A comparison of patient and physician-rated New York Heart Association class in a community-based heart failure clinic

Goode, Kevin M.; Nabb, Samantha; Cleland, John G.F.; Clark, Andrew L.

Abstract

OBJECTIVE: The New York Heart Association (NYHA) classification is recommended for grading symptoms of chronic heart failure and is a powerful prognostic marker. Patient-rated NYHA (Pa-NYHA) and physician-rated NYHA (Dr-NYHA) class have never been compared directly, and it is unknown whether they carry similar prognostic significance. METHODS AND RESULTS: NYHA class was rated independently by a physician and patient in 1752 patients referred with suspected heart failure. Pa-NYHA and Dr-NYHA varied by 1 class in 37.1% cases and by 2 classes in 12.8% cases. Mean Dr-NYHA and Pa-NYHA were higher in women than men (1.98 vs 1.89, P = .016; 2.17 vs 2.02, P = .002) despite less cardiac disease. Dr-NYHA correlated more with 6-minute walk test distance and severity of left ventricular systolic dysfunction than Pa-NYHA (Spearman's rho: -0.53 vs -0.44 and 0.32 vs 0.16). Dr-NYHA better predicted mortality when compared with Pa-NYHA (log-rank: chi(2) = 105 vs 46, both P < .001). CONCLUSION: Patients rate NYHA differently from physicians, and women rate NYHA differently from men. Dr-NYHA relates more strongly to survival and severity of left ventricular systolic dysfunction, suggesting that for physicians the NYHA classification may have become a "heart failure severity score" and not as was intended, purely a measure of a patient's symptoms and functional status

Citation

Goode, K. M., Nabb, S., Cleland, J. G., & Clark, A. L. (2008). A comparison of patient and physician-rated New York Heart Association class in a community-based heart failure clinic. Journal of cardiac failure, 14(5), 379-387. https://doi.org/10.1016/j.cardfail.2008.01.014

• Journal Article Type: Article
• Acceptance Date: Jan 23, 2008
• Online Publication Date: May 27, 2008
• Publication Date: Jun 1, 2008
• Deposit Date: Nov 13, 2014
• Journal: Journal Of Cardiac Failure
• Print ISSN: 1071-9164
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 5
• Pages: 379-387
• DOI: https://doi.org/10.1016/j.cardfail.2008.01.014
• Keywords: Heart failure; Prognosis; Symptom score
• Public URL: https://hull-repository.worktribe.com/output/465811
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1071916408000420?via%3Dihub
• Contract Date: Nov 13, 2014