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The patient-reported outcome measurement in heart failure clinic trial: Rationale and methods of the PRO-HF trial - 08/12/22

Doi : 10.1016/j.ahj.2022.10.081 
Neil M. Kalwani, MD, MPP a, b, Jamie Calma, BA a, George M. Varghese, MBBS a, Anshal Gupta, MTM c, Jimmy Zheng, BS c, Cati Brown-Johnson, PhD d, Alexis Amano, MS d, Stacie Vilendrer, MD, MBA, MS d, Marcy Winget, PhD d, Steven M. Asch, MD MPH b, d, Paul Heidenreich, MD, MS a, b, Alexander Sandhu, MD, MS a, b,
a Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 
b Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 
c Stanford University School of Medicine, Stanford, CA 
d Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA 

Reprint requests:Alexander Sandhu, MD MS, Stanford University, Division of Cardiovascular Medicine, Department of Medicine, 300 Pasteur Drive, Stanford, CA, 94305Stanford UniversityDivision of Cardiovascular MedicineDepartment of Medicine300 Pasteur DriveStanfordCA94305

Riassunto

Background

Among patients with heart failure (HF), patient-reported health status provides information beyond standard clinician assessment. Although HF management guidelines recommend collecting patient-reported health status as part of routine care, there is minimal data on the impact of this intervention.

Study Design

The Patient-Reported Outcomes in Heart Failure Clinic (PRO-HF) trial is a pragmatic, randomized, implementation-effectiveness trial testing the hypothesis that routine health status assessment via the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) leads to an improvement in patient-reported health status among patients treated in a tertiary health system HF clinic. PRO-HF has completed randomization of 1,248 participants to routine KCCQ-12 assessment or usual care. Patients randomized to the KCCQ-12 arm complete KCCQ-12 assessments before each HF clinic visit with the results shared with their treating clinician. Clinicians received education regarding the interpretation and potential utility of the KCCQ-12. The primary endpoint is the change in KCCQ-12 over 1 year. Secondary outcomes are HF therapy patterns and health care utilization, including clinic visits, testing, hospitalizations, and emergency department visits. As a sub-study, PRO-HF will also evaluate the impact of routine KCCQ-12 assessment on patient experience and the accuracy of clinician-assessed health status. In addition, clinicians completed semi-structured interviews to capture their perceptions on the trial's implementation of routine KCCQ-12 assessment in clinical practice.

Conclusions

PRO-HF is a pragmatic, randomized trial based in a real-world HF clinic to determine the feasibility of routinely assessing patient-reported health status and the impact of this intervention on health status, care delivery, patient experience, and the accuracy of clinician health status assessment.

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 Trial Registration: https://clinicaltrials.gov/ct2/show/NCT041640


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Vol 255

P. 137-146 - Gennaio 2023 Ritorno al numero
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