ASSESSMENT OF QUALITY OF LIFE OF HEART FAILURE PATIENTS WITH REDUCED EJECTION FRACTION ON SACUBITRIL VALSARTAN THERAPY USING THE KANSAS CITY CARDIOMYOPATHY QUESTIONNAIRE 23 QUESTIONNAIRE
DOI:
https://doi.org/10.22159/ajpcr.2026v19i6.59433Keywords:
Heart failure with reduced ejection fraction, Kansas City cardiomyopathy questionnaire-23, Quality of life, Sacubitril/valsartan,, Patientreported outcomes.Abstract
Objectives: To assess the effect of sacubitril/valsartan therapy on health-related quality of life (HRQoL) and functional status among patients with heart failure (HF) with reduced ejection fraction using the Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23).
Methods: A prospective observational study was conducted among 235 patients with HF with reduced ejection fraction (HFrEF) at a tertiary care hospital in Kerala, India. Eligible patients receiving sacubitril/valsartan therapy were assessed at baseline and after therapy using the validated KCCQ- 23. Domain-wise pre- and post-therapy scores were compared using paired statistical analysis to determine changes in physical limitation, symptom frequency, symptom burden, self-efficacy, social limitation, and overall quality of life.
Results: Sacubitril/valsartan therapy was associated with significant improvement in all assessed KCCQ-23 domains. Physical limitation, symptom frequency, symptom burden, self-efficacy, social limitation, and overall quality-of-life scores improved after therapy. The differences between baseline and post-therapy scores were statistically significant across all major domains, with p<0.0001, indicating a marked improvement in patient-reported health status and functional well-being.
Conclusion: Sacubitril/valsartan therapy significantly improved HRQoL, symptom experience, and functional status in patients with HFrEF. The findings support the usefulness of the KCCQ-23 as a patient-reported outcome measure for evaluating therapeutic benefit in routine clinical practice.
Downloads
References
1. Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. 2017;3(1):7-11. doi: 10.15420/cfr.2016:25:2, PMID 28785469
2. Bozkurt B, Coats AJ, Tsutsui H, Abdelhamid M, Adamopoulos S, Albert N. Universal definition and classification of heart failure: A report of the Heart Failure Society of America, heart failure association of the European Society of Cardiology, Japanese Heart Failure Society and writing committee of the universal definition of heart failure. J Card Fail. 2021;27(4):387-413. doi: 10.1016/j.cardfail.2021.01.022, PMID 33663906
3. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. doi: 10.1093/eurheartj/ehab368, PMID 34447992
4. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation. 2022;145(18):e895-e1032. doi: 10.1161/Cir.0000000000001063, PMID 35363499
5. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993-1004. doi: 10.1056/nejmoa1409077, PMID 25176015
6. Packer M, McMurray JJ, Desai AS, Gong J, Lefkowitz MP, Rizkala AR. Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Circulation. 2015;131(1):54-61. doi: 10.1161/ Circulationaha.114.013748, PMID 25403646
7. Lewis EF, Claggett BL, McMurray JJ, Packer M, Lefkowitz MP, Rouleau JL. Health-related quality of life outcomes in PARADIGM-HF. Circ Heart Fail. 2017;10(8):e003430. doi: 10.1161/circheartfailure.116.003430, PMID 28784687
8. Chandra A, Lewis EF, Claggett BL, Desai AS, Packer M, Zile MR. Effects of sacubitril/valsartan on physical and social activity limitations in patients with heart failure: a secondary analysis of the PARADIGM-HF trial. JAMA Cardiol. 2018;3(6):498-505. doi: 10.1001/jamacardio.2018.0398, PMID 29617523
9. Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City cardiomyopathy Questionnaire: A new health status measure for heart failure. J Am Coll Cardiol. 2000;35(5):1245-55. doi: 10.1016/S0735-1097(00)00531-3, PMID 10758967
10. Spertus JA, Jones PG. Development and validation of a short version of the Kansas City cardiomyopathy Questionnaire. Circ Cardiovasc Qual Outcomes. 2015;8(5):469-76. doi: 10.1161/circoutcomes.115.001958, PMID 26307129
11. Spertus JA, Jones PG, Sandhu AT, Arnold SV. Interpreting the Kansas City cardiomyopathy Questionnaire in clinical trials and clinical care: JACC state-of-the-art review. J Am Coll Cardiol. 2020;76(20):2379-90. doi: 10.1016/j.jacc.2020.09.542, PMID 33183512
12. Butler J, Khan MS, Mori C, Filippatos GS, Ponikowski P, Comin- Colet J. Minimal clinically important difference in quality of life scores for patients with heart failure and reduced ejection fraction. Eur J Heart Fail. 2020;22(6):999-1005. doi: 10.1002/ejhf.1810, PMID 32239794
13. Khariton Y, Fonarow GC, Arnold SV, Hellkamp AS, Nassif ME, Sharma PP. Association between sacubitril/valsartan initiation and health status outcomes in heart failure with reduced ejection fraction. JACC Heart Fail. 2019;7(11):933-41. doi: 10.1016/j.jchf.2019.05.016, PMID 31521679
14. Thomas M, Khariton Y, Fonarow GC, Arnold SV, Hill L, Nassif ME. Association between sacubitril/valsartan initiation and real-world health status trajectories over 18 months in heart failure with reduced ejection fraction. ESC Heart Fail. 2021;8(4):2670-8. doi: 10.1002/ ehf2.13298, PMID 33932120
15. Piña IL, Camacho A, Ibrahim NE, Felker GM, Butler J, Maisel AS. Improvement of health status following initiation of sacubitril/ valsartan in heart failure and reduced ejection fraction. JACC Heart Fail. 2021;9(1):42-51. doi: 10.1016/j.jchf.2020.09.012, PMID 33189630
Published
How to Cite
Issue
Section
Copyright (c) 2026 ARCHANA P, HEMALATHA SELVARAJ, SULTHANRESLIN SALIH
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.