Patients' Self-Assessed Functional Status in Heart Failure by New York Heart Association Class: A Prognostic Predictor of Hospitalizations, Quality of Life and Death
Received 23 April 2009; received in revised form 21 August 2009; accepted 31 August 2009. published online 23 October 2009.
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.
3Norfolk & Norwich University Hospital NHS Trust, UK
Reprint requests: Dr Richard Holland, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. Tel.: +44(0)1603 593574; Fax: 44(0)1603 593752.
Research costs were funded by a project grant from the British Heart Foundation (Grant number: PG/02/171). Excess treatment costs were funded by Great Yarmouth and Southern Norfolk Primary Care Trusts. The HeartMed trial received support for the educational training events from Pfizer UK. All researchers are independent from the British Heart Foundation who funded this study and from Pfizer UK who funded the educational events for the trial intervention.
R.H. and B.R. designed this secondary analysis of the HeartMed trial data, K.S. wrote the first draft of the introduction for this paper, B.R. used that and produced the first full draft of the paper which was modified by R.H. I.B. and I.H. contributed to design and delivery of the original trial on which this subsequent analysis was based and all authors contributed to the final draft of this paper. R.H. is the guarantor for the data and this article.
Ethical approval: Norwich District, King's Lynn, and Great Yarmouth and Waveney local research ethics committees.
ABSTRACT