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Association of Changes in HF Treatment With Health Status
Study Questions:
In patients with heart failure with reduced ejection fraction (HFrEF), what is the association between changes in patients’ medications with changes in health status?
Methods:
The authors used the CHAMP-HF (Change the Management of Patients With HF) study registry to determine the association of any change in HFrEF medications with 3-month change in health status. They did this by utilizing the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale (KCCQ-OS), in unadjusted and multivariate-adjusted (25 clinical characteristics, baseline health status) models using hierarchical linear regression. Change in KCCQ-OS between enrollment and 3-month follow-up was the primary outcome of this analysis. A 5-point change in score signifies a clinically meaningful change in both individual- and population-level assessments of health status and is associated with an approximate 10% change in mortality and rehospitalizations. Large and very large clinical changes are associated with changes of 10 and 20 points, respectively, on the KCCQ.
Results:
The final study cohort comprised 3,313 HFrEF outpatients who had baseline and 3-month KCCQ scores available, of whom 21.9% had medication changes. Three months later, 23.7% and 46.4% had clinically meaningfully worse (≥5-point decrease) and improved (≥5-point increase) KCCQ-OS scores. The 3-month median change in KCCQ-OS Scale score for patients whose HFrEF medications were changed was significantly larger (7.3 points; interquartile range, -3.1 to 20.8 points) than in patients whose medications were not changed (3.1 points; interquartile range, -4.7 to 12.5 points) (adjusted difference, 3.0 points; 95% confidence interval, 1.4-4.6 points; p < 0.001). Among patients whose medications were adjusted, 26% had very large clinical improvement (≥20 points) compared with 14% whose regimens were not changed. Patients with large improvements in their health status were more likely to be younger (65.6 ± 12.5 years vs. 66.5 ± 12.4 years; p = 0.01), to be obese (32.9% vs. 29.3%; p = 0.04), to have diabetes (44.0% vs. 40.0%; p = 0.03), and to smoke (21.9% vs. 18.3%; p = 0.01).
Conclusions:
The authors of this study concluded that in routine care of HFrEF systolic, changes in guideline-directed medical therapy (GDMT) medications were associated with significant improvements in patients’ health status, suggesting that health status–based performance measures can quantify the benefits of titrating medicines in patients with HFrEF.
Perspective:
The findings of this study are important because it suggests that all HFrEF patients will benefit with GDMT titration. Clearly, the take-home message is to have a titration plan for all patients with HFrEF. Prospective studies are needed to determine whether patient-reported outcome measures improve overall outcomes in HFrEF.
Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Smoking
Keywords: Cardiomyopathies, Diabetes Mellitus, Health Status, Heart Failure, Medication Therapy Management, Obesity, Outpatients, Secondary Prevention, Smoking, Stroke Volume, Systole, Treatment Outcome
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