Patient-reported Outcomes In Heart Failure: Insights From A Simplified Kccq In Heartmate 3 Lvad Recipients

Abstract

Background

Patient-reported outcomes, such as the Kansas City Cardiomyopathy Questionnaire (KCCQ), are pivotal in assessing the impact of left ventricular assist device (LVAD) support on patients’ heart failure-related quality of life (hf-QOL) as part of hierarchical outcomes. However, translating improvements in composite KCCQ scores into a meaningful message for patients and referring providers remains challenging. In registries, incompleteness of KCCQ scores is also common after 1 year, perhaps due to questionnaire length.

Purpose

This study aims to a) evaluate the utility of a simplified KCCQ score in describing the LVAD patient journey and b) to generate a patient-friendly graphic on hf-QOL trajectory for use during shared decision making encounters.

Methods

Question-level KCCQ responses were analyzed in HeartMate 3 LVAD recipients from the MOMENTUM 3 studies (2,200 patients) preoperatively and at 6- 12-, and 24-months after implant. Patients had to complete one preoperative and ≥1 postoperative KCCQ assessment for inclusion. The simplified LVAD-KCCQ is as follows: 23 KCCQ questions from 5 domains were simplified into 5 questions, 1 from each domain. Response options were consolidated into severely, moderately and minimal/none from 5-7 prior options. The trajectories of within patient changes in the simplified KCCQ domains were evaluated at each time point.

Results

There were sustained improvements from baseline in the summary standard and simplified KCCQ scores and within each simplified domain, beginning 6 months postoperatively (table 1, figure 1). Intra-patient improvements occurred rapidly in each domain and were sustained to two years. Of those who were severely limited in their enjoyment of life (blue) prior to LVAD (n=1133), <17.8% (n=202) and <8.2% (n=93) had persistently severe limitations at 6 months and 1 year, respectively. Overall, 63% of patients has no/minimal limitations at 2 years (Fig 1A, Fig 2). Similar rapid and sustained improvements were noted for response to the other simplified KCCQ domains (Fig 1B-C).

Conclusion

An assessment of individual simplified KCCQ domain responses allows for a succinct assessment of the patient journey after HM3. These data may assist in improving KCCQ data compliance with registries and in conveying average changes in hf-QOL after LVAD to patients.