PMID- 31771438
OWN - NLM
STAT- MEDLINE
DCOM- 20210107
LR  - 20210110
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 8
IP  - 23
DP  - 2019 Dec 3
TI  - Clinical Implications of the New York Heart Association Classification.
PG  - e014240
LID - 10.1161/JAHA.119.014240 [doi]
LID - e014240
AB  - Background The New York Heart Association (NYHA) classification has served as a 
      fundamental tool for risk stratification of heart failure (HF) and determines 
      clinical trial eligibility and candidacy for drugs and devices. However, its 
      ability to adequately stratify risk is unclear. Methods and Results To compare 
      NYHA class with objective assessments and survival in patients with HF, we 
      performed secondary analyses of 4 multicenter National Institutes of 
      Health-funded HF clinical trials that included patients classified as NYHA class 
      II or III: TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an 
      Aldosterone Antagonist), DIG (The Effect of Digoxin on Mortality and Morbidity in 
      Patients With Heart Failure), HF-ACTION (Efficacy and Safety of Exercise Training 
      in Patients With Chronic Heart Failure), and GUIDE-IT (Guiding Evidence-Based 
      Therapy Using Biomarker Intensified Treatment in Heart Failure). Twenty-month 
      cumulative survival was compared between classes using Kaplan-Meier curves and 
      the log rank test. NT-proBNP (N-terminal pro-B-type natriuretic peptide), Kansas 
      City Cardiomyopathy Questionnaire (KCCQ) scores, 6-minute walk distances, left 
      ventricular ejection fraction, and cardiopulmonary test parameters were compared 
      using Wilcoxon rank sum tests and percentage overlap using kernel density 
      estimations. Cumulative mortality varied significantly across NYHA classes and HF 
      clinical trials (likelihood ratio, P<0.001). Mortality at 20 months for NYHA 
      class II ranged from 7% for patients in HF-ACTION to 15% in GUIDE-IT, whereas 
      mortality for NYHA class III ranged from 12% in TOPCAT to 26% in GUIDE-IT. There 
      was substantial percentage overlap in values for NT-proBNP levels (79% and 69%), 
      KCCQ scores (63% and 54%), 6-minute walk distances (63% and 54%), and left 
      ventricular ejection fraction (88% and 83%). Similarly, there was substantial 
      overall in values for minute ventilation-carbon dioxide production relationship 
      (71%), maximal oxygen uptake (54%), and exercise duration (53%). Conclusions The 
      NYHA system poorly discriminates HF patients across the spectrum of functional 
      impairment. These findings raise important questions about the need for improved 
      phenotyping of these patients to facilitate risk stratification and response to 
      interventions.
FAU - Caraballo, Cesar
AU  - Caraballo C
AD  - Section of Cardiovascular Medicine Center for Outcomes Research Evaluation (CORE) 
      Yale University School of Medicine New Haven CT.
FAU - Desai, Nihar R
AU  - Desai NR
AD  - Section of Cardiovascular Medicine Center for Outcomes Research Evaluation (CORE) 
      Yale University School of Medicine New Haven CT.
FAU - Mulder, Hillary
AU  - Mulder H
AD  - Duke Clinical Research Institute Durham NC.
FAU - Alhanti, Brooke
AU  - Alhanti B
AD  - Duke Clinical Research Institute Durham NC.
FAU - Wilson, F Perry
AU  - Wilson FP
AD  - Program of Applied Translational Research Yale University School of Medicine New 
      Haven CT.
FAU - Fiuzat, Mona
AU  - Fiuzat M
AD  - Duke Clinical Research Institute Durham NC.
FAU - Felker, G Michael
AU  - Felker GM
AD  - Duke Clinical Research Institute Durham NC.
FAU - Pina, Ileana L
AU  - Pina IL
AD  - Detroit Medical Center Detroit MI.
FAU - O'Connor, Christopher M
AU  - O'Connor CM
AD  - Inova Heart and Vascular Institute Fairfax VA.
FAU - Lindenfeld, Joanne
AU  - Lindenfeld J
AD  - Vanderbilt University Medical Center Nashville TN.
FAU - Januzzi, James L
AU  - Januzzi JL
AD  - Massachusetts General Hospital and Baim Institute for Clinical Research Boston 
      MA.
FAU - Cohen, Lawrence S
AU  - Cohen LS
AD  - Program of Applied Translational Research Yale University School of Medicine New 
      Haven CT.
FAU - Ahmad, Tariq
AU  - Ahmad T
AD  - Section of Cardiovascular Medicine Center for Outcomes Research Evaluation (CORE) 
      Yale University School of Medicine New Haven CT.
LA  - eng
GR  - P30 DK079310/DK/NIDDK NIH HHS/United States
GR  - UL1 TR001863/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
DEP - 20191127
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
SB  - IM
MH  - Heart Failure/*classification/mortality
MH  - Humans
MH  - New York
MH  - Risk Assessment/standards
MH  - Societies, Medical
PMC - PMC6912957
OTO - NOTNLM
OT  - NYHA class
OT  - clinical trials
OT  - heart disease
OT  - heart failure
EDAT- 2019/11/28 06:00
MHDA- 2021/01/08 06:00
PMCR- 2019/12/03
CRDT- 2019/11/28 06:00
PHST- 2019/11/28 06:00 [entrez]
PHST- 2019/11/28 06:00 [pubmed]
PHST- 2021/01/08 06:00 [medline]
PHST- 2019/12/03 00:00 [pmc-release]
AID - JAH34635 [pii]
AID - 10.1161/JAHA.119.014240 [doi]
PST - ppublish
SO  - J Am Heart Assoc. 2019 Dec 3;8(23):e014240. doi: 10.1161/JAHA.119.014240. Epub 
      2019 Nov 27.