Importance of patient-reported outcomes in cardiovascular illnesses

Patient-reported outcomes (PROs) are increasingly recognized as pivotal tools in understanding health status, treatment impact, and quality of life (QoL) in patients, particularly those with chronic cardiovascular diseases. These standardized and validated tools capture the patient’s perspective on physical, emotional, and social health dimensions, bridging gaps often missed by clinical evaluations. Despite their growing adoption in research, the use of PROs in new drug approvals has declined, from 30% between 1997–2002 to 16.5% between 2011–2015, raising concerns about their underutilization in real-world settings. However, their role in clinical care and research continues to expand, with the proportion of clinical trials incorporating PROs increasing from 14% between 2004–2007 to 27% between 2007–2013. PRO measures (PROMs) span multiple domains, including overall health, such as EQ-5D, SF-36, and PROMIS Profile-29 to evaluate health-related quality of life (HRQoL), psychological health, evaluated by instruments like the Patient Health Questionnaire-9 (PHQ-9), specific symptoms, such as pain and fatigue, functional status, and disease-specific outcomes such as the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). The clinical impact of PROs is evident in their association with prognostic outcomes. Each 5-point decrease in the KCCQ score correlates with a 6–9% higher risk of cardiovascular death or heart failure hospitalization. Meta-analyses reveal that higher HRQoL reduces mortality risk by 37% (HR 0.633, 95% CI: 0.514–0.780). Additionally, in pre-terminal cancer patients, self-reported abilities to walk 4 meters and wash oneself independently predicted survival, hazard ratios of 0.63 (p=0.015) and 0.67 (p=0.024), respectively. Moreover, in chronic obstructive pulmonary disease, pain and discomfort predicted re-hospitalization and HRQoL predicted 180-day survival. These findings underscore the critical role of PROs in enhancing patient care, guiding therapeutic decisions, and shaping healthcare policies.