title: New York Heart Association class assessment by cardiologists and outpatients with congenital cardiac disease: a head-to-head comparison of three patient-based versions.
abstract: BACKGROUND
  The objective of this study was to compare three patient-based New York Heart Association assessments with cardiologist assessments in outpatients with congenital cardiac disease.
  
  
  METHODS
  Consecutive adult outpatients completed three questionnaires in a random order: a patient-based translation of the New York Heart Association classes, a self-constructed questionnaire based on the New York Heart Association classes, and the Specific Activity Scale. The treating cardiologist assessed the New York Heart Association class on the same day. Patient-cardiologist agreement was assessed by calculating percent agreement and weighted kappa. We also explored the level of agreement for patients without co-morbidity.
  
  
  RESULTS
  In all, 86 adults--with a median age of 35.8 years--including 46 women participated. An agreement of 75.6% (weighted kappa is 0.43; probability is smaller than 0.01), 70.6% (weighted kappa is 0.44; probability is smaller than 0.01), and 74.4% (weighted kappa is 0.28; probability is smaller than 0.01) was found between the cardiologist assessment and the patient-based translation, self-constructed questionnaire, and the Specific Activity Scale, respectively. The patient-based translation equally over- and underestimated the New York Heart Association class, whereas the self-constructed questionnaire overestimated and the Specific Activity Scale underestimated the New York Heart Association class. Agreement levels for patients without co-morbidity were higher than agreement levels for the total group.
  
  
  CONCLUSIONS
  The patient-based translation yielded adequate agreement with cardiologist-assessed New York Heart Association class, showed equal over- and underestimation, and was easy to complete. The patient-based translation with the instruction to only consider functional impairments caused by the congenital cardiac defect is recommended in future studies of outpatients with congenital cardiac disease.
authors: Department of Medical Psychology, Academic Medical Centre, Meibergdreef 5, Amsterdam, The Netherlands.
authors: Dounya
authors: D
authors: Schoormans
authors: Yuma L
authors: YL
authors: Mager
authors: Frans J
authors: FJ
authors: Oort
authors: Mirjam A G
authors: MA
authors: Sprangers
authors: Barbara J M
authors: BJ
authors: Mulder
mesh_terms: D000293:Adolescent; D000328:Adult; D002309:Cardiology; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011795:Surveys and Questionnaires; D014177:Translations; D055815:Young Adult