Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317984
Author(s):  
Mariana Blacher ◽  
André Zimerman ◽  
Pedro H B Engster ◽  
Eduardo Grespan ◽  
Carisi A Polanczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Heart Association ◽  
Functional Class ◽  
Class I ◽  
Objective Measures ◽  
Functional Evaluation ◽  
Self Perception ◽  
Reduced Ejection Fraction ◽  
Nyha Classification

ObjectiveNew York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial.MethodsThe ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient’s self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0–100).ResultsOf 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4–30) for class I vs 27.5 (11–49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248–1333) vs 778 (421–1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330–466) vs 351 m (286–408), p=0.028; overlap=64%). Among NYHA class I patients, 19%–34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%–10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14).ConclusionsMost patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.

Abstract 310: Variability in Patient-Reported Health Status by NYHA Classification: Implications for Clinical Trials

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Andy T Tran ◽  
Paul S Chan ◽  
Phillip G Jones ◽  
John Spertus
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Health Status ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Class I ◽  
Nyha Classification ◽  
Patient Reported ◽  
Patients With Heart Failure ◽  
Reported Health

Background: A foundation of current clinical trials is to categorize the severity of heart failure (HF) by New York Heart Association (NYHA) classification to ensure that enrolled patients have similar disease severity. Because the NYHA represents a clinician’s assessment of patients’ health status, it may vary from patients’ perspectives and can lead to more or less symptomatic patients being enrolled in clinical trials. We sought to directly compare the ranges of patient-reported health status, as assessed by the well-validated and reliable Kansas City Cardiomyopathy Questionnaire (KCCQ), with NYHA class in recent clinical studies. Methods: We used data from 2 contemporary HF clinical trials, HF-ACTION in patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and TOPCAT in patients with Heart Failure with Preserved Ejection Fraction (HFpEF), and 1 prospective cohort study, the KCCQ Interpretability study (KCCQINT) in patients with HFrEF, where both NYHA and the KCCQ were contemporaneously collected. The distributions of KCCQ Overall Summary (KCCQ-os) scores by NYHA and the variation in assigned NYHA classes among patients with KCCQ scores ≥80 (congruent with NYHA Class I) were then described. Results: A total of 6,072 patients (mean age 64±12 years, 41% female) were included across the 3 studies. Figure 1 shows marked overlap in KCCQ scores across NYHA classes. In KCCQINT, 148 (27%) out of 545 patients reported a KCCQ-os score ≥80, of whom 39 (26%), 81 (55%) and 28 (19%) were coded as NYHA Class I, II and III. None were classified as NYHA Class IV. In HF-ACTION, 677 (32%) of 2129 patients reported a KCCQ-os score ≥80, of whom 548 (81%), 128 (19%) and 1 (<1%) were coded as NYHA Class II, III and IV, respectively. In TOPCAT, 484 (14%) out of 3398 patients reported a KCCQ-os score ≥80, of whom 410 (85%) and 74 (15%) were considered NYHA Class I-II and III-IV, respectively. Conclusions: Although the NYHA is used to identify similarly ill patients for enrollment in clinical trials, there is marked variability within and across studies in patients’ self-reported health status. Future trials should consider patient-reported outcome measures as the basis for defining patient eligibility to enroll a more homogenous cohort of disease severity.

scholarly journals Effects of a mindfulness-based intervention on symptoms and signs in chronic heart failure: A feasibility study

2017 ◽  
Vol 17 (1) ◽  
pp. 54-65 ◽  
Author(s):  
Jonna Norman ◽  
Michael Fu ◽  
Inger Ekman ◽  
Lena Björck ◽  
Kristin Falk
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Usual Care ◽  
Feasibility Study ◽  
Nyha Class ◽  
Symptom Burden ◽  
Heart Association ◽  
Walking Distance ◽  
Nyha Classification ◽  
Symptoms And Signs

Aims: Despite treatment recommended by guidelines, many patients with chronic heart failure remain symptomatic. Evidence is accumulating that mindfulness-based interventions (MBIs) have beneficial psychological and physiological effects. The aim of this study was to explore the feasibility of MBI on symptoms and signs in patients with chronic heart failure in outpatient clinical settings. Methods: A prospective feasibility study. Fifty stable but symptomatic patients with chronic heart failure, despite optimized guideline-recommended treatment, were enrolled at baseline. In total, 40 participants (median age 76 years; New York Heart Association (NYHA) classification II−III) adhered to the study. Most patients ( n=17) were randomized into MBI, a structured eight-week mindfulness-based educational and training programme, or controls with usual care ( n=16). Primary outcome was self-reported fatigue on the Fatigue severity scale. Secondary outcomes were self-reported sleep quality, unsteadiness/dizziness, NYHA functional classification, walking distance in the six-minute walk test, and heart and respiratory rates. The Mann–Whitney U test was used to analyse median sum changes from baseline to follow-up (week 10±1). Results: Compared with usual care (zero change), MBI significantly reduced the self-reported impact of fatigue (effect size −8.0; p=0.0165), symptoms of unsteadiness/dizziness ( p=0.0390) and breathlessness/tiredness related to physical functioning (NYHA class) ( p=0.0087). No adverse effects were found. Conclusions: In stable but symptomatic outpatients with chronic heart failure, MBI alleviated self-reported symptoms in addition to conventional treatment. The sample size is small and further studies are needed, but findings support the role of MBI as a feasible complementary option, both clinically and as home-based treatment, which might contribute to reduction of the symptom burden in patients diagnosed with chronic heart failure.

Association of Physical Activity and Prognostic Parameters in Elderly Patients With Heart Failure

2011 ◽  
Vol 19 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Melissa Jehn ◽  
Arno Schmidt-Trucksäss ◽  
Henner Hanssen ◽  
Tibor Schuster ◽  
Martin Halle ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Nyha Class ◽  
Clinical Status ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Objective:Assessment of habitual physical activity (PA) in patients with heart failure.Methods:This study included 50 patients with heart failure (61.9 ± 4.0 yr). Seven days of PA were assessed by questionnaire (AQ), pedometer, and accelerometer and correlated with prognostic markers including VO2peak, percent left-ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and New York Heart Association (NYHA) functional class.Results:Accelerometry showed a stronger correlation with VO2peak and NYHA class (R = .73 and R = −.68; p < .001) than AQ (R = .58 and R = −.65; p < .001) or pedometer (R = .52 and R = −.50; p < .001). In the multivariable regression model accelerometry was the only consistent independent predictor of VO2peak (p = .002). Moreover, when its accuracy of prediction was tested, 59% of NYHA I and 95% of NYHA III patients were correctly classified into their assigned NYHA classes based on their accelerometer activity.Conclusion:PA assessed by accelerometer is significantly associated with exercise capacity in patients with heart failure and is predictive of disease severity. The data suggests that PA monitoring can aid in evaluating clinical status.

scholarly journals New York Heart Association Functional Class correlated with Depression: Study in Saiful Anwar Hospital

2021 ◽  
Vol 2 (3) ◽  
pp. 25-30
Author(s):  
Yusuf Arifin ◽  
Mohammad Saifur Rohman ◽  
Cholid Tri Tjahjono ◽  
Djanggan Sargowo ◽  
Anna Fuji Rahimah
Keyword(s):  
Heart Failure ◽  
New York ◽  
Marital Status ◽  
Rating Scale ◽  
Nyha Class ◽  
Heart Association ◽  
Functional Class ◽  
Baseline Characteristic ◽  
Significant Difference ◽  
New York Heart Association

Background: Heart Failure prevalence was raising as one of the most Objective: to find the correlation of New York Heart Association Functional Class in heart failure patient with Depression Method: This cross-sectional study recruited 342 patients diagnosed with HF with previously for more than 3 months, at dr. Saiful Anwar General Hospital during December 2016 to March 2021. Each patient was interviewed for their demography data, and their clinical data, and assessed for their depression with Montgomery-Asberg Depression Rating Scale for Indonesian version. We used Spearman coefficients (rs) to evaluate the correlations between variables. Results: Baseline characteristic among depression and non-depression group demonstrated no significant difference (p>0.05), but for marital status. Populations was predominantly male, with ACE-i/ARB and Beta-blockers treatment. Non predominant treatment was MRAs, Diuretics, Digoxin. Baseline age was 22 years old until 87 years old. Baseline LVEF was 50.4±12.9%. (p >0.05). There were significant correlations between NYHA Class and marital status (p < 0.05), while the other baseline was not significantly different. We performed log regression for the confounding. The result was NYHA Class significantly correlated with and effects the depression. Conclusion: In heart failure patients, NYHA Class was significantly correlated with depression.

Arterial embolisation and coiling for high-output heart failure and pulmonary hypertension ınduced by hepatic arteriovenous fistula in a patient with hereditary hemorrhagic telengiectasia

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 369-373
Author(s):  
Sadık Açikgöz ◽  
Gülten Taçoy ◽  
Baran Önal ◽  
Beytullah Yıldırım ◽  
Atiye Çengel
Keyword(s):  
Heart Failure ◽  
New York ◽  
Pulmonary Hypertension ◽  
Arteriovenous Fistula ◽  
Arteriovenous Malformations ◽  
Nyha Class ◽  
Severe Heart Failure ◽  
Heart Association ◽  
Functional Class ◽  
Class Iii

AbstractHereditary hemorrhagic telangiectasia (HHT) is a genetic vascular disorder characterised by epistaxis, telangiectases, and visceral arteriovenous malformations. Hyperdynamic blood flow associated with arteriovenous malformations may lead to pulmonary hypertension, global heart failure, and valvular insufficiencies. We report a patient who had HHT with severe heart failure (New York Heart Association [NYHA] class III-IV) and pulmonary hypertension caused by an hepatic arteriovenous fistula. After successful transarterial embolisation of the right branch of the hepatic artery with polyvinyl alcohol (PVA) particles and coils, 4 to 7 mm in size, the patient was discharged with functional class II (NYHA) heart failure.

scholarly journals Differential Role of Circulating microRNAs to Track Progression and Pre-Symptomatic Stage of Chronic Heart Failure: A Pilot Study

Biomedicines ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. 597
Author(s):  
Yuri D’Alessandra ◽  
Mattia Chiesa ◽  
Maria Cristina Carena ◽  
Antonio Paolo Beltrami ◽  
Paola Rizzo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pilot Study ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Linear Regression Analysis ◽  
Heart Association ◽  
Left Ventricular ◽  
Analysis Of Covariance ◽  
Class I ◽  
Micro Rnas

(1)Background: Chronic heart failure (CHF) contributes to the overall burden of cardiovascular disease. Early identification of at-risk individuals may facilitate the targeting of precision therapies. Plasma microRNAs are promising circulating biomarkers for their implications with cardiac pathologies. In this pilot study, we investigate the possible exploitability of circulating micro-RNAs (miRNAs) to track chronic heart failure (CHF) occurrence, and progression from NYHA class I to IV. (2)Methods: We screened 367 microRNAs using TaqMan microRNA Arrays in plasma samples from healthy controls (HC) and CHF NYHA-class I-to-IV patients (5/group). Validation was performed by singleplex assays on 10 HC and 61 CHF subjects. Differences in the expression of validated microRNAs were evaluated through analysis of covariance (ANCOVA). Associations between N-terminal pro-BNP (NT-proBNP), left ventricular end-diastolic volume (LVEDV) or peak oxygen uptake (VO2 peak) and plasma microRNA were assessed by multivariable linear regression analysis. (3)Results: Twelve microRNAs showed higher expression in CHF patients vs. HC. Seven microRNAs were associated with NT-proBNP concentration; of these, miR-423-5p was also an independent predictor of LVEDV. Moreover, miR-499-5p was a predictor of the VO2 peak. Finally, a cluster of 5 miRNAs discriminated New York Heart Association (NYHA) class-I from HC subjects. (4)Conclusions: Our data suggest that circulating miRNAs have the potential to serve as pathophysiology-based markers of HF status and progression, and as indicators of pre-symptomatic individuals.

scholarly journals The Effects of Sacubitril/Valsartan on Clinical, Biochemical and Echocardiographic Parameters in Patients with Heart Failure with Reduced Ejection Fraction: The “Hemodynamic Recovery”

2019 ◽  
Vol 8 (12) ◽  
pp. 2165 ◽  
Author(s):  
Giuseppe Romano ◽  
Giuseppe Vitale ◽  
Laura Ajello ◽  
Valentina Agnese ◽  
Diego Bellavia ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Heart Association ◽  
Class Iii ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Echocardiographic Parameters ◽  
The Impact

Background: Sacubitril/valsartan has been shown to be superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF). However, knowledge of the impact on cardiac performance remains limited. We sought to evaluate the effects of sacubitril/valsartan on clinical, biochemical and echocardiographic parameters in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Sacubitril/valsartan was administered to 205 HFrEF patients. Results: Among 230 patients (mean age 59 ± 10 years, 46% with ischemic heart disease) 205 (89%) completed the study. After a follow-up of 10.49 (2.93 ± 18.44) months, the percentage of patients in New York Heart Association (NYHA) class III changed from 40% to 17% (p < 0.001). Median N–Type natriuretic peptide (Nt-proBNP) decreased from 1865 ± 2318 to 1514 ± 2205 pg/mL, (p = 0.01). Furosemide dose reduced from 131.3 ± 154.5 to 120 ± 142.5 (p = 0.047). Ejection fraction (from 27± 5.9% to 30 ± 7.7% (p < 0.001) and E/A ratio (from 1.67 ± 1.21 to 1.42 ± 1.12 (p = 0.002)) improved. Moderate to severe mitral regurgitation (from 30.1% to 17.4%; p = 0.002) and tricuspid velocity decreased from 2.8 ± 0.55 m/s to 2.64 ± 0.59 m/s (p < 0.014). Conclusions: Sacubitril/valsartan induce “hemodynamic recovery” and, consistently with reduction in Nt-proBNP concentrations, improve NYHA class despite diuretic dose reduction.

scholarly journals Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria

2020 ◽  
Vol 9 (7) ◽  
pp. 2089
Author(s):  
Anna Camps-Vilaró ◽  
Juan F. Delgado-Jiménez ◽  
Núria Farré ◽  
Helena Tizón-Marcos ◽  
Jesús Álvarez-García ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Sglt2 Inhibitor ◽  
Heart Association ◽  
Cardiovascular Effects ◽  
Functional Class ◽  
Adverse Outcomes ◽  
Reduced Ejection Fraction ◽  
Patient Profile ◽  
Number Of Patients

Heart failure (HF) is one of the main causes of morbidity, mortality, and high healthcare costs. Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, reduced cardiovascular mortality and hospitalization for HF compared to placebo in patients with chronic HF, and reduced ejection fraction (EF) in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. Our aim was to estimate the number of patients with DAPA-HF characteristics in Spain. Our literature review identified epidemiological studies whose objective was to quantify the prevalence of HF and its comorbidities in Spain. We estimated the prevalence of HF with reduced EF, of New York Heart Association (NYHA) functional class II–IV, and with a glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m². In this population, we analysed the prevalence of diabetes using data from the REDINSCOR (Spanish Network for Heart Failure) registry. Our estimations indicate there are 594,684 patients ≥45 years old with HF in Spain (2.6% of this population age group), of which 52.4%, 84.0%, and 93.9% have reduced EF, are NYHA II–IV, and have a GFR ≥ 30 mL/min/1.73 m², respectively. By our calculations, approximately 245,789 Spanish patients would meet the DAPA-HF patient profile, and therefore could benefit from the protective cardiovascular effects of dapagliflozin.

scholarly journals Salivary Biomarkers, Oral Inflammation, and Functional Status in Patients With Heart Failure

2016 ◽  
Vol 19 (2) ◽  
pp. 153-161 ◽  
Author(s):  
Rebecca L. Dekker ◽  
Terry A. Lennie ◽  
Debra K. Moser ◽  
Craig S. Miller ◽  
Jeffrey L. Ebersole ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Nyha Class ◽  
Heart Association ◽  
Serum Levels ◽  
Functional Class ◽  
Reactive Protein ◽  
Patients With Heart Failure ◽  
New York Heart Association ◽  
Oral Inflammation

Aims: To describe correlations and agreement between salivary and serum B-type natriuretic peptide (BNP), C-reactive protein (CRP), interleukin (IL)-6, and IL-10 and determine which biomarkers predict worse functional class in patients with heart failure (HF). Methods: Serum and saliva were collected from 75 hospitalized patients with HF (57 ± 12 years, 43% female, New York Heart Association [NYHA] Classes I [4%], II [43%], and III [53%]). Oral inflammation was rated as good, fair, or poor. Spearman’s ρ and Bland–Altman were used to determine correlations and agreement of the salivary and serum forms of each biomarker. Logistic regressions were used to determine which biomarkers predicted worse NYHA functional class, controlling for depression, body mass index, smoking, and oral inflammation. Results: Median biomarker concentrations were as follows: BNP (serum 361 pg/ml, saliva 9 pg/ml), CRP (serum 13 ng/ml, saliva 25.6 ng/ml), IL-6 (serum 19.3 pg/ml, saliva 10.5 pg/ml), and IL-10 (serum 64.1 pg/ml, saliva 4.7 pg/ml). There was a moderate-to-strong correlation for serum–salivary CRP, weak correlation for serum–salivary IL-6, and no correlations for serum–salivary BNP and IL-10. The Bland–Altman test showed good salivary–serum agreement for all biomarkers, but as serum concentrations rose, salivary measures underestimated serum levels. Visible oral inflammation was the only predictor of worse NYHA class.

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