The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a self-administered, 23-item questionnaire that quantifies five subscales of (1) physical limitations, (2) symptoms, (3) self-efficacy, (4) social interference, and (5) quality of life in heart failure (HF) patients. It is scored from 0 to 100 with higher scores indicating better health status. It was originally developed by Dr. John Spertus in 1996 and published in 2000 in response to the lack of a standardized, comprehensive, universally accepted disease-specific health-related quality-of-life (HRQoL) instrument for HF. In April 2020, the U.S. Food and Drug Administration (FDA) qualified the KCCQ as a Clinical Outcome Assessment and recommended it as a primary endpoint in drug trials to quantify the quality of care in HF patients.
Strengths
The KCCQ is a highly recommended outcome measure for HF given its reliability, validity, and responsiveness. The original validation study reported high internal consistency within its five subscales including Cronbach’s alpha ranging from 0.62 to 0.95. It also found significant differences in the three-month mean score changes for stable HF patients (0.8 to –4.0) versus those admitted for HF exacerbation (15.4 to 40.4). The KCCQ was also found to be substantially more sensitive than other measures that were utilized in the setting of HF such as the Minnesota Living with Heart Failure (LiHFe) and the Short Form-36 (SF-36) questionnaires.
Another notable advantage of the KCCQ is that it is a valid measure of patient-reported health status for a variety of etiologies for HF including ischemic heart disease, obstruction, valve pathology, and anemia among others. This renders it widely applicable for a majority, if not all, HF patients.
As aforementioned, KCCQ has been officially approved by the FDA for use in drug trials and can serve as a critical outcome tool in the advancement of HF care and treatment.
Considerations
Despite its important role in research and drug trials, the KCCQ currently needs further definition of what score or score change corresponds to a clinically acceptable outcome. Recent studies have quantified score changes that correspond to the minimum clinically important difference (MCID) but call for further investigation and standardization.
While comprehensive, the KCCQ is 23 items long and takes an average of 5-8 minutes for patients to complete. Spertus et al. addressed this limitation by creating the KCCQ-12, an abridged 12-item questionnaire which excludes items regarding symptom stability and self-efficacy. Despite these exclusions, the validation study conducted by Spertus et al. in 2015 reports that the KCCQ-12 demonstrated high correlations with the original scales, high test-retest reliability, high responsiveness, and comparable prognostic significance and interpretation of clinically important differences when compared to the original KCCQ.
Costs and Licensing
Both the KCCQ and KCCQ-12 are free and available online.
Conclusion
The KCCQ is a widely used patient-reported outcome measure that exhibits superb psychometric properties in capturing the health of HF patients due to various etiologies. It plays an important role in HF research and care advancement and shows continued promise despite some of its limitations.
Sources | Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure (https://www.jacc.org/doi/full/10.1016/S0735-1097%2800%2900531-3) | Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art Review (https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.09.542) | Development and Validation of a Short Version of the Kansas City Cardiomyopathy Questionnaire (https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.115.001958) | Validation of the Kansas City Cardiomyopathy Questionnaire in Symptomatic Obstructive Hypertrophic Cardiomyopathy (https://www.jacc.org/doi/abs/10.1016/j.jchf.2022.03.002) | Use of the Kansas City Cardiomyopathy Questionnaire for Monitoring Health Status in Patients With Aortic Stenosis (https://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.112.970053) | Validity, reliability, and responsiveness of the Kansas City Cardiomyopathy Questionnaire in anemic heart failure patients (https://link.springer.com/article/10.1007/s11136-007-9302-5) | Reliability and validity of the Kansas City Cardiomyopathy Questionnaire in patients with previous myocardial infarction (https://onlinelibrary.wiley.com/doi/full/10.1016/j.ejheart.2004.05.012) | Current challenges for using the Kansas City Cardiomyopathy Questionnaire to obtain a standardized patient‐reported health status outcome (https://pmc.ncbi.nlm.nih.gov/articles/PMC8049137/)
