Health Status Variation Across Practices in Outpatients With Heart Failure: Insights From the CHAMP-HF (Change the Management of Patients With Heart Failure) Registry.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Khariton, Y; Hernandez, AF; Fonarow, GC; Sharma, PP; Duffy, CI; Thomas, L; Mi, X; Albert, NM; Butler, J; McCague, K; Nassif, ME; Williams, FB; DeVore, A; Patterson, JH; Spertus, JA

Published Date

  • April 2018

Published In

Volume / Issue

  • 11 / 4

Start / End Page

  • e004668 -

PubMed ID

  • 29627798

Pubmed Central ID

  • 29627798

Electronic International Standard Serial Number (EISSN)

  • 1941-7705

International Standard Serial Number (ISSN)

  • 1941-7713

Digital Object Identifier (DOI)

  • 10.1161/CIRCOUTCOMES.118.004668

Language

  • eng