{
  "abstract": "Background Holistic patient-centred intervention to improve outcomes of older people living with FraIlTy and Heart Failure (FIT-HF), is a novel multidisciplinary programme designed to optimise health-related quality of life (HRQoL) of this patient population. Delivered by an interprofessional team of clinicians, FIT-HF is a 12- week programme co-produced with patients, their carers and healthcare professionals involved in the care of older people with HF and frailty.Purpose To assess changes in Kansas City Cardiomyopathy Questionnaire (KCCQ-12), a HF-specific HRQoL measure, before and after implementation of FIT-HF programme in a single arm, uncontrolled feasibility study.Methods We recruited 50 older patients (aged ≥ 65) with HF and frailty (Clinical Frailty Scale ≥ 5) from an outpatient HF clinic between October 2024 – January 2020. At baseline, patients underwent comprehensive assessments (including clinical, physical, frailty assessments) along with HRQoL measurement using KCCQ-12. Informed by findings from baseline assessments, individual cases were reviewed by a multidisciplinary team (MDT) comprising a HF specialist, geriatrician, HF specialist nurse, pharmacist, dietitian, rehabilitation specialist and occupational therapist. The MDT developed individualised care plans for patients, consisting of management of HF and comorbidities, medication review, home-based exercise programme, nutritional counselling, and environmental and social support. The care plans were delivered to patients at a One-Stop Clinic, with scheduled 2-weekly follow up by a keyworker ± MDT, by telephone or in person, for 12 weeks. At the end of the programme, patients completed post-intervention assessments.Results Of the 50 participants enrolled, 47 completed the programme and are included in the analysis. Table 1 presents participant demographics at baseline. Median age 81 (range 65-95) years, 36% female. One fifth had NYHA III symptoms; 20 patients (53%) had HF with preserved ejection fraction. Median NT-proBNP was 1746 ng/L (IQR = 1091 - 4512).Forty-four patients (94%) reported improvement in their KCCQ-12 scores post-intervention; 3 patients recorded deterioration. The average KCCQ-12 Summary Score increased from 40.4 at baseline to 62.9 post-intervention (difference = +22.5 points). Intrapatient variability in the scores before and after intervention ranged from –21.2 to +59.9 points. Figure 1 shows the range of changes in KCCQ-12 Summary Score for each study participant.The minimal clinically significant change in KCCQ score is considered to be 5. Based on threshold for clinical significance,1 changes in the Summary Score were categorised into: insignificant (difference < 5 points); small improvement (difference 5-9 points); moderate improvement (difference 10-19 points) and large improvement (difference ≥ 20). Almost half the study population (n=23), reported large improvement in their health status; these participants tended to be younger compared to other categories of responders (table 1).Within individual domains of KCCQ-12, the scores for Social Limitation showed the largest improvement (from 38.4 to 65.1, difference = +26.6); followed by Quality of Life (difference = +22.6), Symptom Frequency (difference = +21.9) and Physical Limitation (difference = +18.4). Mean difference in individual domains of KCCQ-12 among study participants pre- and post- intervention are illustrated in figure 2.Conclusion Participants of FIT-HF feasibility study reported an increase of 22.5 points in the KCCQ-12 Summary Score, suggesting a large-to-very large improvement in their health status, post-intervention. These findings support the value of conducting a randomised trial to confirm effectiveness of such multidisciplinary intervention.Reference 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. Journal of the American College of Cardiology 2020;76(20):2379–2390. https://doi.org/10.1016/j.jacc.2020.09.542Abstract 100 Table 1Demographics of study participants at baseline stratified by degree of improvement in KCCQ-12 summary ScoreAbstract 100 Figure 1Range of changes in KCCQ-12 Summary Score for each study participant, pre- and post-interventionAbstract 100 Figure 2Population mean difference in individual domains of KCCQ-12 (i.e., symptom frequency, social limitation, quality of life and physical limitation)",
  "authors": [
    {
      "affiliations": [
        "University of Leicester, Leicester, United Kingdom"
      ],
      "name": "Sunanthiny Krishnan"
    },
    {
      "affiliations": [
        "University of Leicester, Leicester, United Kingdom"
      ],
      "name": "Shirley Sze"
    },
    {
      "affiliations": [
        "University of Leicester, Leicester, United Kingdom"
      ],
      "name": "Iain B Squire"
    }
  ],
  "title": "100 Assessing preliminary effects of a multidisciplinary intervention on health-related quality of life of older adults living with frailty and heart failure",
  "uid": "6cee43fc-ae7b-5331-a160-af985e6d9a44"
}