Background: Heart failure with reduced ejection fraction (HFrEF) has a significant impact on patients’ health status. A primary goal of treatment is to minimize patients’ symptoms, while maximizing their functional status and quality of life. The variability across outpatient practices, and the characteristics of those practices, in optimizing patients’ health status is unknown.
Methods: In the multicenter CHAMP-HF registry, the association between practice characteristics and Kansas City Cardiomyopathy Questionnaire Overall Summary Scores (KCCQ-os) in 3,494 patients across 140 US centers was assessed with hierarchical logistic regression adjusting for 23 patient characteristics to predict excellent health status (KCCQ-os ≥75). A median odds ratio (MOR) was estimated to quantify the average relative difference a patient would exhibit excellent health status when being treated at one random practice versus another.
Results: The mean (±standard deviation) KCCQ-os was 64.2±24, and 39% (n=1,380) had a KCCQ-os ≥75. In a fully-adjusted model, patients were more likely to have excellent health status if the practice was in a suburban (vs. urban) location (OR=1.47, p = 0.02), while those enrolled at a primary care (vs. cardiology) setting were less likely to have a KCCQ≥75 (OR=0.52, p = 0.02). The MOR across practices was 1.69 (95% CI=1.46, 1.90; p < 0.0001) indicating a median 69% higher odds of a statistically identical patient having excellent health status when treated at one random practice versus another.
Conclusion: In this first large, contemporary assessment of health status in outpatients with HFrEF, we found marked variation by site in patients having excellent health status. Proposed efforts to use patient-reported outcomes as a quality measure may support improved attention to patients’ health status in clinical care.