Elsevier

American Heart Journal

Volume 151, Issue 2, February 2006, Pages 444-450
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function

https://doi.org/10.1016/j.ahj.2005.03.066Get rights and content

Background

The association between higher New York Heart Association (NYHA) class and outcomes in patients with heart failure and preserved systolic function is not well known.

Methods

We performed a retrospective follow-up study of 988 patients with heart failure with ejection fraction >45% who participated in the DIG trial. Using Cox proportional hazard models, we estimated risks and all-cause mortality, heart failure mortality, all-cause hospitalization, and hospitalization due to worsening heart failure during a median follow-up of 38.5 months.

Results

Patients had a median age of 68 years; 41.2% were women and 13.9%, nonwhites. Overall, 23.4% of patients died, and 19.9% were hospitalized because of worsening heart failure. Proportion of patients with NYHA classes I, II, III, and IV were 19.9%, 58.0%, 20.9%, and 1.2%, respectively, and 14.7%, 21.1%, 35.9%, and 58.3%, respectively, died of all causes (P < .001 for trend). Respective rates for heart failure–related hospitalizations were 14.2%, 17.1%, 32.5%, and 33.3% (P < .001 for trend). Compared with NYHA class I patients, adjusted hazard ratios (HRs) for all-cause mortality for class II, III, and IV patients were 1.54 (95% CI 1.02-2.32, P = .042), 2.56 (95% CI 1.64-24.01, P < .001), and 8.46 (95% CI 3.57-20.03, P < .001), respectively. Respective adjusted HRs (95% CI) for hospitalization due to heart failure for class II, III, and IV patients were 1.16 (0.76-1.77) (P = .502), 2.27 (1.45-3.56) (P < .001), and 3.71 (1.25-11.02) (P = 018). New York Heart Association classes II through IV were also associated with higher risk of all-cause hospitalization.

Conclusion

Higher NYHA classes were associated with poorer outcomes in patients with heart failure and preserved systolic function.

Section snippets

Methods

In the DIG trial, 7788 ambulatory patients with chronic heart failure and normal sinus rhythm from 302 clinical centers in the United States (186 centers) and Canada (116 centers) were randomized to receive digoxin or placebo to determine the effects of digoxin on mortality and hospitalization.6, 7 The main trial consisted of 6800 patients with a left ventricular ejection fraction (LVEF) ≤45%. In the ancillary DIG trial, 988 patients with heart failure and LVEF >45% (preserved systolic function

Results

Patients had a median age of 68 years; 41.2% were women and 13.9% were nonwhites. The proportions of patients in NYHA classes I, II, III, and IV were 19.8%, 58.1%, 20.9%, and 1.2%, respectively. Table I compares baseline characteristics of patients with heart failure in NYHA classes III to IV with those in NYHA classes I and II. Patients in NYHA classes III and IV were more likely to be older; female; have shorter duration of heart failure, current angina, and chronic kidney disease; elevated

Discussion

The results from the current analysis of the DIG data set demonstrate that higher NYHA classes were associated with higher mortality and hospitalization among a wide spectrum of ambulatory patients with chronic heart failure and preserved systolic function. These findings are important, as NYHA functional classification is a simple tool for risk stratification in clinical practice and can be used to help tailor management of patients with heart failure and preserved systolic function.

Compared

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Ahmed is supported by a National Institutes of Health Mentored Patient-Oriented Research Career Development Award 1-K23-AG19211-01.

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