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[Functional classification of cardiac insufficiency]
P Gibelin1, M Dadoun-Dybal, P Morand
1Service de cardiologie, hôpital Pasteur, CHRU de Nice.
Insights
A new activity scale for chronic heart failure improves functional assessment in French patients. This reproducible tool correlates well with exercise capacity, aiding clinical practice and research.
Area of Science:
- Cardiology
- Clinical Assessment
Context:
- Existing functional impairment classifications for chronic heart failure (CHF) like NYHA and Goldman scales have limitations.
- Subjectivity, poor reproducibility, and lack of validation hinder accurate patient assessment and comparison.
Purpose:
- To develop and validate a specific activity scale for assessing functional impairment in French patients with chronic heart failure.
- To improve the reproducibility and correlation with objective exercise measures compared to existing scales.
Summary:
- A novel, adapted specific activity scale was developed for French CHF patients, addressing limitations of previous classifications.
- Studied in 45 patients with chronic primary dilated cardiomyopathy, the scale demonstrated good reproducibility.
- It showed a strong correlation with peak oxygen consumption (VO2), a key indicator of exercise capacity.
Impact:
- This validated scale offers a more precise and reliable method for assessing functional capacity in daily clinical practice.
- Its design minimizes contradictions, enhancing patient classification accuracy.
- The scale is suitable for both routine use and multicenter research studies in cardiology.
Abstract:
Several systems have been proposed for assessing the degree of functional impairment of chronic cardiac failure in order to be able to compare patients and to appreciate progression of the condition in individual patients. The NYHA classification is subjective, not very reproducible, and does not provide a good prediction of exercise capacity. The Canadian classification is not much better. Feinstein's classification is too complex, impractical and has never been validated. The specific activity scale proposed by Goldman indicates the degree of functional incapacity by comparison with activities of everyday life selected for their variability and classified according to the effort required to perform them. This classification has a good reproducibility and correlates well with exercise stress testing (exercise duration, VO2 max). However, it is not particularly well suited to the French population. The examples are not very precise; in addition, contradictions are possible, making it difficult to classify some patients. The authors propose a specific activity scale adapted for French patients. This classification was studied in 45 patients with chronic primary dilated cardiomyopathy. It was reproducible and correlated well with peak VO2. The progressive design of the symptom questionnaire avoids contradiction. This classification could be useful both in everyday practice and for multicentre research studies.