PMID- 16209970
OWN - NLM
STAT- MEDLINE
DCOM- 20051128
LR  - 20220410
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 150
IP  - 4
DP  - 2005 Oct
TI  - Monitoring clinical changes in patients with heart failure: a comparison of 
      methods.
PG  - 707-15
AB  - BACKGROUND: Although monitoring the clinical status of patients with heart 
      failure rests at the core of clinical medicine, the ability of different 
      techniques to reflect clinical change has not been evaluated. This study sought 
      to describe changes in various measures of disease status associated with 
      gradations of clinical change. METHODS: A prospective, 14-center cohort of 476 
      outpatients was assessed at baseline and 6 +/- 2 weeks to compare changes in 7 
      heart failure measures with clinically observed change. Measures included health 
      status instruments (the Kansas City Cardiomyopathy Questionnaire [KCCQ], Short 
      Form-12, and EQ-5D), physician-assessed functional class (New York Heart 
      Association [NYHA]), an exercise test (6-minute walk), patient weight, and a 
      biomarker (B-type natriuretic peptide). Cardiologists, blinded to all measures 
      except weight and NYHA, categorized clinical change ranging from large 
      deterioration to large improvement. RESULTS: The KCCQ, NYHA, and 6-minute walk 
      test were most sensitive to clinical change. For patients with large, moderate, 
      and small deteriorations, the KCCQ decreased by 25 +/- 16, 17 +/- 14, and 5.3 +/- 
      11 points, respectively. For patients with small, moderate, and large 
      improvements, the KCCQ increased by 5.7 +/- 16, 10.5 +/- 16, and 22.3 +/- 16 
      points, respectively (P < .01 for all compared with the no change group). New 
      York Heart Association and 6-minute walk distance were significantly different 
      for those with moderate and large changes (P < .05) but neither revealed a 
      difference between those with small versus no clinical deterioration. The KCCQ 
      had the highest c statistic for monitoring individual patients, followed by NYHA 
      and 6-minute walk. CONCLUSION: The KCCQ, followed by the NYHA and the 6-minute 
      walk test, most accurately reflected clinical change in patients with heart 
      failure.
FAU - Spertus, John
AU  - Spertus J
AD  - Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO, USA. 
      spertusj@umkc.edu
FAU - Peterson, Eric
AU  - Peterson E
FAU - Conard, Mark W
AU  - Conard MW
FAU - Heidenreich, Paul A
AU  - Heidenreich PA
FAU - Krumholz, Harlan M
AU  - Krumholz HM
FAU - Jones, Philip
AU  - Jones P
FAU - McCullough, Peter A
AU  - McCullough PA
FAU - Pina, Ileana
AU  - Pina I
FAU - Tooley, Joseph
AU  - Tooley J
FAU - Weintraub, William S
AU  - Weintraub WS
FAU - Rumsfeld, John S
AU  - Rumsfeld JS
CN  - Cardiovascular Outcomes Research Consortium
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
CIN - Am Heart J. 2006 Jun;151(6):e5; author reply e7. PMID: 16781209
MH  - Diagnostic Tests, Routine
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/complications/*diagnosis/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Sensitivity and Specificity
MH  - Surveys and Questionnaires
MH  - Time Factors
EDAT- 2005/10/08 09:00
MHDA- 2005/12/13 09:00
CRDT- 2005/10/08 09:00
PHST- 2004/09/01 00:00 [received]
PHST- 2004/12/09 00:00 [accepted]
PHST- 2005/10/08 09:00 [pubmed]
PHST- 2005/12/13 09:00 [medline]
PHST- 2005/10/08 09:00 [entrez]
AID - S0002-8703(04)00906-8 [pii]
AID - 10.1016/j.ahj.2004.12.010 [doi]
PST - ppublish
SO  - Am Heart J. 2005 Oct;150(4):707-15. doi: 10.1016/j.ahj.2004.12.010.