Hospital- versus Home-based Evaluation of Quality of Life in Heart Failure with Reduced Ejection Fraction: a Randomized Study

Abstract

Background: Heart failure (HF) patients often experience poor health-related quality-of-life (HR-QoL). The Kansas City Cardiomyopathy Questionnaire (KCCQ) is frequently used for assessing HR-QoL in HF. Whether KCCQ scores vary in a clinical meaningful manner according to the setting (home vs office) where patients respond to the questionnaire is currently unknown. Aims: Access the differences in the responses to KCCQ-23 questionnaire when completed at home or office. Methods: Randomized parallel-group study, including patients with HF with reduced ejection fraction (HFrEF). Primary outcome was home vs office comparison of overall summary score (KCCQ-OSS). Main secondary outcomes were clinical summary score (KCCQ-CSS) and total symptom score (KCCQ-TSS). Results: A total of 100 patients were included in the study: 50 home vs 50 office. Mean age was 71yrs. Most baseline characteristics were well balanced between groups, except male sex, MRA use, and prior HF hospitalizations more frequent in home group. No statistically-significant between-group differences were found regarding KCCQ-OSS (median [percentile25-75]) scores: home 69.1 (42.0-86.5) vs office 63.1 (44.3-82.3) points, P-value=0.59. No significant differences were found in main secondary outcome scores: KCCQ-CSS home 62.2 (46.5-79.9) vs office 68.1 (51.9-79.2) points, P-value=0.69, and KCCQ-TSS home 84.7 (59.7-97.2) vs office 76.4 (66.7-94.4) points, P-value=0.85. Results remained similar after adjustment for differences in baseline characteristics and using non-parametric regressions. Conclusions: No major differences were found in KCCQ-23 scores when the questionnaire was completed at home or office. These findings can be useful to make HR-QoL more accessible, allowing patients to respond at home using email or cell-phone applications.