Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing
Background Patient‐reported outcomes may be discordant to severity of illness as assessed by objective parameters. The frequency of this discordance and its influence on clinical outcomes in patients with heart failure is unknown. Methods and Results In HF‐ACTION (Heart Failure: A Controlled Trial I...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.019864 |
| _version_ | 1797936099304144896 |
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| author | Katherine C. Michelis Justin L. Grodin Lin Zhong Ambarish Pandey Kathleen Toto Colby R. Ayers Jennifer T. Thibodeau Mark H. Drazner |
| author_facet | Katherine C. Michelis Justin L. Grodin Lin Zhong Ambarish Pandey Kathleen Toto Colby R. Ayers Jennifer T. Thibodeau Mark H. Drazner |
| author_sort | Katherine C. Michelis |
| collection | DOAJ |
| description | Background Patient‐reported outcomes may be discordant to severity of illness as assessed by objective parameters. The frequency of this discordance and its influence on clinical outcomes in patients with heart failure is unknown. Methods and Results In HF‐ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), participants (N=2062) had baseline assessment of health‐related quality of life via the Kansas City Cardiomyopathy Clinical Summary score (KCCQ‐CS) and objective severity by cardiopulmonary stress testing (minute ventilation [VE]/carbon dioxide production [VCO2] slope). We defined 4 groups by median values: 2 concordant (lower severity: high KCCQ‐CS and low VE/VCO2 slope; higher severity: low KCCQ‐CS and high VE/VCO2 slope) and 2 discordant (symptom minimizer: high KCCQ‐CS and high VE/VCO2 slope; symptom magnifier: low KCCQ‐CS and low VE/VCO2 slope). The association of group assignment with mortality was assessed in adjusted Cox models. Symptom magnification (23%) and symptom minimization (23%) were common. Despite comparable KCCQ‐CS scores, the risk of all‐cause mortality in symptom minimizers versus concordant–lower severity participants was increased significantly (hazard ratio [HR], 1.79; 95% CI, 1.27–2.50; P<0.001). Furthermore, despite symptom magnifiers having a KCCQ‐CS score 28 points lower (poorer QOL) than symptom minimizers, their risk of mortality was not increased (HR, 0.79; 95% CI, 0.57–1.1; P=0.18, respectively). Conclusions Severity of illness by patient report versus cardiopulmonary exercise testing was frequently discordant. Mortality tracked more closely with the objective data, highlighting the importance of relying not only on patient report, but also objective data when risk stratifying patients with heart failure. |
| first_indexed | 2024-04-10T18:24:28Z |
| format | Article |
| id | doaj.art-58915023b7aa45be8e2ee3e42ee58a65 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T18:24:28Z |
| publishDate | 2021-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-58915023b7aa45be8e2ee3e42ee58a652023-02-02T06:18:05ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-07-01101310.1161/JAHA.120.019864Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise TestingKatherine C. Michelis0Justin L. Grodin1Lin Zhong2Ambarish Pandey3Kathleen Toto4Colby R. Ayers5Jennifer T. Thibodeau6Mark H. Drazner7Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Bioinformatics Department of Clinical Sciences University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXBackground Patient‐reported outcomes may be discordant to severity of illness as assessed by objective parameters. The frequency of this discordance and its influence on clinical outcomes in patients with heart failure is unknown. Methods and Results In HF‐ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), participants (N=2062) had baseline assessment of health‐related quality of life via the Kansas City Cardiomyopathy Clinical Summary score (KCCQ‐CS) and objective severity by cardiopulmonary stress testing (minute ventilation [VE]/carbon dioxide production [VCO2] slope). We defined 4 groups by median values: 2 concordant (lower severity: high KCCQ‐CS and low VE/VCO2 slope; higher severity: low KCCQ‐CS and high VE/VCO2 slope) and 2 discordant (symptom minimizer: high KCCQ‐CS and high VE/VCO2 slope; symptom magnifier: low KCCQ‐CS and low VE/VCO2 slope). The association of group assignment with mortality was assessed in adjusted Cox models. Symptom magnification (23%) and symptom minimization (23%) were common. Despite comparable KCCQ‐CS scores, the risk of all‐cause mortality in symptom minimizers versus concordant–lower severity participants was increased significantly (hazard ratio [HR], 1.79; 95% CI, 1.27–2.50; P<0.001). Furthermore, despite symptom magnifiers having a KCCQ‐CS score 28 points lower (poorer QOL) than symptom minimizers, their risk of mortality was not increased (HR, 0.79; 95% CI, 0.57–1.1; P=0.18, respectively). Conclusions Severity of illness by patient report versus cardiopulmonary exercise testing was frequently discordant. Mortality tracked more closely with the objective data, highlighting the importance of relying not only on patient report, but also objective data when risk stratifying patients with heart failure.https://www.ahajournals.org/doi/10.1161/JAHA.120.019864dyspneaepidemiologyprognosisquality of lifestress test |
| spellingShingle | Katherine C. Michelis Justin L. Grodin Lin Zhong Ambarish Pandey Kathleen Toto Colby R. Ayers Jennifer T. Thibodeau Mark H. Drazner Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease dyspnea epidemiology prognosis quality of life stress test |
| title | Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing |
| title_full | Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing |
| title_fullStr | Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing |
| title_full_unstemmed | Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing |
| title_short | Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing |
| title_sort | discordance between severity of heart failure as determined by patient report versus cardiopulmonary exercise testing |
| topic | dyspnea epidemiology prognosis quality of life stress test |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.019864 |
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