Incorporating PROs in Heart Failure Can Improve Patient Experience, Understanding of Symptoms

Alexander T. Sandhu, MD, MS

Data from a substudy of the PRO-HF study is shedding new light on the potential utility of patient-reported outcomes (PROs) in management of heart failure.

Presented at the American Heart Association 2022 Scientific Sessions, results of the analysis, which examined use of routine Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) collection in heart failure clinics, suggest use of PROs contributed to more accurate assessments of health status by clinicians and a greater belief among patients that their clinician understood their symptoms.

“In this pragmatic randomized trial, routine assessment of patient-reported health status in HF clinic using the KCCQ-12 led to improved accuracy of clinician assessments of patients’ health status and improved patient perception of clinicians’ understanding of their disease. The downstream impact of patient-reported health status assessment on clinical decision-making and outcomes remains to be seen and should be further investigated,” wrote investigators.

As therapies and technologies for management of multiple cardiovascular disease have demonstrably improved clinicians’ abilities to improve quality of life and outcomes among their patients, particularly in heart failure, a new emphasis has grown on patient-centric care, including incorporation of PROs and patient-reported quality metrics into disease management. The Patient-Reported Outcome Measurement in Heart Failure Clinic (PRO-HF) was launched in 2021 to develop a greater understanding of optimal strategies for implementation of PROs into standard care and clinical processes.

With this in mind, investigators designed the trial to randomize patients with heart failure to early or delayed implementation of a validated health-related quality of life survey. In the prespecified subsidy presented by Alexander T. Sandhu, MD, MS, of Stanford University, investigators provided insight into whether access to the KCCQ-12 improved the accuracy of clinicians’ NYHA assessment or patients’ perspectives on their clinician interaction through a comparison of clinician responses with patients’ KCCQ-12 scores and surveys of patients regarding their clinician interactions.

Overall, 1051 of the 1248 enrolled individuals attended a visit during the substudy. Results of the KCCQ-12 were provided to clinicians treating 528 patients in the KCCQ-12 arm of the study. Infvestigao5s pointed out the 523 patients in the usual care arm completed the KCCQ-12, but these results were not shared with clinicians.

Upon analysis, results suggest the correlation between NYHA class and KCCQ-12 scores were stronger when clinicians had access to the KCCQ-12 scores (r=-0.73 vs. r=-0.61, p<0.001). Additionally, a greater proportion of patients in the KCCQ-12 arm of the study indicated they strongly agreed that their clinician understood their symptoms (95.2% vs 89.7%; OR, 2.27 [95% CI, 1.31-3.87]). Investigators did point out patients in both arms of the study reported similar quality of clinician communication and therapeutic alliance.

“These results support the implementation of patient-reported health status as part of routine clinical care for heart failure to improve the accuracy of patients’ health status assessments and to improve patients’ experiences with care. Our results support prior work demonstrating the potential of incorporating PROs into routine care,” wrote investigators.

This study, “Impact of Patient-Reported Outcome Measurement in Heart Failure Clinic on Clinician Health Status Assessment and Patient Experience: A Sub-Study of the PRO-HF Trial,” was presented at AHA 22 and simultaneously published in Circulation: Heart Failure.