Patient-reported health status is an important and strong independent predictor of mortality and other outcomes, including cardiovascular events, hospitalization and cost of care, but also is underused in clinical studies and clinical practice, according to a new scientific statement from the American Heart Association (AHA) published in Circulation. 

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Overall, the statement focuses on the important role of measuring patient-reported health status in clinical research and clinical management of cardiovascular diseases and advocates for greater use of patient-reported health status as a measure of cardiovascular health, and reviews and describes available reporting instruments. "Patient health status is important both as a risk factor and a health outcome," the authors note. "Standardized cardiovascular patient health status surveys have been developed and used successfully in clinical trials and observational studies. Yet these validated measures remain underused. This statement advocates for the broader inclusion of patient-reported health status as a key measure of cardiovascular health in clinical research, clinical practice, and disease surveillance."

The statement highlights three components of patient-reported health status: symptom burden, functional status, and health-related quality of life (HRQL). The third component is for capturing a patient's perceptions of his or her health status and is best achieved by patient self-reporting, the authors explain. It specifically recommends:

• Use of validated patient health status surveys, including disease-specific instruments for patients with cardiovascular disease, for the quantification of critical, patient-centered outcomes.
• A closer look at cofactors like comorbid depression, as well as consideration of health status in cohorts like the elderly, when assessing a patient's health status.
• Recognition that patient-reported health status is an independent predictor of subsequent mortality, cardiovascular events, hospitalization and cost of care and may have potential implications for risk adjustment and targeting of health care resources.
• Use of patient health status data have to help inform clinical decision making, particularly in cases where shared decision-making is warranted.
• Potential integration of health status into accountable care organization activities related to disease surveillance and quantification of population health as a means of enhancing patient-centered care and better characterizing the impact of health care delivery on patient health.

Moving forward, the authors note that additional research is needed to better understand the determinants of patient health status, the effects of interventions on cardiovascular health and the most effective strategies to incorporate cardiovascular patient health status measurement in clinical practice and disease surveillance.

"These standardized surveys can help cardiovascular clinicians quantify the impact of disease on their patients' lives," said John S. Rumsfeld, MD, PhD, FACC, chair of the writing group. "This supports more patient-centered, higher value health care, and patient-reported outcomes will be increasingly important as healthcare reform evolves. We need to promote measuring patient health status in routine clinical care, so both patients and clinicians become as familiar with these as other clinical metrics like blood pressure."

Keywords: Depression, Health Care Reform, Quality of Life, Self Report, Cardiovascular Diseases, Risk Factors, Blood Pressure, Health Status, Hospitalization, Patient-Centered Care

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