A patient-reported outcome measure (PROM) for adults with heart failure reliably predicted hospitalizations and mortality and outperformed all other electronic health record variables, according to new research from Vanderbilt University Medical Center.
The article, “Predicting Heart Failure Outcomes Using Patient-Reported Health Status: Real-World Validation of the KCCQ-12,” was recently published in the Journal of the American College of Cardiology.
The study looked at responses to the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), a patient-reported survey for adult patients with heart failure. The 12-item questionnaire asks patients about symptoms, physical function, social limitations and quality of life.
Though the KCCQ-12 is primarily a clinical communication tool between clinicians and patients, VUMC researchers evaluated if the survey results could predict hospitalizations and mortality when administered during outpatient heart failure care.
Researchers examined 4,406 patients who were assigned the KCCQ-12 during VUMC Heart Failure Clinic visits from July 2019 through March 2024, of whom 2,888 completed at least one questionnaire. They found that patients who had severe symptoms (with scores less than 25) had markedly higher risks of 90-day hospitalization and mortality than those with scores greater than 75.
Patient KCCQ-12 responses were obtained using the innovative Vanderbilt Patient-Reported Outcomes Measurement System (VPROMS), which was launched in 2019 as part of the Office of Population Health and is now one of the largest collections of patient-reported surveys (including the KCCQ-12) in the United States. Patients fill out the short, targeted surveys in a few minutes, either prior to arriving at their appointment or on a tablet in the waiting room before their visit.
“Vanderbilt has long had a focus on personalized medicine,” said the article’s corresponding author, Justin Bachmann, MD, MPH, a cardiologist at VUMC. “This is kind of the apex of it, because these surveys focus on outcomes that matter to patients. In patients with heart failure, for example, the survey asks whether they can walk to their mailbox, spend time with friends and other very relevant items to their daily lives.”
Bachmann, who serves as the medical director of VPROMS, said the next area of study will be to determine what factors cause significant shifts in KCCQ scores over time.
“I think there is a lot of opportunity to help clinicians have a better sense of how patients are doing,” said Bachmann, assistant professor of Medicine, Biomedical Informatics and Physical Medicine and Rehabilitation. “There will be any number of other possibilities we can investigate.”
The study is the latest fruit of a growing repository of PROM data generated by VPROMS, which was launched after Bachmann received a $719,628 grant from the Patient-Centered Outcomes Research Institute (PCORI) in 2018. He was the principal investigator for a multicenter PCORI study in which a standardized PROM for patients with heart failure was implemented. The PROM data from three medical centers was then uploaded to PCORnet, a secure national database of patient information from multiple health care systems, to test ways to use the data to improve patient care.
To gather the latest survey data, Bachmann partnered with clinicians in Vanderbilt Health’s Heart Failure Program, led by Kelly Schlendorf, MD, MHS, associate professor of Medicine, director of Heart Failure and Transplant, and medical director of the Adult Heart Transplant Program.
“I am grateful to Dr. Schlendorf and the heart failure team for their partnership,” he said. “This isn’t just a research effort; it’s an operational effort and a clinical effort.”
Schlendorf is one of many other authors of the paper, including first author Bassim R. El-Sabawi, MD, a fellow in the Division of Cardiovascular Medicine, as well as Mohammed A. Al-Garadi, PhD; Bryan Steitz, PhD; Amy Perkins, MS; Allison McCoy, PhD; Donald Sengstack, MS; Robert Greevy, Jr., PhD; Emily Burnell; JoAnn Lindenfeld, MD; Lynne Stevenson, MD; Deepak Gupta, MD, MSCI; John Spertus, MD, MPH; Sean Collins, MD; and Michael Matheny, MD, MPH, MS.
“Our study suggests that the KCCQ-12 has significant predictive utility for hospitalizations and mortality in heart failure patients when administered during routine outpatient clinic visits,” Schlendorf said. “Further research is needed to optimize the use of the KCCQ-12 in routine heart failure care and evaluate interventions based on questionnaire scores to enhance quality of life and reduce mortality.”
