Validation of heart failure quality of life tool and usage to predict all-cause mortality in acute heart failure in Uganda: the Mbarara heart failure registry (MAHFER)

• Published in: BMC cardiovascular disorders Vol. 18; no. 1; p. 232
• Main Authors: Okello, Samson, Abeya, Fardous Charles, Lumori, Boniface Amanee Elias, Akello, Suzan Joan, Moore, Christopher Charles, Annex, Brian H, Buda, Andrew J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12-12-2018; BioMed Central; BMC
• Subjects: 36-item short form health survey; Acute heart failure; Adult; Aged; Alcoholic beverages; All-cause mortality; Analysis; Beta blockers; Brain natriuretic peptide; Cardiomyopathy; Congestive heart failure; Creatine; Decision Support Techniques; Epidemiology; Epidermal growth factor receptors; Family medical history; Female; Glomerular filtration rate; Health risk assessment; Health surveys; Heart diseases; Heart failure; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - psychology; Hospitalization; Hospitals; Humans; Kansas City cardiomyopathy questionnaire; Kidney diseases; Life Style; Male; Middle Aged; Mortality; Patients; Peptides; Predictive Value of Tests; Prognosis; Quality of Life; Quantitative psychology; Questionnaires; Registries; Reproducibility of Results; Risk Assessment; Risk Factors; Rural Health; Social Determinants of Health; Socioeconomic Factors; Studies; Sub-Saharan Africa; Surveys and Questionnaires; Time Factors; Uganda; New York; Zambia; Kansas City Missouri; Africa; All-cause mortality; 36-item short form health survey; Kansas City cardiomyopathy questionnaire; Sub-Saharan Africa; Acute heart failure
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-018-0959-1

The health-related quality of life (HRQoL) is an important treatment goal that could serve as low-cost prognostication tool in resource poor settings. We sought to validate the Kansas City Cardiomyopathy Questionnaire (KCCQ) and evaluate its use as a predictor of 3 months all-cause mortality among heart failure participants in rural Uganda.
The Mbarara Heart Failure Registry Cohort study observes heart failure patients during hospital stay and in the community in rural Uganda. Participants completed health failure evaluations and HRQoL questionnaires at enrollment, 1 and 3 months of follow-up. We used Cronbach's alpha coefficients to define internal consistency, intraclass correlation coefficients as a reliability coefficient, and Cox proportional hazard models to predict the risk of 3 months all-cause mortality.
Among the 195 participants who completed HRQoL questionnaires, the mean age was 52 (standard deviation (SD) 21.4) years, 68% were women and 29% reported history of hypertension. The KCCQ had excellent internal consistency (87% Cronbach alpha) but poor reliability. Independent predictors of all-cause mortality within 3 months included: worse overall KCCQ score (Adjusted Hazard ratio (AHR) 2.9, 95% confidence interval (CI) 1.1, 8.1), highest asset ownership (AHR 3.6, 95% CI 1.2, 10.8), alcoholic drinks per sitting (AHR per 1 drink 1.4, 95% CI 1.0, 1.9), New York Heart Association (NYHA) functional class IV heart failure (AHR 2.6, 95% CI 1.3, 5.4), estimated glomerular filtration rate (eGFR) 30 to 59 ml/min/1.73 m
(AHR 3.4, 95% CI 1.1, 10.8), and eGFR less than 15 ml/min/1.73 m
(AHR 2.7, 95% CI 1.0, 7.1), each 1 pg/mL increase in Brain Natriuretic Peptide (BNP) (AHR, 1.0, 95% CI 1.0, 1.0), and each 1 ng/mL increase in Creatine-Kinase MB isomer (CKMB) (AHR 1.0, 95% CI 1.0, 1.1).
The KCCQ showed excellent internal consistency. Worse overall KCCQ score, highest asset ownership, increasing alcoholic drink per sitting, NYHA class IV, decreased estimated glomerular filtration rate, BNP, and CKMB predicted all-cause mortality at 3 months. The KCCQ could be an additional low-cost tool to aid in the prognostication of acute heart failure patients.