Self-assessed symptoms in chronic heart failure--important information for clinical management.
OBJECTIVE
To compare the patients' self-assessment of the severity of their symptoms with a physicians assessment and to evaluate the ability of self-assessed symptoms and ejection fraction (EF) to predict long-term survival in heart failure patients.


METHODS
Patients (n=332) evaluated symptoms using a self-administered functional classification scale (Specific Activity Scale, SAS), which is equivalent to the NYHA scale. EF and NYHA functional class was also recorded. All patients were followed over a 3-year period.


RESULTS
Approximately 50% of patients classified themselves into SAS class I. In contrast, the cardiologists classified only 9% of the patients as NYHA class I. In patients with severe left ventricular dysfunction (EF<or=0.35) SAS score (HR 1.48, 95% CI [1.03-2.12] p=0.03) and ACE inhibitor treatment (0.23 [0.11-0.51], p=0.0003) independently predicted 3-year mortality in a multivariable analysis. EF was not predictive of mortality in the low EF group. Only age predicted long-term outcome in patients with preserved systolic function.


CONCLUSIONS
Patients' self-assessed symptoms and NYHA classification are not coherent. Left ventricular EF is of less importance in comparison with symptoms in chronic heart failure. Patients reporting less severe symptoms had a favourable 3-year prognosis, regardless of EF.
Ekman
Inger
I
Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Department of Cardiology, Sahlgrenska University Hospital, Box 457, SE 405 30 Göteborg, Sweden. inger.ekman@fhs.gu.se
Kjörk
Ewa
E
Andersson
Bert
B
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013534:Survival; D013997:Time Factors