-4 · Cited by 433
Epidemiology of Diastolic Heart Failure
Owan, T. E., & Redfield, M. M. (2005) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2005.02.010 · Cited by 417
Quality of life in patients with advanced heart failure.
Dracup, K., Walden, J. A., Stevenson, L. W., & Brecht, M. L. (1992) · PubMed · Cited by 319
Interpreting patient-reported outcome results: US FDA guidance and emerging methods
McLeod, L., Coon, C. D., Martin, S. A., Fehnel, S. E., & Hays, R. D. (2011) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.11.12 · Cited by 318
Dunlay, S. M., Roger, V. L., Weston, S. A., Jiang, R., & Redfield, M. M. (2012) · Circulation Heart Failure · doi:10.1161/circheartfailure.111.966366 · Cited by 317 · cited 5×
“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…”
BackgroundInfluentialHealth Status Identifies Heart Failure Outpatients at Risk for Hospitalization or Death
Heidenreich, P. A., Spertus, J. A., Jones, P. G., Weintraub, W. S., Rumsfeld, J. S., Rathore, S. S., Peterson, E. D., Masoudi, F. A., Krumholz, H. M., Havranek, E. P., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.11.021 · Cited by 300
Self-citationDesai, A. S., Lewis, E. F., Li, R., Solomon, S. D., Assmann, S. F., Boineau, R., Clausell, N., Díaz, R., Fleg, J. L., Гордеев, И. Г., et al. (2011) · American Heart Journal · doi:10.1016/j.ahj.2011.09.007 · Cited by 276 · cited 2×
“Unfortunately, no treatment options have been proven to reduce mortality in HFpEF.(32,33) To improve the care of patients with HFpEF, a means of monitoring the impact of the disease on their health status is needed to supplement the traditional outcomes of hospitalization and mortality.”
BackgroundMethodHeart failure with preserved systolic function
Senni, M., & Redfield, M. M. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01567-4 · Cited by 270 · cited 8×
“The Kansas City Cardiomyopathy Questionnaire (KCCQ) has proven to be a valid, reliable, responsive, and prognostically important measure of patients’ health status for patients with HFrEF.7,11–14 The purpose of this study was to examine the psychometric performance of the KCCQ in patients with HFpEF.”
ResultInfluentialLewis, E. F., Lamas, G. A., O’Meara, E., Granger, C. B., Dunlap, M. E., McKelvie, R. S., Probstfield, J. L., Young, J. B., Michelson, E. L., Halling, K., et al. (2006) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2006.10.012 · Cited by 252
Heart Failure With a Normal Ejection Fraction
Burkhoff, D., Maurer, M. S., & Packer, M. (2003) · Circulation · doi:10.1161/01.cir.0000053947.82595.03 · Cited by 245
Prognostic Value of Health Status in Patients With Heart Failure After Acute Myocardial Infarction
Soto, G. E., Jones, P. G., Weintraub, W. S., Krumholz, H. M., & Spertus, J. A. (2004) · Circulation · doi:10.1161/01.cir.0000136991.85540.a9 · Cited by 229
Self-citationProgress in Cardiovascular Diseases
Birkenhäger, W. H., & Staessen, J. A. (2006) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2006.03.001 · Cited by 202
Kosiborod, M., Soto, G. E., Jones, P. G., Krumholz, H. M., Weintraub, W. S., DEEDWANIA, P. C., & Spertus, J. A. (2007) · Circulation · doi:10.1161/circulationaha.106.670901 · Cited by 190
Self-citationArnold, S. V., Spertus, J. A., Lei, Y., Allen, K. B., Chhatriwalla, A. K., Leon, M. B., Smith, C. R., Reynolds, M. R., Webb, J. G., Svensson, L. G., et al. (2012) · Circulation Heart Failure · doi:10.1161/circheartfailure.112.970053 · Cited by 184 · cited 1×
“As such, QOL is increasingly recognized as a key end point in recent HF studies, especially in older adults,(33,38,39) and was recently found to be valid in a cohort of patients with aortic stenosis undergoing transcutaneous aortic valve replacement.(40) In addition, because the mortality rate in HFpEF is probably low…”
BackgroundSelf-citationFDA guidance on patient reported outcomes
Speight, J., & Barendse, S. (2010) · BMJ · doi:10.1136/bmj.c2921 · Cited by 172 · cited 3×
“The first 4 domains can be combined into an overall summary scale, which has previously been shown to be valid, reliable, sensitive to clinical change and associated with survival, hospitalization, and costs in patients with HFrEF.8,9,11,15–19 Values for all domains range from 0 to 100, with higher scores indicating l…”
BackgroundEvolving Applications for Patient-Centered Health Status Measures
Spertus, J. A. (2008) · Circulation · doi:10.1161/circulationaha.107.747568 · Cited by 172
Self-citationQuality of Life and Survival in Patients with Heart Failure
Hoekstra, T., Jaarsma, T., van Veldhuisen, D. J., Hillege, H. L., Sanderman, R., & Lesman‐Leegte, I. (2012) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfs148 · Cited by 145 · cited 1×
“Unfortunately, no treatment options have been proven to reduce mortality in HFpEF.(32,33) To improve the care of patients with HFpEF, a means of monitoring the impact of the disease on their health status is needed to supplement the traditional outcomes of hospitalization and mortality.”
BackgroundSomaratne, J., Berry, C., McMurray, J. J. V., Poppe, K., Doughty, R. N., & WHALLEY, G. A. (2009) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfp103 · Cited by 135
Association of Functional and Health Status Measures in Heart Failure
MYERS, J. N., Zaheer, N., Quaglietti, S. E., Madhavan, R., Froelicher, V. F., & Heidenreich, P. A. (2006) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2006.04.004 · Cited by 123
Zile, M. R. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00186-4 · Cited by 112
Hoekstra, T., Lesman‐Leegte, I., van Veldhuisen, D. J., Sanderman, R., & Jaarsma, T. (2011) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfr072 · Cited by 103
Patient Health Status and Costs in Heart Failure
Chan, P. S., Soto, G. E., Jones, P. G., Nallamothu, B. K., Zhang, Z., Weintraub, W. S., & Spertus, J. A. (2009) · Circulation · doi:10.1161/circulationaha.108.820472 · Cited by 88
Self-citationKer, J. (2010) · South African Family Practice · Cited by 78
Flynn, K. E., Lin, L., Moe, G. W. P. L., Howlett, J. G., Fine, L. J., Spertus, J. A., McConnell, T. R., Piña, I. L., & Weinfurt, K. P. (2011) · American Heart Journal · doi:10.1016/j.ahj.2011.09.027 · Cited by 76
Self-citationFaller, H., Steinbüchel, T., Schowalter, M., Spertus, J. A., Störk, S., & Angermann, C. E. (2005) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/s-2004-834597 · Cited by 68
Self-citationSpertus, J. A., Jones, P. G., Kim, J., & GLOBE, D. R. (2007) · Quality of Life Research · doi:10.1007/s11136-007-9302-5 · Cited by 67
Self-citationArnold, S., Spertus, J., Jones, P. G., Xiao, L., & Cohen, D. (2009) · American Heart Journal · doi:10.1016/j.ahj.2009.03.021 · Cited by 65 · cited 1×
“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-citationThe Relationship Between B-type Natriuretic Peptide and Health Status in Patients With Heart Failure
Luther, S. A., McCullough, P. A., Havranek, E. P., Rumsfeld, J. S., Jones, P. G., Heidenreich, P. A., Peterson, E. D., Rathore, S. S., Krumholz, H. M., Weintraub, W. S., et al. (2005) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2005.02.004 · Cited by 63
Self-citationParissis, J., Nikolaou, M., Farmakis, D. T., PARASKEVAIDIS, I. A., Bistola, V., Venetsanou, K. F., Katsaras, D. N., Filippatos, G. S., & Kremastinos, D. T. (2009) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfn032 · Cited by 61
Interpreting statistics in medical literature: A vade mecum for surgeons1
Güller, U., & DeLong, E. R. (2004) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2003.09.017 · Cited by 52 · cited 1×
“The c-statistic evaluates the discriminatory ability of the KCCQ to differentiate events and nonevents.(27) Because inpatients with HF tend to have rapidly changing symptoms, there is a potential risk for variable responses depending on the understanding of patients completing the KCCQ.”
MethodSullivan, M. D., Levy, W. C., Russo, J. E., Crane, B., & Spertus, J. A. (2007) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2007.04.001 · Cited by 48 · cited 1×
“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-citationParthasarathy, H. K., Pieske, B. M., Weisskopf, M., Andrews, C., Brunel, P., Struthers, A. D., & MacDonald, T. M. (2009) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfp120 · Cited by 44
Daniel, K. R., Wells, G., Stewart, K. P., Moore, B., & Kitzman, D. W. (2009) · Congestive Heart Failure · doi:10.1111/j.1751-7133.2009.00056.x · Cited by 37
The treatment of heart failure with preserved ejection fraction (“diastolic heart failure”)
Hogg, K. J., & McMurray, J. J. V. (2006) · Heart Failure Reviews · doi:10.1007/s10741-006-9488-6 · Cited by 30
O’Meara, E., Lewis, E. F., Granger, C. B., Dunlap, M. E., McKelvie, R. S., Probstfield, J. L., Young, J. B., Michelson, E. L., Östergren, J., Carlsson, J., et al. (2005) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2005.01.021 · Cited by 27
Lesman‐Leegte, I., Jaarsma, T., Sanderman, R., Hillege, H. L., & VANVELDHUISEN, D. (2007) · European Journal of Heart Failure Supplements · doi:10.1016/s1567-4215(07)60185-4 · Cited by 19
Counting Performance With Therapies for Heart Failure
Stevenson, L. W. (2010) · Circulation · doi:10.1161/circulationaha.110.970061 · Cited by 11
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Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care
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Self-citation
Metadata
- 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.).
- Venue
- Circulation: Heart Failure
- Published
- 2013-11
- Volume
- 6
- Issue
- 6
- Pages
- 1139-1146
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- 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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