Short Form Versions: KCCQ-12 and SAQ-7
The KCCQ-12 reduces the KCCQ’s 23 items to 12, while the SAQ-7 reduces the SAQ’s 19 items to 7. Both shortened versions significantly increase the speed and ease of questionnaire administration while preserving the sensitivity, specificity, and reliability of the original instruments.
Quantifying patients’ perspectives about the degree to which their heart failure (HF) impacts their health status
(their symptoms, function, and quality of life) is becoming an increasingly important outcome in clinical trials, quality assessment, and clinical care. Creating shorter and simpler health status measures is a critical step in supporting their use in clinical care and can support inexpensive, serial monitoring of patients’ HF that might help identify those who warrant additional testing with biomarkers or physiological measures or treatment intensification.
The Kansas City Cardiomyopathy Questionnaire (KCCQ), a commonly used instrument for measuring health status in patients with HF, has excellent psychometric properties, but is currently 23 items long, taking 5 to 8 minutes for patients to complete. The Seattle Angina Questionnaire (SAQ), a commonly used instrument for measuring health status in patients with CAD, has been frequently used as an outcome in clinical trials and has been endorsed as a performance measure for assessing the quality of CAD care. The use of the SAQ in quality assessment and clinical care, however, has been limited because of its length (19 questions) and the absence of a single summary score that facilitates an overall assessment of patients’ health status.
Using data from 4167 patients with heart failure in different clinical settings, the KCCQ was reduced from 23 to 12 items. The KCCQ-12 is highly correlated with the original 23-item scale scores and preserves the validity, reliability, responsiveness, prognostic importance, and interpretability of the original instrument. The KCCQ-12 may prove to be a more feasible instrument for quantifying the health status of heart failure patients.
The availability of a shortened disease-specific health status measure for patients with HF has the potential to improve care. First, quantifying patients’ health status at each outpatient visit has been endorsed as a performance measure of healthcare quality. Although this measure can be met with either the New York Heart Association classification or 1 of 3 PROs, including the KCCQ, the inter-rater reliability of the New York Heart Association is poor, with a concordance of 54% as compared with the intraclass correlation coefficient of 92% for the KCCQ-12 overall summary score. Having more reliable estimates of patients’ health status through self-reported PROs becomes, in essence, a standardized history that can provide a better estimate from which to assess whether patients’ conditions have changed over time. In addition, incorporating a short PRO into the clinical examination can theoretically improve the efficiency of a provider’s visit by enabling providers to know, at a glance, whether the patient is doing better or worse as compared with the prior visit.
We have derived and validated a 7-item shortened version of the SAQ (SAQ-7), as well as an overall summary score, to facilitate assessments of health status in patients with coronary artery disease. The SAQ-7 performed well in patients with stable coronary artery disease, undergoing percutaneous coronary intervention, and presenting with acute myocardial infarction. The SAQ-7 has the potential to improve clinical care by providing physicians an objective, efficient mechanism to follow the trajectory of their coronary artery disease patients’ health status.
The use of a shorter health status instrument and an overall summary score may also have applications in quality assessment. Recently, appropriate use criteria have been developed for coronary revascularization to better highlight the judicious use of procedures such as PCI in patients with obstructive CAD. In a subsequent study involving >500 000 patients undergoing PCI since the dissemination of these criteria, ≈12% of procedures performed in patients with stable CAD were categorized as inappropriate, wherein a technical panel determined that the benefits of the procedure were not felt to outweigh the risks.
Created: December 16, 2015 17:15
Last updated: January 07, 2016 19:26