Report on Predictive Utility of Patient-Reported Outcome Measures in Heart Failure Care

Introduction

Recent research conducted by Vanderbilt University Medical Center (VUMC) has demonstrated that a patient-reported outcome measure (PROM) for adults with heart failure reliably predicts hospitalizations and mortality. This PROM outperforms all other electronic health record variables, highlighting its potential to improve patient care and align with Sustainable Development Goals (SDGs) related to health and well-being.

Study Overview

The study, titled “Predicting Heart Failure Outcomes Using Patient-Reported Health Status: Real-World Validation of the KCCQ-12,” was published in the Journal of the American College of Cardiology. It evaluated the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), a 12-item survey assessing symptoms, physical function, social limitations, and quality of life among adult heart failure patients.

Methodology

1. Data Collection: Responses from 4,406 patients assigned the KCCQ-12 during outpatient visits at the VUMC Heart Failure Clinic (July 2019 – March 2024).
2. Completion Rate: 2,888 patients completed at least one questionnaire.
3. Assessment: Patients with severe symptoms (scores 75 regarding 90-day hospitalization and mortality risks.

Key Findings

• Patients reporting severe symptoms had significantly higher risks of hospitalization and mortality within 90 days.
• The KCCQ-12 demonstrated superior predictive capability compared to other electronic health record variables.

Innovative Data Collection System

Patient responses were collected via the Vanderbilt Patient-Reported Outcomes Measurement System (VPROMS), launched in 2019 as part of the Office of Population Health. VPROMS is one of the largest repositories of patient-reported surveys in the United States, facilitating rapid and efficient data collection either before appointments or in waiting rooms.

Implications for Sustainable Development Goals (SDGs)

• SDG 3: Good Health and Well-being – The study advances personalized medicine by focusing on patient-centered outcomes, improving quality of life and reducing mortality among heart failure patients.
• SDG 9: Industry, Innovation, and Infrastructure – Utilization of innovative digital health tools like VPROMS supports resilient health infrastructure and promotes sustainable health innovations.
• SDG 17: Partnerships for the Goals – Collaboration among clinicians, researchers, and national databases such as PCORnet exemplifies effective partnerships to enhance healthcare delivery.

Future Directions

• Investigate factors influencing significant changes in KCCQ-12 scores over time.
• Explore additional clinical applications of PROM data to better monitor patient health status.
• Optimize integration of KCCQ-12 in routine heart failure care to improve patient outcomes and reduce hospitalizations.

Collaborative Efforts and Funding

The research was supported by a $719,628 grant from the Patient-Centered Outcomes Research Institute (PCORI). The study involved a multidisciplinary team including cardiologists, biomedical informaticians, and rehabilitation specialists. Key collaborators included Dr. Justin Bachmann (medical director of VPROMS), Dr. Kelly Schlendorf (director of Heart Failure and Transplant), and multiple co-authors from Vanderbilt Health.

Conclusion

The validated use of the KCCQ-12 PROM during outpatient heart failure visits offers a powerful tool to predict hospitalizations and mortality, thereby enhancing patient-centered care. This aligns with global health priorities under the Sustainable Development Goals by promoting health equity, innovation, and collaborative healthcare solutions.

1. Sustainable Development Goals (SDGs) Addressed or Connected to the Issues Highlighted in the Article

1. SDG 3: Good Health and Well-being
   • The article focuses on improving health outcomes for adults with heart failure, addressing hospitalizations and mortality.
   • It emphasizes personalized medicine and patient-reported outcome measures (PROMs) to enhance quality of life and clinical care.
2. SDG 9: Industry, Innovation and Infrastructure
   • The use of innovative electronic health record systems and patient-reported outcome measurement systems (VPROMS) reflects advancements in healthcare infrastructure and innovation.
3. SDG 17: Partnerships for the Goals
   • The collaboration between multiple medical centers, researchers, and national databases (PCORnet) exemplifies partnerships to improve health research and outcomes.

2. Specific Targets Under Those SDGs Identified Based on the Article’s Content

1. SDG 3: Good Health and Well-being
   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • Target 3.b: Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries.
2. SDG 9: Industry, Innovation and Infrastructure
   • Target 9.5: Enhance scientific research, upgrade the technological capabilities of industrial sectors, including health technology innovations.
3. SDG 17: Partnerships for the Goals
   • Target 17.6: Enhance North-South, South-South and triangular regional and international cooperation on and access to science, technology and innovation.
   • Target 17.8: Fully operationalize the technology bank and science, technology and innovation capacity-building mechanism for least developed countries.

3. Indicators Mentioned or Implied in the Article to Measure Progress Towards the Identified Targets

1. SDG 3 Indicators
   • Hospitalization rates within 90 days for heart failure patients (used to measure morbidity and healthcare outcomes).
   • Mortality rates among heart failure patients (used to measure premature mortality from non-communicable diseases).
   • Patient-reported health status scores from the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), reflecting quality of life and functional status.
   • Completion rates of PROMs (patient engagement and access to quality care).
2. SDG 9 Indicators
   • Implementation and utilization rates of electronic health record systems and patient-reported outcome measurement systems (VPROMS).
   • Number of research studies and innovations in health technology (e.g., predictive utility of KCCQ-12).
3. SDG 17 Indicators
   • Number and scope of partnerships between medical centers and research institutions (e.g., PCORI grant collaboration, PCORnet data sharing).
   • Data integration and sharing across multiple healthcare systems.

4. Table: SDGs, Targets and Indicators

Source: news.vumc.org