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


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.
Holland
Richard
R
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. r.holland@uea.ac.uk
Rechel
Boika
B
Stepien
Karolina
K
Harvey
Ian
I
Brooksby
Iain
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology; D012647:Self-Assessment; D012720:Severity of Illness Index; D012955:Societies, Medical