PMID- 35999668 OWN - NLM STAT- MEDLINE DCOM- 20221215 LR - 20230413 IS - 1879-0844 (Electronic) IS - 1388-9842 (Print) IS - 1388-9842 (Linking) VI - 24 IP - 11 DP - 2022 Nov TI - Trajectories in New York Heart Association functional class in heart failure across the ejection fraction spectrum: data from the Swedish Heart Failure Registry. PG - 2093-2104 LID - 10.1002/ejhf.2644 [doi] AB - AIMS: To investigate incidence, predictors and prognostic implications of longitudinal New York Heart Association (NYHA) class changes (i.e. improving or worsening vs. stable NYHA class) in heart failure (HF) across the ejection fraction (EF) spectrum. METHODS AND RESULTS: From the Swedish HF Registry, 13 535 patients with EF and >/=2 NYHA class assessments were considered. Multivariable multinomial regressions were fitted to identify the independent predictors of NYHA change. Over a 1-year follow-up, 69% of patients had stable, 17% improved, and 14% worsened NYHA class. Follow-up in specialty care predicted improving NYHA class, whereas an in-hospital patient registration, lower EF, renal disease, lower mean arterial pressure, older age, and longer HF duration predicted worsening. The association between NYHA change and subsequent outcomes was assessed with multivariable Cox models. When adjusting for the NYHA class at baseline, improving NYHA class was independently associated with lower while worsening with higher risk of all-cause and cardiovascular mortality, and first HF hospitalization. After adjustment for the NYHA class at follow-up, NYHA class change did not predict morbidity/mortality. NYHA class assessment at baseline and follow-up predicted morbidity/mortality on top of the changes. Results were consistent across the EF spectrum. CONCLUSION: In a large real-world HF population, NYHA class trajectories predicted morbidity/mortality after extensive adjustments. However, the prognostic role was entirely explained by the resulting NYHA class, i.e. the follow-up value. Our results highlight that considering one-time NYHA class assessment, rather than trajectories, might be the preferable approach in clinical practice and for clinical trial design. CI - (c) 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. FAU - Lindberg, Felix AU - Lindberg F AD - Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. FAU - Lund, Lars H AU - Lund LH AD - Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. AD - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. FAU - Benson, Lina AU - Benson L AD - Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. FAU - Dahlstrom, Ulf AU - Dahlstrom U AD - Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden. FAU - Karlstrom, Patric AU - Karlstrom P AD - Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden. AD - Department of Internal Medicine, Ryhov County Hospital, Jonkoping, Sweden. FAU - Linde, Cecilia AU - Linde C AD - Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. AD - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. FAU - Rosano, Giuseppe AU - Rosano G AD - IRCCS San Raffaele Roma, Rome, Italy. FAU - Savarese, Gianluigi AU - Savarese G AUID- ORCID: 0000-0001-7732-0887 AD - Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. AD - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. LA - eng PT - Journal Article DEP - 20220823 PL - England TA - Eur J Heart Fail JT - European journal of heart failure JID - 100887595 SB - IM CIN - Eur J Heart Fail. 2022 Nov;24(11):2105-2107. PMID: 36088541 EIN - Eur J Heart Fail. 2023 Mar;25(3):444. PMID: 36799255 MH - Humans MH - *Heart Failure MH - Societies, Medical MH - Heart Failure, Diastolic PMC - PMC10087442 OTO - NOTNLM OT - Ejection fraction OT - Heart failure OT - NYHA functional class OT - Prognosis OT - Symptoms EDAT- 2022/08/25 06:00 MHDA- 2022/12/15 06:00 PMCR- 2023/04/11 CRDT- 2022/08/24 00:03 PHST- 2022/07/09 00:00 [revised] PHST- 2022/05/02 00:00 [received] PHST- 2022/07/31 00:00 [accepted] PHST- 2022/08/25 06:00 [pubmed] PHST- 2022/12/15 06:00 [medline] PHST- 2022/08/24 00:03 [entrez] PHST- 2023/04/11 00:00 [pmc-release] AID - EJHF2644 [pii] AID - 10.1002/ejhf.2644 [doi] PST - ppublish SO - Eur J Heart Fail. 2022 Nov;24(11):2093-2104. doi: 10.1002/ejhf.2644. Epub 2022 Aug 23.