Yevgeniy Khariton1, Adrian F Hernandez2, Gregg C Fonarow2, Puza P Sharma2, Carol I Duffy2, Laine Thomas2, Xiaojuan Mi2, Nancy M Albert2, Javed Butler2, Kevin McCague2, Michael E Nassif2, Fredonia B Williams2, Adam DeVore2, J Herbert Patterson2, John A Spertus2. 1. Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.). kharitony@umkc.edu. 2. Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (Y.K., J.A.S.). Department of Medicine, Duke University School of Medicine, Durham, NC (A.F.H., A.D.). Department of Cardiology, Duke Clinical Research Institute, Durham, NC (A.F.H., L.T., X.M., A.D.). Department of Cardiovascular Medicine Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.). Novartis Pharmaceuticals Corporation, East Hanover, NJ (P.P.S., C.I.D., K.M.). Department of Cardiology Cleveland Clinic, OH (N.M.A.). Stony Brook University, NY (J.B.). Washington University School of Medicine, Saint Louis, MO (M.E.N.). Mended Hearts, Huntsville, AL (F.B.W.). Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.).
Abstract
BACKGROUND: Although a key treatment goal for patients with heart failure with reduced ejection fraction is to optimize their health status (their symptoms, function, and quality of life), the variability across outpatient practices in achieving this goal is unknown. METHODS AND RESULTS: In the CHAMP-HF (Change the Management of Patients With Heart Failure) registry, associations between baseline practice characteristics and Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) and Symptom Frequency (SF) scores were assessed in 3494 patients across 140 US practices using hierarchical regression after accounting for 23 patient and 11 treatment characteristics. We then calculated an adjusted median odds ratio to quantify the average difference in likelihood that a patient would have excellent (KCCQ-OS, ≥75) health status or minimal (monthly or fewer) symptoms (KCCQ-SF, ≥75) when treated at one practice versus another, at random. The mean (±SD) KCCQ-OS and KCCQ-SF were 64.2±24 and 68.9±25.6, with 40% (n=1380) and 50% (n=1760) having KCCQ scores ≥75, respectively. The adjusted median odds ratio across practices, for KCCQ-OS ≥75, was 1.70 (95% confidence interval, 1.54-1.99; P<0.001) indicating a median 70% higher odds of a patient having good-to-excellent health status when treated at one random practice versus another. In regard to KCCQ-SF, the adjusted median odds ratio for KCCQ-SF ≥75 was 1.54 (95% confidence interval, 1.41-1.76; P=0.001). CONCLUSIONS: In a large, contemporary registry of outpatients with chronic heart failure with reduced ejection fraction, we observed significant practice-level variability in patients' health status. Quantifying patients' health status as a measure of quality should be explored as a foundation for improving care. CLINICAL TRIAL REGISTRATION: URL: https://www.centerwatch.com. Unique identifier: TX144901.
BACKGROUND: Although a key treatment goal for patients with heart failure with reduced ejection fraction is to optimize their health status (their symptoms, function, and quality of life), the variability across outpatient practices in achieving this goal is unknown. METHODS AND RESULTS: In the CHAMP-HF (Change the Management of Patients With Heart Failure) registry, associations between baseline practice characteristics and Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) and Symptom Frequency (SF) scores were assessed in 3494 patients across 140 US practices using hierarchical regression after accounting for 23 patient and 11 treatment characteristics. We then calculated an adjusted median odds ratio to quantify the average difference in likelihood that a patient would have excellent (KCCQ-OS, ≥75) health status or minimal (monthly or fewer) symptoms (KCCQ-SF, ≥75) when treated at one practice versus another, at random. The mean (±SD) KCCQ-OS and KCCQ-SF were 64.2±24 and 68.9±25.6, with 40% (n=1380) and 50% (n=1760) having KCCQ scores ≥75, respectively. The adjusted median odds ratio across practices, for KCCQ-OS ≥75, was 1.70 (95% confidence interval, 1.54-1.99; P<0.001) indicating a median 70% higher odds of a patient having good-to-excellent health status when treated at one random practice versus another. In regard to KCCQ-SF, the adjusted median odds ratio for KCCQ-SF ≥75 was 1.54 (95% confidence interval, 1.41-1.76; P=0.001). CONCLUSIONS: In a large, contemporary registry of outpatients with chronic heart failure with reduced ejection fraction, we observed significant practice-level variability in patients' health status. Quantifying patients' health status as a measure of quality should be explored as a foundation for improving care. CLINICAL TRIAL REGISTRATION: URL: https://www.centerwatch.com. Unique identifier: TX144901.
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Authors: Sarwat I Chaudhry; Jennifer A Mattera; Jeptha P Curtis; John A Spertus; Jeph Herrin; Zhenqiu Lin; Christopher O Phillips; Beth V Hodshon; Lawton S Cooper; Harlan M Krumholz Journal: N Engl J Med Date: 2010-11-16 Impact factor: 91.245
Authors: Merrill Thomas; Yevgeniy Khariton; Gregg C Fonarow; Suzanne V Arnold; Larry Hill; Michael E Nassif; Puza P Sharma; Javed Butler; Laine Thomas; Carol I Duffy; Adam D DeVore; Adrian Hernandez; Nancy M Albert; J Herbert Patterson; Fredonia B Williams; Kevin McCague; John A Spertus Journal: JACC Heart Fail Date: 2019-06-05 Impact factor: 12.035
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Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: Circ Cardiovasc Qual Outcomes Date: 2020-11-02
Authors: Sri Lekha Tummalapalli; Leila R Zelnick; Amanda H Andersen; Robert H Christenson; Christopher R deFilippi; Rajat Deo; Alan S Go; Jiang He; Bonnie Ky; James P Lash; Stephen L Seliger; Elsayed Z Soliman; Michael G Shlipak; Nisha Bansal Journal: J Am Heart Assoc Date: 2020-06-24 Impact factor: 5.501
Authors: Adam D DeVore; Claude Larry Hill; Laine E Thomas; Nancy M Albert; Javed Butler; J Herbert Patterson; Adrian F Hernandez; Fredonia B Williams; Xian Shen; John A Spertus; Gregg C Fonarow Journal: ESC Heart Fail Date: 2021-11-17
Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2020-11-02 Impact factor: 24.094
Authors: John R Teerlink; Rafael Diaz; G Michael Felker; John J V McMurray; Marco Metra; Scott D Solomon; Kirkwood F Adams; Inder Anand; Alexandra Arias-Mendoza; Tor Biering-Sørensen; Michael Böhm; Diana Bonderman; John G F Cleland; Ramon Corbalan; Maria G Crespo-Leiro; Ulf Dahlström; Luis E Echeverria Correa; James C Fang; Gerasimos Filippatos; Cândida Fonseca; Eva Goncalvesova; Assen R Goudev; Jonathan G Howlett; David E Lanfear; Mayanna Lund; Peter Macdonald; Vyacheslav Mareev; Shin-Ichi Momomura; Eileen O'Meara; Alexander Parkhomenko; Piotr Ponikowski; Felix J A Ramires; Pranas Serpytis; Karen Sliwa; Jindrich Spinar; Thomas M Suter; Janos Tomcsanyi; Hans Vandekerckhove; Dragos Vinereanu; Adriaan A Voors; Mehmet B Yilmaz; Faiez Zannad; Lucie Sharpsten; Jason C Legg; Siddique A Abbasi; Claire Varin; Fady I Malik; Christopher E Kurtz Journal: Eur J Heart Fail Date: 2020-10-27 Impact factor: 15.534