Merrill Thomas1, Yevgeniy Khariton1, Gregg C Fonarow2, Suzanne V Arnold1, Larry Hill3, Michael E Nassif4, Puza P Sharma5, Javed Butler6, Laine Thomas3, Carol I Duffy5, Adam D DeVore7, Adrian Hernandez7, Nancy M Albert8, J Herbert Patterson9, Fredonia B Williams10, Kevin McCague5, John A Spertus11. 1. Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri. 2. Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California. 3. Duke Clinical Research Institute, Durham, North Carolina. 4. Washington University School of Medicine in Saint Louis, Saint Louis, Missouri. 5. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey. 6. University of Mississippi, Jackson, Mississippi. 7. Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. 8. Cleveland Clinic, Cleveland, Ohio. 9. Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina. 10. Mended Hearts, Huntsville, Alabama. 11. Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: spertusj@umkc.edu.
Abstract
OBJECTIVES: The aim of this study was to use a multicenter, observational outpatient registry of patients with heart failure with reduced ejection fraction (HFrEF) to describe the association between changes in patients' medications with changes in health status. BACKGROUND: Alleviating symptoms and improving function and quality of life for patients with HFrEF are primary treatment goals and potential indicators of quality. Whether titrating medications in routine clinical care improves patients' health status is unknown. METHODS: The association of any change in HFrEF medications with 3-month change in health status, as measured using the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale, was determined in unadjusted and multivariate-adjusted (25 clinical characteristics, baseline health status) models using hierarchical linear regression. RESULTS: Among 3,313 outpatients with HFrEF from 140 centers, 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) Kansas City Cardiomyopathy Questionnaire Overall Summary Scale scores. The 3-month median change in Kansas City Cardiomyopathy Questionnaire Overall Summary 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 to 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. CONCLUSIONS: In routine care of patients with HFrEF, changes in HFrEF 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.
OBJECTIVES: The aim of this study was to use a multicenter, observational outpatient registry of patients with heart failure with reduced ejection fraction (HFrEF) to describe the association between changes in patients' medications with changes in health status. BACKGROUND: Alleviating symptoms and improving function and quality of life for patients with HFrEF are primary treatment goals and potential indicators of quality. Whether titrating medications in routine clinical care improves patients' health status is unknown. METHODS: The association of any change in HFrEF medications with 3-month change in health status, as measured using the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale, was determined in unadjusted and multivariate-adjusted (25 clinical characteristics, baseline health status) models using hierarchical linear regression. RESULTS: Among 3,313 outpatients with HFrEF from 140 centers, 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) Kansas City Cardiomyopathy Questionnaire Overall Summary Scale scores. The 3-month median change in Kansas City Cardiomyopathy Questionnaire Overall Summary 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 to 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. CONCLUSIONS: In routine care of patients with HFrEF, changes in HFrEF 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.
Authors: John A Spertus; Robert O Bonow; Paul Chan; George A Diamond; Joseph P Drozda; Sanjay Kaul; Harlan M Krumholz; Frederick A Masoudi; Sharon-Lise T Normand; Eric D Peterson; Martha J Radford; John S Rumsfeld Journal: Circulation Date: 2010-11-08 Impact factor: 29.690
Authors: John A Spertus; Robert O Bonow; Paul Chan; George A Diamond; Joseph P Drozda; Sanjay Kaul; Harlan M Krumholz; Frederick A Masoudi; Sharon-Lise T Normand; Eric D Peterson; Martha J Radford; John S Rumsfeld Journal: J Am Coll Cardiol Date: 2010-11-16 Impact factor: 24.094
Authors: John A Spertus; Kim A Eagle; Harlan M Krumholz; Kristi R Mitchell; Sharon-Lise T Normand Journal: Circulation Date: 2005-04-05 Impact factor: 29.690
Authors: John Spertus; Eric Peterson; Mark W Conard; Paul A Heidenreich; Harlan M Krumholz; Philip Jones; Peter A McCullough; Ileana Pina; Joseph Tooley; William S Weintraub; John S Rumsfeld Journal: Am Heart J Date: 2005-10 Impact factor: 4.749
Authors: Gregg C Fonarow; Nancy M Albert; Anne B Curtis; Wendy Gattis Stough; Mihai Gheorghiade; J Thomas Heywood; Mark L McBride; Patches Johnson Inge; Mandeep R Mehra; Christopher M O'Connor; Dwight Reynolds; Mary Norine Walsh; Clyde W Yancy Journal: Circulation Date: 2010-07-26 Impact factor: 29.690
Authors: Gabriel E Soto; Philip Jones; William S Weintraub; Harlan M Krumholz; John A Spertus Journal: Circulation Date: 2004-07-19 Impact factor: 29.690
Authors: Paul S Chan; Gabriel Soto; Philip G Jones; Brahmajee K Nallamothu; Zefeng Zhang; William S Weintraub; John A Spertus Journal: Circulation Date: 2009-01-12 Impact factor: 29.690
Authors: Gregg C Fonarow; William T Abraham; Nancy M Albert; Wendy Gattis Stough; Mihai Gheorghiade; Barry H Greenberg; Christopher M O'Connor; Karen Pieper; Jie Lena Sun; Clyde W Yancy; James B Young Journal: Arch Intern Med Date: 2007-07-23
Authors: Mikhail Kosiborod; Gabriel E Soto; Philip G Jones; Harlan M Krumholz; William S Weintraub; Prakash Deedwania; John A Spertus Journal: Circulation Date: 2007-04-09 Impact factor: 29.690
Authors: Mona Fiuzat; Justin Ezekowitz; Wendimagegn Alemayehu; Cynthia M Westerhout; Marco Sbolli; Dario Cani; David J Whellan; Tariq Ahmad; Kirkwood Adams; Ileana L Piña; Chetan B Patel; Kevin J Anstrom; Lawton S Cooper; Daniel Mark; Eric S Leifer; G Michael Felker; James L Januzzi; Christopher M O'Connor Journal: JAMA Cardiol Date: 2020-07-01 Impact factor: 14.676
Authors: Andy T Tran; Gregg C Fonarow; Suzanne V Arnold; Philip G Jones; Laine E Thomas; C Larry Hill; Adam D DeVore; Javed Butler; Nancy M Albert; John A Spertus Journal: Circ Cardiovasc Qual Outcomes Date: 2021-10-07
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: 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