Clinical InvestigationCongestive Heart FailureHigher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular 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.