Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function

  • Ahmed W. S.; Fleg, J. L. A
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Abstract

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.; CONCLUSION: Higher NYHA classes were associated with poorer outcomes in patients with heart failure and preserved systolic function.

Author-supplied keywords

  • *Heart Failure/cl [Classification]
  • *Heart Failure/mo [Mortality]
  • *Severity of Illness Index
  • *Stroke Volume
  • 0 (Cardiotonic Agents)
  • 73K4184T59 (Digoxin)
  • Aged
  • Cardiotonic Agents/tu [Therapeutic Use]
  • Cause of Death
  • Diabetes Complications/mo [Mortality]
  • Digoxin/tu [Therapeutic Use]
  • Female
  • Heart Failure/dt [Drug Therapy]
  • Heart Failure/pp [Physiopathology]
  • Hospitalization
  • Humans
  • Kidney Diseases/co [Complications]
  • Male
  • Proportional Hazards Models
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Statistics, Nonparametric

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  • PMID: 16442912

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