Benefits of Patient-Reported Outcomes in Heart Failure Medication Management

Among patients with heart failure and reduced ejection fraction (HFrEF), medication changes may result in rapid improvement in patient health status, according to data published in JACC: Heart Failure. Additionally, study results indicated the use of patient-reported outcome measures may help clinicians in monitoring medication titration.

Researchers sought to assess the association between medication changes and changes in health status among patients with HFrEF. Data were drawn from the multicenter, prospective, outpatient Change the Management of Patients with HF (CHAMP-HF) registry. Changes in both medications and 3-month health status were measured via the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale (KCCQ-OS).

Data were collected from 3313 outpatients (66.2±12.5 years, 30% women, 74.8% white) with HFrEF from 140 centers across the United States between 2015 and 2017. All patients had baseline and 3-month KCCQ scores available for analysis. Just over half of patients were classified as New York Heart Association Class II (58.5%); 29.2% were NYHA Class III.

Most frequently, patients were treated with evidence-based therapies for HF, including beta-blockers (78.7%), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (56.4%), angiotensin receptor neprilysin inhibitors (10.1%), mineralocorticoid antagonists (30.4%), and diuretics (48.7%).

Within 1 week of the baseline visit, 21.9% of patients changed their HFrEF therapy (20.8% increased dosage and 2.1% decreased dosage). At 3 months, 23.7% and 46.4% of patients within the cohort experienced clinically meaningful worse or improved (≥5-point decrease and ≥5-point increase, respectively) in KCCQ-OS scores; 15.2% and 33.1% had a ≥10-point decrease and ≥10-point increase in KCCQ-OS scores, respectively.

Researchers found that any change in HFrEF medication was associated with a statistically significant improvement in KCCQ-OS compared with no medication change (7.3 points [95% CI, -3.1 to 20.8] vs 3.1 points [95% CI, -4.7 to 12.5]; P <.001). The effect was similar in patients who had a medication increase or decrease.

Following multivariable adjustment, a statistically significant mean improvement of 3-points was observed in KCCQ-OS scores with any change in guideline-directed medical therapy (95% CI, 1.43-4.60; P <.001).

Study limitations include the potential of residual confounding or placebo effect among patients and the potentially conservative nature of the results. Results may not be generalizable throughout the United States as the CHAMP-HF registry only includes patients who agreed to informed consent and were able to complete multiple surveys over time.

“[T]hese findings suggest that clinicians might be able to further improve their patients’ health status through careful adjustment of their medical regimens and potentially reduce the observed variability in patient’s health status,” the researchers concluded. “Collectively, these observations support the use of [patient-reported outcomes] as quality assessment tools.”

Disclosure: This study was sponsored by Novartis Pharmaceuticals Corporation. Multiple authors disclosed affiliations with pharmaceutical companies. See the reference for complete disclosure information.

Reference

Thomas M, Khariton Y, Fonarow GC, et al. Association of changes in heart failure treatment with patients’ health status: real-world evidence from CHAMP-HF [published online June 5, 2019]. JACC Heart Fail. doi: 10.1016/j.jchf.2019.03.020