How patient-reported data compare to NYHA classifications for evaluating heart failure

Clinicians have turned to the New York Heart Association (NYHA) functional classification system to quantify the health of heart failure (HF) patients for more than 90 years now. According to a new analysis published in JAMA Cardiology, however, using patient-reported outcomes (PROs) may provide a more complete picture of a patient’s health.

“Since the initial development of the NYHA classification, PROs have evolved substantially,” wrote lead author Stephen J. Greene, MD, a cardiologist at Duke University School of Medicine in Durham, North Carolina, and colleagues. “Given the increasing availability of validated HF-specific PRO instruments, such as the Kansas City Cardiomyopathy Questionnaire (KCCQ), the appropriate role and relative importance of clinician-assessed NYHA class, as compared with directly assessing health status from patients in clinical practice, is unclear.”

The study’s authors tracked data from more than 2,800 outpatients who received care at one of 145 practices throughout the United States. All patients were diagnosed with chronic HF with reduced ejection fraction (HFrEF) and enrolled in the study from December 2015 to October 2017. NYHA classifications and Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) scores for 12 consecutive months were available for each patient.

Overall, after making certain adjustments, the team found that NYHA classifications were not associated with subsequent patient outcomes. When the KCCQ-OS improved by at least five points, it was independently associated with drops in mortality and HF hospitalization.

In addition, the most common NYHA class change for HFrEF patients after 12 months was no change at all (65.1%). The most common KCCQ-OS change during that same timeframe was an improvement of at least 10 points (36.5%).

“Findings of this cohort study suggest that, in contemporary U.S. clinical practice, compared with NYHA class, KCCQ-OS is more sensitive to clinically meaningful changes in health status over time,” the authors concluded. “Changes in KCCQ-OS may have more prognostic value than changes in NYHA class.

Read the full study here.