Patients' Self-Assessed Functional Status in Heart Failure by New York Heart Association Class: A Prognostic Predictor of Hospitalizations, Quality of Life and Death

Abstract

BackgroundClinician-assigned New York Heart Association (NYHA) class is an established predictor of outcomes in heart failure. This study aims to test whether patients' self-assessment of functional status by NYHA class predicts hospital admissions, quality of life, and mortality.Methods and ResultsThis was an observational study within a randomized controlled trial. A total of 293 adult patients diagnosed with heart failure were recruited after an emergency admission at 3 acute hospitals in Norfolk, UK. Outcome measures included number of emergency admissions over 6 months, self-assessed quality of life measured with the Minnesota Living with Heart Failure questionnaire (MLHFQ) and EQ-5D at 6 months, and deaths up to 20 months' follow-up. Patients were grouped into 3 NYHA groups (I/II, III, and IV) based on patients' self-assigned NYHA class (SA-NYHA). A Poisson model indicated an increased readmission rate associated with higher SA-NYHA class (adjusted rate ratio 1.21; 95% CI 1.04–1.41; P = .02). Higher SA-NYHA class at baseline predicted worse quality of life at 6 months' follow-up (P = .002 for MLHFQ; P = .047 for EQ-5D), and was associated with higher mortality rate (adjusted hazard ratio 1.84; 95% CI 1.10–3.06; P = .02).ConclusionsSA-NYHA class is predictive of hospitalization, quality of life, and mortality among patients with heart failure.

Functional Limitations Predict the Risk of Rehospitalization Among Patients With Chronic Heart Failure

“…Severe FL has been suggested to be associated with increased risk for rehospitalization and mortality in CHF patients. 9, 10 Therefore, FLs are not only a marker of functional decline but also have the potential to predict clinical status in CHF patients. Both standardized measures for FL and prospective cohort studies are needed in order to examine this relationship.…”

Changes in Aortic Pulse Wave Velocity and the Predictors of Improvement in Arterial Stiffness Following Aortic Valve Replacement

“…23) Functional status assessed by NYHA classification is the most popular, validated variable used in risk evaluation models for prediction of survival, clinical outcomes in heart failure, AVR, AS patients. 24,25) Again, there is only one study investigating the relationship between preoperative and postoperative NYHA class, with preoperative PWV values. 13) In this study, preoperative PWV-normal patients scored significantly improved NYHA class compared with PWV-high patients postoperatively.…”

A Comparison of the NYHA Classification and the Duke Treadmill Score in Patients with Cardiovascular Disease

“…Functional status is not just capacity or performance, and the NYHA was not developed to adequately represent these specific dimensions. Nurse researchers who choose the NYHA as an inclusion criterion should, 1) include a description of how the classes are assigned by raters, 2) include patients as self raters [40], 3) provide the objective components of the NYHA, 4) include evidence of interrater or intrarater reliability, and 5) administer training to raters.…”

“…The NYHA does not take into account physical limitations that interfere with the ability of a person to perform "normal activities". In addition, if patients rate current symptom status against a previous point in time, they may shift responses in light of their current state of health [12] [40]. Living with long-term, multiple, chronic health conditions can result in patients' adjustment to illness and a redefining of what "normal" is for them.…”