Rocky Mountain Regional VA Medical Center, Cardiology, Department of Medicine, 1700 North Wheeling Street, Aurora, CO, USA.
Colorado Cardiovascular Outcomes Research Consortium, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Denver, CO, USA.
Eur Heart J Qual Care Clin Outcomes. 2019 Jul 1;5(3):233-241. doi: 10.1093/ehjqcco/qcy061.
Patients with heart failure often have under-recognized symptoms, depression, anxiety, and poorer spiritual well-being ('QoL domains'). Ideally all patients should have heart failure-specific health status and quality of life (QoL) domains routinely evaluated; however, lack of time and resources are limiting in most clinical settings. Therefore, we aimed to evaluate whether heart failure-specific health status was associated with QoL domains and to identify a score warranting further evaluation of QoL domain deficits.
Participants (N = 314) enrolled in the Collaborative Care to Alleviate Symptoms and Adjust to Illness trial completed measures of heart failure-specific health status [Kansas City Cardiomyopathy Questionnaire, KCCQ (score 0-100, 0 = worst health status)], additional symptoms (Memorial Symptom Assessment Scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and spiritual well-being (Facit-Sp) at baseline. Mean ± standard deviation (SD) KCCQ score was 46.9 ± 19.3, mean age was 65.5 ± 11.4, and 79% were male. Prevalence of QoL domain deficits ranged from 11% (nausea) to 47% (depression). Sensitivity/specificity of KCCQ for each QoL domain ranged from 20-40%/80-96% for KCCQ ≤ 25, 61-84%/48-62% for KCCQ ≤ 50, 84-97%/26-40% for KCCQ ≤ 60, and 96-100%/8-13% for KCCQ ≤ 75. Patients with KCCQ ≤ 60 had mean ± SD 4.5 ± 2.5 QoL domain deficits (maximum 12), vs. 1.6 ± 1.6 for KCCQ > 60 (P < 0.001). Similar results were seen for KCCQ ≤25 (6.6 ± 2.4 vs. 3.3 ± 2.4), KCCQ ≤ 50 (4.8 ± 2.6 vs. 2.5 ± 2) and KCCQ ≤ 75 (4.0 ± 2.6 vs. 1.0 ± 1.2) (all P < 00001).
KCCQ ≤ 60 had good sensitivity for each QoL domain deficit and for patients with at least one QoL domain deficit. Screening for QoL domain deficits should target patients with lower KCCQ scores based on a clinic's KCCQ score distribution and clinical resources for addressing QoL domain deficits.
心力衰竭患者常存在被低估的症状、抑郁、焦虑和较差的精神健康状况（“生活质量领域”）。理想情况下，所有患者都应定期评估心力衰竭特异性健康状况和生活质量（QoL）领域；然而，在大多数临床环境中，缺乏时间和资源是限制因素。因此，我们旨在评估心力衰竭特异性健康状况是否与 QoL 领域相关，并确定一个需要进一步评估 QoL 领域缺陷的评分。
参加协作护理以减轻症状和适应疾病试验的 314 名参与者在基线时完成了心力衰竭特异性健康状况的测量[堪萨斯城心肌病问卷，KCCQ（得分 0-100，0 表示最差的健康状况）]、其他症状（纪念症状评估量表）、抑郁（患者健康问卷-9）、焦虑（广泛性焦虑症-7）和精神健康状况（FACIT-Sp）。平均±标准偏差（SD）的 KCCQ 评分是 46.9±19.3，平均年龄为 65.5±11.4，79%为男性。QoL 领域缺陷的患病率范围为 11%（恶心）至 47%（抑郁）。KCCQ 对每个 QoL 领域的敏感性/特异性范围为 KCCQ≤25 为 20-40%/80-96%，KCCQ≤50 为 61-84%/48-62%，KCCQ≤60 为 84-97%/26-40%，KCCQ≤75 为 96-100%/8-13%。KCCQ≤60 的患者有 4.5±2.5 个 QoL 领域缺陷的平均±SD（最大 12 个），而 KCCQ＞60 的患者有 1.6±1.6 个（P＜0.001）。对于 KCCQ≤25（6.6±2.4 vs. 3.3±2.4）、KCCQ≤50（4.8±2.6 vs. 2.5±2）和 KCCQ≤75（4.0±2.6 vs. 1.0±1.2），也观察到了类似的结果（均 P＜0.00001）。
KCCQ≤60 对每个 QoL 领域缺陷和至少有一个 QoL 领域缺陷的患者均具有良好的敏感性。根据诊所的 KCCQ 评分分布和解决 QoL 领域缺陷的临床资源，应针对 KCCQ 评分较低的患者进行 QoL 领域缺陷筛查。
