Health Status Variation Across Practices in Outpatients with Heart Failure: Insights from the CHAMP-HF Registry

BACKGROUND: While a key treatment goal for patients with heart failure and reduced ejection fraction (HFrEF) is to optimize their health status (their symptoms, function, and quality of life), the variability across outpatient practices in achieving this goal is unknown. METHODS AND RESULTS: In the CHAMP-HF registry, associations between baseline practice characteristics and Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) and Symptom Frequency (KCCQ-SF) scores were assessed in 3,494 patients across 140 US practices using hierarchical regression after accounting for 23 patient and 11 treatment characteristics. We then calculated an adjusted median odds ratio (aMOR) to quantify the average difference in likelihood that a patient would have excellent (KCCQ-OS ≥75) health status or minimal (monthly or fewer) symptoms (KCCQ-SF≥75) when treated at one practice versus another, at random. The mean (±SD) KCCQ-OS and KCCQ-SF were 64.2±24 and 68.9±25.6, with 40% (n=1,380) and 50% (n= 1,760) having KCCQ scores ≥ 75, respectively. The aMOR across practices, for KCCQ-OS ≥ 75, was 1.70 (95% CI 1.54, 1.99; p < 0.001) indicating a median 70% higher odds of a patient having good to excellent health status when treated at one random practice versus another. In regard to KCCQ-SF, the aMOR for KCCQ-SF ≥75 was 1.54 (95% CI 1.41, 1.76; p = 0.001). CONCLUSIONS: In a large, contemporary registry of outpatients with chronic HFrEF, we observed significant practice-level variability in patients’ health status. Quantifying patients’ health status as a measure of quality should be explored as a foundation for improving care. CLINICAL TRIAL REGISTRATION: URL: https://www.centerwatch.com; Unique Identifier: TX144901