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Multicenter Study
. 2006 Feb;151(2):444-50.
doi: 10.1016/j.ahj.2005.03.066.

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

Ali Ahmed  1 , Wilbert S Aronow, Jerome L Fleg
Affiliations
Multicenter Study

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

Ali Ahmed et al. Am Heart J. 2006 Feb.

Abstract

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.

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Figures

Figure 1
Figure 1
Kaplan-Meier plots for cumulative probability of (a) all-cause mortality and (b) heart failure mortality by New York Heart Association functional class
Figure 2
Figure 2
Kaplan-Meier plots for cumulative probability of (a) all-cause hospitalization and (b) hospitalization due to worsening heart failure by New York Heart Association functional class
See this image and copyright information in PMC

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