Correspondence to European Heart Journal-Quality of Care and Clinical Outcomes in response to paper by Thomas, M. et al. 2021: Predicting the EQ-5D from the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with heart failures.

We congratulate Thomas et al. for developing algorithms mapping Kansas CityCardiomyopathy Questionnaire (KCCQ) toEQ-5D health-utility scores for patients with heart failure (HF). EQ-5D is a standard tool for assessing cost-effectiveness (QALYs) across disease areas. However, such generic health-utility measures may fail to capture key health states relevant to heart failure (such as breathlessness and fatigue). There is a need fora disease-specific utility measure for heart failure.

Mapping disease-specific, patient-reported outcomes like KCCQ to EQ-5D has limitations, as the authors acknowledge. However, the potential insensitivity of EQ-5D to changes in health state should be considered. EQ-5D may be sensitive to the effects of interventions in advanced heart failure (New York Heart Association (NYHA) III–IV), but perhaps less so for milder disease.,

Thomas et al. used EuroQoL-5 Dimension (EQ-5D) data from the HF-ACTION trial (n = 2331 HF patients) but do not mention that no difference was observed at 12 months in either EQ-5D index score or visual analogue scale (VAS) with exercise-based rehabilitation compared with control (VAS: Rehab: 1 ± 17 vs. control: 2 ± 17; P = 0.15). Was the intervention ineffective or was the tool insensitive to change? Mapping KCCQ to a tool that is not sensitive to change could undervalue the effects of the intervention.

Conflict of interest: none declared.