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

Goode, K. M., Nabb, S., Cleland, J. G.F. and 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), pp. 379-387. (doi: 10.1016/j.cardfail.2008.01.014) (PMID:18514929)

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 ρ: −0.53 vs −0.44 and 0.32 vs 0.16). Dr-NYHA better predicted mortality when compared with Pa-NYHA (log-rank: χ2 = 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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Goode, K. M., Nabb, S., Cleland, J. G.F., and Clark, A. L.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Journal of Cardiac Failure
• Publisher: Elsevier
• ISSN: 1071-9164
• Published Online: 27 May 2008