Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function.
BACKGROUND
The association between higher New York Heart Association (NYHA) class and outcomes in patients with heart failure and preserved systolic function is not well known.


METHODS
We performed a retrospective follow-up study of 988 patients with heart failure with ejection fraction > 45% who participated in the DIG trial. Using Cox proportional hazard models, we estimated risks and all-cause mortality, heart failure mortality, all-cause hospitalization, and hospitalization due to worsening heart failure during a median follow-up of 38.5 months.


RESULTS
Patients had a median age of 68 years; 41.2% were women and 13.9%, nonwhites. Overall, 23.4% of patients died, and 19.9% were hospitalized because of worsening heart failure. Proportion of patients with NYHA classes I, II, III, and IV were 19.9%, 58.0%, 20.9%, and 1.2%, respectively, and 14.7%, 21.1%, 35.9%, and 58.3%, respectively, died of all causes (P < .001 for trend). Respective rates for heart failure-related hospitalizations were 14.2%, 17.1%, 32.5%, and 33.3% (P < .001 for trend). Compared with NYHA class I patients, adjusted hazard ratios (HRs) for all-cause mortality for class II, III, and IV patients were 1.54 (95% CI 1.02-2.32, P = .042), 2.56 (95% CI 1.64-24.01, P < .001), and 8.46 (95% CI 3.57-20.03, P < .001), respectively. Respective adjusted HRs (95% CI) for hospitalization due to heart failure for class II, III, and IV patients were 1.16 (0.76-1.77) (P = .502), 2.27 (1.45-3.56) (P < .001), and 3.71 (1.25-11.02) (P = 018). New York Heart Association classes II through IV were also associated with higher risk of all-cause hospitalization.


CONCLUSIONS
Higher NYHA classes were associated with poorer outcomes in patients with heart failure and preserved systolic function.
Ahmed
Ali
A
Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Alabama, Birmingham, AL, USA. aahmed@uab.edu
Aronow
Wilbert S
WS
Fleg
Jerome L
JL
D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002423:Cause of Death; D048909:Diabetes Complications / Q000401:mortality; D004077:Digoxin / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000145:classification* / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume
D002316:Cardiotonic Agents; D004077:Digoxin