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Cardiovascular outcomes by time-varying New York Heart Association class among patients with obstructive hypertrophic
Yan Wang1, Weihua Gao2, Xu Han2
1Analysis Group, Inc, Los Angeles, CA, USA.
Insights
Worsening New York Heart Association (NYHA) functional class in patients with obstructive hypertrophic cardiomyopathy (HCM) is linked to higher risks of death and cardiovascular events. Monitoring NYHA class is crucial for predicting adverse outcomes in HCM patients.
Area of Science:
- Cardiology
- Clinical Research
- Patient Outcomes
Background:
- Obstructive hypertrophic cardiomyopathy (HCM) is a significant cardiovascular condition.
- The New York Heart Association (NYHA) functional class is a common metric for assessing disease severity.
- Understanding the prognostic value of NYHA class in obstructive HCM is essential for patient management.
Purpose of the Study:
- To evaluate the association between NYHA functional class and cardiovascular (CV) outcomes in patients with obstructive HCM.
- To determine if changes in NYHA class over time impact CV event risk.
Main Methods:
- Retrospective cohort study utilizing linked claims and electronic health records from the Optum Market Clarity database.
- Included adults (≥18 years) with obstructive HCM and at least one NYHA class assessment.
- Assessed thirteen CV outcomes using Kaplan-Meier method and cumulative incidence functions, with time-varying Cox models for risk evaluation.
Main Results:
- The study included 4,631 patients with obstructive HCM.
- Higher index NYHA class and worsening NYHA class over time were associated with increased risks of all-cause mortality and CV outcomes.
- Deterioration in NYHA class correlated with elevated risks of adverse events.
Conclusions:
- Worsening NYHA functional class is a significant predictor of increased all-cause mortality and cardiovascular events in obstructive HCM.
- NYHA functional class serves as a valuable prognostic indicator in this patient population.
Aims:
Assess the relationship between New York Heart Association (NYHA) functional class and cardiovascular (CV) outcomes in obstructive hypertrophic cardiomyopathy (HCM).
Materials And Methods:
This retrospective cohort study used the Optum Market Clarity database with linked claims and electronic health records. Adults (aged ≥18 years) with obstructive HCM and ≥1 NYHA class assessment after first HCM diagnosis were eligible (selection period: 2007-2021). Thirteen outcomes were assessed following the index date (first documented NYHA class assessment after first HCM diagnosis in the study period): all-cause mortality; first occurrences of all-cause hospitalization; CV-related hospitalization; primary ischemic stroke or transient ischemic attack (TIA); myocardial infarction (MI); deep vein thrombosis (DVT) or pulmonary embolism (PE); and major adverse CV event (MACE); as well as first incident events of atrial fibrillation or flutter; primary ischemic stroke or TIA; heart failure; acute MI; DVT/PE; and a composite endpoint of pacemaker and cardiac resynchronization therapy. Their associations with the index NYHA class were described using the Kaplan-Meier method (mortality) or cumulative incidence functions (other outcomes). Hazard ratios between NYHA class over time and outcomes were evaluated using time-varying Cox models, adjusting for age at first observed HCM diagnosis, sex, and race.
Results:
Among 4,631 eligible patients, the mean age was 59 years at the first observed HCM diagnosis (female, 47%; White, 77%). The risks of all outcomes increased with worse (higher) index NYHA class and worsening NYHA class over time. Deterioration in the NYHA class from the index date was associated with increased risks of outcomes.
Limitations:
The study population may not be representative of all patients with obstructive HCM in the real world. Documented NYHA classes may not fully reflect the longitudinal variation of NYHA class for each patient.
Conclusions:
Worsening NYHA class was associated with increased risks of all-cause mortality and CV outcomes in obstructive HCM.
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