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Agreement between heart failure patients and providers in assessing New York Heart Association functional class
Brent A Williams1, Sanjay Doddamani1, Melissa A Troup1
1Geisinger Health System, Danville, PA, USA.
Insights
Patient and provider assessments of New York Heart Association (NYHA) functional classification show poor agreement in heart failure (HF) patients. Provider assessments better correlate with 6-minute walk test distance.
Area of Science:
- Cardiology
- Clinical Assessment
- Heart Failure Management
Background:
- Discrepancies exist in assessing New York Heart Association (NYHA) functional classification in heart failure (HF) patients.
- The preference between patient and provider NYHA assessments remains unclear.
Purpose of the Study:
- To compare patient versus provider NYHA functional classification assessments.
- To evaluate the correlation of both assessments with 6-minute walk test (6MWT) distance in HF patients.
Main Methods:
- Prospective study of 101 HF patients.
- Patients self-assessed NYHA classification; providers, blinded to patient ratings, also assessed NYHA.
- Patients underwent a standardized 6MWT; Spearman correlation coefficients were used.
Main Results:
- Patient and provider NYHA assessments showed poor correlation (rs = 0.40).
- Patients reported significantly better NYHA class (72% Class I) than providers (15% Class I).
- Provider NYHA correlated better with 6MWT distance (rs = -0.36) than patient NYHA (rs = -0.22).
Conclusions:
- Significant disagreement exists between patient and provider NYHA functional classification in HF.
- Provider assessment of NYHA functional class demonstrates a stronger association with functional capacity as measured by 6MWT.
Background:
Uncertainty persists regarding whether patient assessment of New York Heart Association (NYHA) functional classification should be preferred over provider assessment among patients with heart failure (HF).
Objectives:
To compare patient against provider NYHA assessments, and both to distance walked on a 6-minute walk test (6MWT) among patients with HF.
Methods:
In this prospective study, we enrolled 101 HF patients who self-assessed NYHA classification. Health care providers who were blinded to patient ratings of NYHA also rated NYHA. Patients completed a 6MWT according to a standardized protocol. We used Spearman coefficients (rs) to evaluate the correlations between variables.
Results:
Patient- and provider-determined NYHA class were poorly correlated, but the relationship was statistically significant (rs = 0.40, p < 0.001). Patients consistently reported better NYHA class (class I: 72% vs 15%) than providers. Provider-determined NYHA had a stronger correlation with 6MWT distance (rs = -0.36, p < 0.001 vs. rs = -0.22, p = 0.03). Providers assigned a worse class to older patients who had comorbidity; patients with dyspnea and longer HF duration assigned themselves a worse class.
Conclusion:
Patients and providers exhibited poor agreement in NYHA assignment.
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