Patients' Self-Assessed Functional Status in Heart Failure by New York Heart Association Class: A Prognostic Predictor of Hospitalizations, Quality of Life and Death

  • Holland R
  • Rechel B
  • Stepien K
 et al. 
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Abstract

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. Methods and 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. © 2010 Elsevier Inc. All rights reserved.

Author-supplied keywords

  • Heart failure
  • functional status
  • self-assessment
  • survival

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Authors

  • Richard Holland

  • Boika Rechel

  • Karolina Stepien

  • Ian Harvey

  • Iain Brooksby

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