title: Association of New York Heart Association functional class IV symptoms at admission and clinical features with outcomes in patients hospitalized for acute heart failure syndromes.
abstract: BACKGROUND
  It remains unclear whether there are subgroups of acute heart failure syndromes (AHFS) patients in whom New York Heart Association (NYHA) class IV symptoms at admission is related to a higher risk of mortality because of the heterogeneity of this patient population. The aim of this study was to evaluate the association of NYHA class IV symptoms at baseline with in-hospital mortality in subgroups of patients with AHFS.
  
  
  RESULTS
  Of the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4786 patients were included in this analysis. The primary endpoint was in-hospital all-cause death. NYHA class IV at baseline was detected in 44.3% of the patients. The all-cause death rate was significantly higher in patients with NYHA class IV than in those with NYHA class II or III (9.0% vs. 4.3%, P<0.001). To examine the heterogeneity of the association between NYHA class IV symptoms at baseline and in-hospital mortality, subgroup analyses were performed. As a result, the presence of NYHA class IV symptoms on admission was associated with a significantly higher risk of all-cause death in patients aged ≥75years, female patients, patients without an idiopathic dilated etiology, and patients with preserved ejection fraction (EF).
  
  
  CONCLUSIONS
  This study demonstrated that an age≥75years, female gender, the absence of idiopathic dilated etiology, and a preserved EF should be considered when assessing the clinical significance of NYHA class IV symptoms in relation to the risk of in-hospital mortality in patients hospitalized for AHFS.
authors.affiliation: Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan. Electronic address: asano201@gmail.com.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Asano
authors.affiliation: Division of Cardiology, Sekikawa Hospital, Tokyo, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kajimoto
authors.affiliation: Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Oka
authors.affiliation: Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Sugiura
authors.affiliation: Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Okada
authors.affiliation: Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Kamishima
authors.affiliation: Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hirata
authors.affiliation: Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
mesh_terms: D000208:Acute Disease; D000368:Aged; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000145:classification* / Q000175:diagnosis / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D007564:Japan / Q000453:epidemiology; D008297:Male; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013577:Syndrome
keywords: Acute heart failure syndromes; Assessment; In-hospital outcome; New York Heart Association functional class