PMID- 7119078
OWN - NLM
STAT- MEDLINE
DCOM- 19821203
LR  - 20190830
IS  - 0021-9681 (Print)
IS  - 0021-9681 (Linking)
VI  - 35
IP  - 10
DP  - 1982
TI  - Pitfalls in the serial assessment of cardiac functional status. How a reduction 
      in "ordinary" activity may reduce the apparent degree of cardiac compromise and 
      give a misleading impression of improvement.
PG  - 763-71
AB  - Because the New York Heart Association (NYHA) classification system categorizes 
      patients based on subjective impression of the degree of functional compromise, a 
      reduction in exercise might make a patient seem improved because the new lower 
      level of ordinary activity produced fewer symptoms. To test this hypothesis, we 
      studied three different sets of patients and compared their NYHA classes to their 
      functional classes as determined by a new Specific Activity Scale (SAS) that is 
      based on the metabolic equivalents of oxygen consumption required for activities 
      the patient actually performs. Among ambulatory patients referred for exercise 
      tests, the NYHA class was higher (i.e. indicated the patient was more limited) in 
      28% of patients and the SAS class was higher in 14% (p less than 0.001). Among 
      patients interviewed at or near the time of catheterization for chest pain, the 
      NYHA was higher in 20% and the SAS class was higher in 20% (p = NS). In both 
      medically and surgically treated patients interviewed 1--3 yr after cardiac 
      catheterization, the NYHA class was higher in only 4%, whereas the SAS class was 
      higher in 28% (p less than 0.001). The SAS class was significantly more likely to 
      be higher in patients who were not working full time and in patients who 
      described their present activity level as sedentary or light. When the NYHA and 
      SAS systems disagreed as to whether a patient was improved, SAS was significantly 
      more likely to correlate with the patient's self-assessment. These findings 
      suggest that some patients restrict their activity as their cardiac disease 
      progresses; the resultant change in the definition of ordinary activity may 
      reduce the apparent degree of cardiac compromise and thus give a false impression 
      of improvement by NYHA criteria.
FAU - Goldman, L
AU  - Goldman L
FAU - Cook, E F
AU  - Cook EF
FAU - Mitchell, N
AU  - Mitchell N
FAU - Flatley, M
AU  - Flatley M
FAU - Sherman, H
AU  - Sherman H
FAU - Cohn, P F
AU  - Cohn PF
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - J Chronic Dis
JT  - Journal of chronic diseases
JID - 2985123R
SB  - IM
MH  - Activities of Daily Living
MH  - Exercise Test
MH  - Heart/*physiopathology
MH  - Heart Diseases/*classification
MH  - Humans
MH  - Oxygen Consumption
EDAT- 1982/01/01 00:00
MHDA- 1982/01/01 00:01
CRDT- 1982/01/01 00:00
PHST- 1982/01/01 00:00 [pubmed]
PHST- 1982/01/01 00:01 [medline]
PHST- 1982/01/01 00:00 [entrez]
AID - 10.1016/0021-9681(82)90087-x [doi]
PST - ppublish
SO  - J Chronic Dis. 1982;35(10):763-71. doi: 10.1016/0021-9681(82)90087-x.