Patients' self-assessed functional status in heart failure by New York Heart Association class: a prognostic predictor of hospitalizations, quality of life and death

Richard Holland, Boika Rechel, Karolina Stepien, Ian Harvey, Iain Brooksby, Richard Holland, Boika Rechel, Karolina Stepien, Ian Harvey, Iain Brooksby

Abstract

Background: Clinician-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 results: This 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).

Conclusions: SA-NYHA class is predictive of hospitalization, quality of life, and mortality among patients with heart failure.

Copyright 2010 Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
Kaplan-Meier graph showing time to death in self-assigned New York Heart Association (SA-NYHA) Class I/II vs SA-NYHA III/IV groups (all patients).

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Source: PubMed

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薬物療法

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