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(Circulation. 2004;110:546-551.)
© 2004 American Heart Association, Inc.

Original Articles

Prognostic Value of Health Status in Patients With Heart Failure After Acute Myocardial Infarction

Gabriel E. Soto, MD, PhD; Philip Jones, MS; William S. Weintraub, MD; Harlan M. Krumholz, MD, MS; John A. Spertus, MD, MPH

From the Washington University School of Medicine, St Louis, Mo (G.E.S.); Mid America Heart Institute and University of Missouri, Kansas City (P.J., J.A.S.); Emory University, Atlanta, Ga (W.S.W.); and Yale University, New Haven, Conn (H.M.K.).

Correspondence to Dr J.A. Spertus, Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail spertusj{at}umkc.edu

Received December 1, 2003; de novo received February 16, 2004; revision received April 6, 2004; accepted April 8, 2004.

Background— Disease-specific health status instruments such as the Kansas City Cardiomyopathy Questionnaire (KCCQ) can quantify symptoms, functional limitations, and quality of life in patients with heart failure. Understanding the relationship between KCCQ scores and prognosis may assist clinicians in both interpreting KCCQ scores and stratifying risk in patients.

Methods and Results— We examined the prognostic value of the KCCQ in a prospective, international cohort of 1516 patients with heart failure after a recent acute myocardial infarction. We focused on the relationship between the KCCQ overall score (KCCQ-os), measured at the first outpatient visit (4 weeks after enrollment), and subsequent 1-year cardiovascular mortality or hospitalization (n=258, 20.3%). KCCQ-os was strongly associated with subsequent cardiovascular events in that those with a score 75 had an 84% 1-year event-free survival compared with 59% for those with a score <25 (P<0.001). After demographic and other clinical characteristics were controlled for in multivariable models, KCCQ-os remained strongly associated with outcome (hazard ratio, 2.02; 95% CI, 1.24 to 3.27 for KCCQ-os <25; P<0.001).

Conclusions— In outpatients with heart failure complicating an acute myocardial infarction, KCCQ-os is strongly associated with subsequent 1-year cardiovascular mortality and hospitalization. Use of the KCCQ in outpatient clinical practice can both quantify patients’ health status and provide insight into their prognosis. (Circulation. 2004;110:546-551.)

Key Words: heart failure • mortality • myocardial infarction • risk factors

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