Table 1. Baseline Demographic, Clinical, and Socioeconomic Characteristics by Degree of Baseline Discordance Between NYHA and KCCQ-OS.
| Characteristic | No. (%) of participants | P value | ||
|---|---|---|---|---|
| Concordance (n = 1085) | Discordance | |||
| Mild (n = 1494) | Moderate-severe (n = 293) | |||
| Age, median (IQR), y | 67 (58-75) | 68 (59-75) | 67 (58-77) | .53 |
| Women | 350 (32.3) | 434 (29.0) | 88 (30.0) | .22 |
| Race | ||||
| White | 813 (74.9) | 1138 (76.2) | 205 (70.0) | .13 |
| Black/African American | 181 (16.7) | 239 (16.0) | 65 (22.2) | |
| Othera | 91 (8.4) | 117 (7.8) | 23 (7.8) | |
| Hispanic ethnicity | 228 (21.0) | 270 (18.1) | 42 (14.3) | .02 |
| Ejection fraction, median (IQR), % | 30 (23-36) | 30 (24-35) | 30 (23-34) | .009 |
| NYHA class | ||||
| I | 219 (20.2) | 67 (4.5) | 26 (8.9) | <.001 |
| II | 604 (55.7) | 1047 (70.1) | 59 (20.1) | |
| III | 249 (22.9) | 366 (24.5) | 189 (64.5) | |
| IV | 13 (1.2) | 14 (0.9) | 19 (6.5) | |
| KCCQ-OS, median (IQR) | 63 (50-72) | 72 (47-88) | 79 (41-89) | <.001 |
| Vital signs and laboratory findings, median (IQR)b | ||||
| Systolic blood pressure, mm Hg | 120 (110-131) | 120 (110-130) | 120 (110-130) | .68 |
| Heart rate, bpm | 72 (65-82) | 72 (65-80) | 72 (66-82) | .20 |
| BMI | 29.6 (26.1-34.5) | 29.5 (25.8-33.9) | 29.4 (25.8-34.1) | .12 |
| Hemoglobin, g/dL | 13.3 (12.0-14.5) | 13.4 (12.0-14.5) | 12.8 (11.5-14.1) | .005 |
| Serum sodium, mEq/L | 139 (137-141) | 140 (138-141) | 139 (137-141) | .19 |
| BUN, mg/dL | 20 (15-27) | 20 (16-27) | 21 (16-29) | .21 |
| eGFR, mL/min/1.73 m2 | ||||
| <30 | 38 (5.3) | 43 (4.3) | 11 (5.3) | .49 |
| 30-44 | 103 (14.4) | 132 (13.3) | 36 (17.3) | |
| 45-59 | 151 (21.2) | 221 (22.2) | 51 (24.5) | |
| ≥60 | 421 (59.0) | 598 (60.2) | 110 (52.9) | |
| NT-proBNP, median (IQR), pg/mL | 1621 (591-3930) | 1755 (804-4227) | 1542 (751-4037) | .53 |
| Hemoglobin A1c, median (IQR), % | 6.4 (5.9-7.4) | 6.6 (5.9-7.9) | 6.5 (5.9-7.7) | .51 |
| Medical history | ||||
| HF hospitalization within past 12 mo | 389 (35.9) | 512 (34.3) | 126 (43.0) | .02 |
| Coronary artery disease | 712 (65.6) | 939 (62.9) | 189 (64.5) | .35 |
| Hypertension | 919 (84.7) | 1248 (83.5) | 257 (87.7) | .19 |
| Hyperlipidemia | 862 (79.4) | 1213 (81.2) | 230 (78.5) | .40 |
| Diabetes | 463 (42.7) | 635 (42.5) | 125 (42.7) | .99 |
| Atrial fibrillation | 366 (33.7) | 564 (37.8) | 106 (36.2) | .11 |
| Chronic renal insufficiency | 221 (20.4) | 305 (20.4) | 63 (21.5) | .91 |
| Asthma or COPD | 367 (33.8) | 426 (28.5) | 98 (33.4) | .01 |
| History of ventricular tachycardia or fibrillation | 207 (19.1) | 325 (21.8) | 64 (21.8) | .23 |
| Depression | 318 (29.3) | 350 (23.4) | 68 (23.2) | .002 |
| Active cigarette smoking | 225 (20.7) | 282 (18.9) | 53 (18.1) | .41 |
| Medical therapy | ||||
| ACEI or ARB | 727 (68.1) | 983 (67.2) | 174 (60.6) | .05 |
| Sacubitril/valsartan | 169 (15.7) | 243 (16.3) | 68 (23.2) | .007 |
| Evidence-based β-blocker | 876 (82.3) | 1172 (80.0) | 237 (82.6) | .27 |
| MRA | 405 (37.5) | 526 (35.4) | 114 (39.9) | .28 |
| Heart failure device therapy | ||||
| Implantable cardioverter-defibrillator | 463 (42.7) | 632 (42.3) | 146 (49.8) | .05 |
| Cardiac resynchronization therapy | 83 (7.6) | 135 (9.0) | 24 (8.2) | .45 |
| Socioeconomic characteristics | ||||
| Insurance status | ||||
| Private insurance or managed care (HMO, PPO) | 298 (27.5) | 404 (27.0) | 69 (23.5) | .22 |
| Medicare | 612 (56.4) | 850 (56.9) | 169 (57.7) | |
| Medicaid | 113 (10.4) | 131 (8.8) | 28 (9.6) | |
| Other | 51 (4.7) | 81 (5.4) | 23 (7.8) | |
| Uninsured | 11 (1.0) | 28 (1.9) | 4 (1.4) | |
| Highest level of education | ||||
| <High school | 122 (11.2) | 162 (10.8) | 37 (12.6) | .07 |
| High school/GED | 387 (35.7) | 491 (32.9) | 100 (34.1) | |
| Some college | 341 (31.4) | 494 (33.1) | 86 (29.4) | |
| 4-y College (bachelor’s degree) | 145 (13.4) | 208 (13.9) | 29 (9.9) | |
| Graduate or other professional degree | 90 (8.3) | 139 (9.3) | 41 (14.0) | |
| Total annual household income, $ | ||||
| <25 000 | 355 (40.3) | 498 (42.2) | 87 (40.8) | .19 |
| 25 000-49 999 | 214 (24.3) | 308 (26.1) | 66 (31.0) | |
| 50 000-99 999 | 229 (26.0) | 260 (22.0) | 45 (21.1) | |
| ≥100 000 | 82 (9.3) | 114 (9.7) | 15 (7.0) | |
| Employment status | ||||
| Full-time employee (≥35 h/wk) | 143 (13.2) | 215 (14.4) | 38 (13.0) | .35 |
| Part-time employee (<35 h/wk) | 76 (7.0) | 116 (7.8) | 29 (9.9) | |
| Disability for medical reasons | 302 (27.8) | 385 (25.8) | 88 (30.0) | |
| Not employed for other reasons (eg, retired, student, or unemployed) | 564 (52.0) | 778 (52.1) | 138 (47.1) | |
| Outpatient clinic characteristics | ||||
| Investigator specialty | ||||
| Family or general medicine | 68 (6.3) | 126 (8.4) | 17 (5.8) | .004 |
| Internal medicine | 134 (12.4) | 132 (8.8) | 20 (6.8) | |
| Heart failure cardiologist | 314 (28.9) | 393 (26.3) | 83 (28.3) | |
| Cardiologist (non–heart failure) | 548 (50.5) | 822 (55.0) | 166 (56.7) | |
| Other | 21 (1.9) | 21 (1.4) | 7 (2.4) | |
| Practice setting | ||||
| Primary university | 15 (1.4) | 30 (2.0) | 5 (1.7) | .79 |
| Teaching university | 199 (18.3) | 262 (17.5) | 54 (18.4) | |
| Nonteaching, nonuniversity | 871 (80.3) | 1202 (80.5) | 234 (79.9) | |
Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); bpm, beats per minute; BUN, blood urea nitrogen; COPD, chronic obstructive pulmonary disease; eGFR, estimated glomerular filtration rate; GED, General Educational Development; HF, heart failure; HMO, health maintenance organization; IQR, interquartile range; KCCQ-OS, Kansas City Cardiomyopathy Questionnaire Overall Summary Score; MRA, mineralocorticoid receptor antagonist; NT-proBNP, N-terminal pro–B-type natriuretic peptide; NYHA, New York Heart Association; PPO, preferred provider organization.
SI conversion factors: To convert hemoglobin to grams per liter, multiply by 10; sodium to millimoles per liter, by 1.0; urea nitrogen to millimoles per liter, by 0.357; hemoglobin A1c to proportion of total hemoglobin, by 0.01.
Defined as Asian, American Indian, Alaska Native, Native Hawaiian, Pacific Islander, multiracial, or other.
Data were available for hemoglobin level for 1696 patients, serum sodium level for 2139 patients, BUN level for 2106 patients, eGFR for 1915 patients, NT-proBNP concentration for 348 patients, and hemoglobin A1c level for 669 patients.