Comparing New York Heart Association Class and Patient-Reported Outcomes Among Patients Hospitalized for Heart Failure

Background: Alignment between clinician-reported New York Heart Association (NYHA) class compared and patient-reported outcomes among patients hospitalized for heart failure (HF) is unclear.

Methods: ASCEND-HF was a global randomized trial comparing nesiritide versus placebo among patients hospitalized for HF, irrespective of ejection fraction (EF). Among patients with complete baseline data for NYHA class and the patient-reported EuroQOL-5 dimensions (EQ5D) (both utility index [UI] and visual analog scale [VAS]), levels of each scale were mapped across 4 pre-specified categories “best” to “worst.” Minor and moderate-severe discordance were defined as NYHA class and EQ-5D differing by 1 level and ≥2 levels, respectively. Multivariable models assessed factors independently associated with moderate-severe discordance, and associations between discordance and clinical outcomes.

Results: Among 5,741 patients, concordance, minor discordance, and moderate-severe discordance between NYHA class and EQ-5D UI occurred in 22%, 40% and 38% of patients respectively. For NYHA class and EQ-5D VAS, this categorization occurred in 29%, 48% and 23%. Discordance was more often due to disproportionately higher EQ-5D score (78% of discordance cases with UI, and 70% with VAS). NYHA class IV, higher EQ-5D scores, race, and geographic region were among patient factors independently associated with moderatesevere discordance. Magnitude of discordance was not associated with clinical outcomes; however, EQ-5D UI disproportionately worse than NYHA class was associated with increased 180-day mortality (adjusted hazard ratio 1.27 [95% CI 1.01-1.60], p=0.04).

Conclusions: In a global trial cohort of patients hospitalized for HF, the majority of patients exhibited discordance between clinician-reported NYHA class and patient-reported health status. Multiple patient factors were independently associated with moderate-severe discordance, and patients who perceived their health status as worse than the clinician’s perception had higher mortality.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov Unique Identifier: NCT00475852