[Use of functional classes to assess the status of patients with severe heart failure]

The possibilities of the classification developed by Lang, Strazhesko, Vasilenko and that of heart failure functional classes, which has been adopted by the New York Heart Association (NYHA), to evaluate the status of patients with severe heart failure are compared in this communication. A total of 1619 patients with Stages IIB-III heart failure of various origin (coronary heart disease, dilated cardiomyopathy, rheumatic heart disease, myocarditis, primary pulmonary hypertension) were studied. To assess the patients' status the attending physicians used 7 grades: (1) satisfactory; (2) close to moderate; (3) moderate; (4) close to severe; (5) severe; (6) close to critical; (7) critical. Each patient was independently evaluated for grade and functional class by experts by using a specially developed schedule. An analysis of the distribution of the patients by grade and functional class demonstrated that the 4-graded functional class classification has advantages over the 7-graded one due to more settled, reproducible, recurrent and less scattered opinions (in case of the common source of information), the functional class, unlike the grade, was found to be unassociated with the nature of the disease. A simple grade summing-up (regrouping the patients from 7 to 4 grades) unenables one to adequately go over to the NYHA functional class. It is concluded that the tested NYHA classification should be used to evaluate the status of patients with severe heart failure.