Providers' assignment of NYHA functional class in patients with heart failure: A vignette study

Abstract

Background: Accuracy of New York Heart Association Functional Classification (NYHA-FC) I-IV assessment is critical to promoting guideline directed care.

Objective: Examine providers' accuracy when diagnosing NYHA-FC I-IV in patients with heart failure (HF).

Methods: A web-based survey using validated vignettes was conducted with 244 physicians, nurse practitioners (NP), clinical nurse specialists (CNS) and physician assistants (PA) who provide care to patients with HF.

Results: Providers comprised of 65% NPs, 19% physicians, 14% CNSs, 2% PAs with an average of 15 years working with HF patients. Accuracy ranged from 36.9% for Class IV to 78.7% for Class I. Increased HF patient volume seen (p=0.024), physician vs. NP/PA/CNS (p=0.021), and typically assigned a HF stage (p<0.001) were associated with increased total correct score accuracy in multivariable modeling.

Conclusion: It is critical that NYHA-FC is accurately assigned to promote optimal outcomes. Research in the future should focus on improving accuracy in assigning NYHA-FC.

Keywords: Functional class; Heart failure; NYHA functional classification; Symptoms.