Usefulness and feasibility of Patient Reported Outcomes in assessing prognosis in Heart Failure patients

Background: Heart failure is a growing chronic disease which severely impacts survival and Quality of Life. In recent years Patient-Reported Outcome Measures have been increasingly more used to incorporate the patients’ point of view into clinical decision. After being imposing themselves as endpoints in Clinical Trials there is now a growing interest for their application in routine clinical practice. They can be used to keep in touch with patients between office visits and they can guide clinical decisions both in outpatient and inpatient settings. To this day there aren’t many reports in literature about results of a continuous and routinary approach aimed at assessing PROs (Patient- in cardiology departments. Rationale: The present work aims at assessing the feasibility, in terms of patients’ willingness to respond, and usefulness, in terms of predictive power for exacerbations and need for increase in diuretic therapy, for heart failure patients. Patients and Methods: Between October 2020 and May 2021, 374 patients were enrolled and they were contacted via SMS and e-mail to fill in the standard patients’ surveys. We explored the relationship between response rates and demographic variables, such as age, education and number of previous visits at the same hospital, together with clinical variables such as comorbidities and therapies. A total of 49 patients completed the KCCQ assessment and, after excluding patients for whom data was missing or who had a short follow-up, we analyzed 35 patients to correlate PROMs and HF hospitalization. For these patients further parameters were collected, BMI, weight change, hospital therapy, creatinine, estimated Glomerular filtration GFR, NT-proBNP, echocardiographic variables and the 3C-HF score was calculated. Results: A response ratio of 13% was observed, respondents were shown to be younger, although by less than 4 years, and to be taking ARNI as a therapy more often than non-respondents. KCCQ and 3C-HF were associated with the patients being hospitalized due to a HF exacerbation, the odds ratio had comparable magnitude at the univariate analysis (1.05 vs 0.95). We found creatinine to be also correlated to the hospitalization outcome. Regarding therapeutic changes, KCCQ wasn’t associated with an increase in diuretic therapy, while 3C-HF was. Conclusions: The Kansas City Cardiomyopathy Questionnaire is a reliable measure to predict rehospitalization in chronic heart failure patients. It should thus be integrated into routine practice to inform on follow-up timing and clinical decisions