Patients report more severe daily limitations than recognized by their physicians

Area of Science:

• Cardiology
• Patient-Reported Outcomes
• Heart Failure Management

Background:

• Heart failure (HF) therapy selection relies on patient limitations, frequently guided by New York Heart Association (NYHA) functional classification.
• Physician-assigned NYHA class is a standard metric for assessing HF severity and guiding treatment.

Purpose of the Study:

• To quantify patient-reported limitations in daily activities.
• To compare these patient-reported limitations with the NYHA class assigned by healthcare providers during the same clinical visit.
• To analyze limitations in relation to left ventricular ejection fraction (LVEF) groups.

Main Methods:

• A questionnaire assessing specific activity limitations was administered to 948 patients during return visits to an ambulatory HF clinic.
• Patient responses were compared against physician-assigned NYHA class and LVEF groups.
• Data analysis focused on the prevalence of specific limitations across different NYHA classes and LVEF categories.

Main Results:

• Significant patient-reported limitations were observed, ranging from 25% for bathing to 71% for jogging/hurrying.
• A notable discrepancy exists: 12% of NYHA Class I patients reported limitations in bathing, and 73% in yardwork/housework.
• Limitations in walking were reported by 50% of NYHA Class II patients, with specific patterns observed across different LVEF groups.

Conclusions:

• Ambulatory HF patients commonly experience activity limitations that are frequently underestimated by physicians.
• Current therapy guidance based on NYHA class may not fully capture the patient's functional status.
• Implementing focused activity-based questions could enhance the tracking of limitations and treatment effectiveness in HF management.