Common strengths and challenges in heart failure care across the Belgian health care system: first results of the heart failure clinic of the future (HFCoF) project

Abstract

103 Changing clinical status and outcomes KCCQ-os (≥10 points decrease) and VAS (>1 point decrease) were associated with HF admission/death (adjusted HR 2.95[2.14-4.06]; 1.93[1.26-2.94] 2.30[1.51-3.52] respectively). Conversely, the same degree of improvement in GSSS KCCQ-os and VAS were with reduced rates (HR 0.35[0.25-0.49]; 0.25[0.16-0.40]; 0.64[0.40-1.00] respectively). Results were consistent across all sex, ethnicity, and SES groups (interaction-P >0.05). Conclusion: Serial measures of patient-reported symptoms and HRQoL are significant and consistent predictors of outcomes among different groups with HF and provide the potential for an individualised patient-centred and pragmatic approach to risk stratification. Funding Acknowledgements: Type of funding sources: Other. Main funding source(s): Dr Yang is funded by China Scholarship Council. Background: Although education in self-management is thought to be an important aspect of the care of patients with heart failure, little is known about whether self-rated knowledge of self-management is associated with outcomes. Purpose: To assess the relationship between patient-reported knowledge of self-management and clinical outcomes in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Using individual patient data from 3 recent clinical trials enrolling participants with HFrEF, we examined patient characteristics and clinical outcomes according to responses to the "self-efficacy" questions of the Kansas City Car-diomyopathy Questionnaire (KCCQ). One question quantifies patients' understanding of how to prevent heart failure exacerbations ("prevention" question) and the other how to manage complications when they arise ("response" question). Results: Of patients (n = 17629) completing the "prevention" question, 4197 (23.8%), 6897 (39.1%), and 6535 (37.1%) had poor, fair, and good self-rated knowledge , respectively. Of those completing the "response" question (n = 17637), 4033 (22.9%), 5463 (31.0%), and 8141 (46.2%) patients, respectively, had poor, fair, and good self-rated knowledge. For both questions, patients with "poor" knowledge were older, more often female, and had a worse HF profile but similar treatment. Patients with "good" knowledge had lower overall mortality than those with "poor" knowledge: for the "prevention" question the hazard ratio was 0.85 (0.78-0.93), p < 0.001; for the "response" question it was 0.82 (0.76-0.90), p < 0.001. Conclusion: Around a quarter of patients with HFrEF reported poor knowledge of "self-efficacy" and this was associated with worse outcomes. Evaluation of knowledge of "self-efficacy" may provide prognostic information and a guide to which patients may benefit from further education about self-management. Figure legend: Cumulative incidence of death from any cause in HFrEF according to patient reported knowledge of self-care. A = KCCQ "prevention" question; B = KCCQ "treatment" question. Patient answers grouped as poor, fair or good knowledge about self-care. Cumulative incidence of death Common strengths and challenges in heart failure care across the Belgian health care system: first results of the heart failure clinic of the future (HFCoF) project