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Patients report more severe daily limitations than recognized by their physicians
Renata R T Castro1,2,3, Emer Joyce4, Neal K Lakdawala1
1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Insights
Heart failure patients report significant daily activity limitations, often underestimated by physicians using the New York Heart Association (NYHA) class. Focused activity assessments may improve patient care and therapy guidance.
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.
Background:
Patient limitations guide selection of heart failure therapies, for which indications often specify New York Heart Association Class.
Objectives:
To determine the extent of patient-reported limitations during daily activities and compare to New York Heart Association class assigned by providers during the same visit, and to left ventricular ejection fraction (LVEF) group.
Methods And Results:
While waiting for their appointment, 948 patients on return visits to an ambulatory HF clinic completed a written questionnaire assessing specific activity limitations, which were compared to physician-assigned NYHA class during the same visit. Patient-reported limitation to perform daily activity ranged from 25% for bathing to 61% for yardwork or housework and 71% for jogging or hurrying. Most patients who did not report limitations to perform daily life activities were correctly classified as NYHA I by the physicians (76%), but 12% of the 376 patients classified as NYHA I reported limitations to showering or bathing and 73% reported limitations while doing yardwork or house work. Limitation to walking was reported by 172 patients (50%) classified as class II. Limitations to walking one block were most common in patients with LVEF ≥40% compared to patients with LVEF <40%, and least commonly, in HF with better EF (improved from 31 ± 13 to 52 ± 7).
Conclusions:
Activity limitations are commonly reported by ambulatory HF patients, but underestimated by physicians. It is not clear how this should guide therapy validated for NYHA class but focused activity questions may merit wider use to track limitations and improvement in ambulatory HF.
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