Prognostic utility of the kansas city cardiomyopathy questionnaire across cognitive function levels in older patients with heart failure: insights from the JROADHF-NEXT registry
T Nakade, T Ide, K Kida, S Matsushima, N Enzan, M Ikeda, T Kitai, T Taniguchi, T Okumura, T Tohyama, H Tsutsui, N Ikemura, J Spertus, T Minamino, Y MatsueAbstract
Background
The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a widely used patient-reported measure and has been independently associated with clinical events across diverse heart failure populations. However, its prognostic utility in older adults with heart failure, particularly those with cognitive impairment, has not been well characterised. Because KCCQ is self-administered, cognitive status may influence score validity and interpretation.
Purpose
To evaluate the association between discharge KCCQ-Overall Summary Score (KCCQ-OSS) and 2-year all-cause mortality in older patients hospitalised for heart failure, and to determine whether cognitive impairment modifies this association.
Methods
Patients aged≥65 years with a KCCQ at discharge were identified from the JROADHF-NEXT registry, a prospective, multicentre registry of patients hospitalised for heart failure in Japan. Cognitive function was evaluated using the Mini-Cog (range from 0-5, with a score <4 defined as a cognitive impairment). The primary outcome was 2-year all-cause mortality. Adjusted Cox proportional hazards models were used to define the independent association of KCCQ-OSS with mortality, including an interaction term for cognitive impairment.
Results
Among the 2,148 included patients, the mean age was 79 ± 8 years, 59.1% were male, and the median KCCQ-OSS was 57.3 (IQR 39.6–73.6). Patients with lower KCCQ-OSS were more often female, had more atrial fibrillation, greater loop diuretic use, and lower albumin levels. During 2-year follow-up, 419 patients (19.5%) died. Kaplan–Meier curves showed significantly higher mortality in lower KCCQ-OSS groups (log-rank P<0.001): 15.0% for KCCQ-OSS 75–100, 18.1% for 50–74, 22.3% for 25–49, and 26.7% for 0–24. Overall, continuous KCCQ-OSS scores were independently associated with higher 2-year mortality after adjustment (per 10-point decrease: adjusted hazard ratio: 1.07, 95% CI 1.03–1.13; P=0.002). This association differed by cognitive status (P for interaction = 0.009) with a strong association among those without cognitive impairment (HR, 1.13 [95% CI, 1.05–1.21]; P<0.001) but not among those with cognitive impairment (HR, 0.99 [95% CI, 0.92–1.06]; P=0.783). To further explore effect modification, we performed stratified analyses by age and left ventricular ejection fraction. The association between KCCQ-OSS and mortality was similar in patients aged <80 and ≥80 years (P for interaction=0.824). Likewise, the association did not differ when stratified by LVEF (<50% vs ≥50%; P for interaction=0.999)
Conclusions
An independent association of KCCQ-OSS scores at hospital discharge with 2-year mortality in older patients with heart failure was observed in those without cognitive impairment, but not in those who were cognitively impaired.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.