Inger Ekman1, Ewa Kjörk, Bert Andersson. 1. Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Department of Cardiology, Sahlgrenska University Hospital, Box 457, SE 405 30 Göteborg, Sweden. inger.ekman@fhs.gu.se
Abstract
AIM: To compare the patients' self-assessment of the severity of their symptoms with a physicians assessment and to evaluate the ability of self-assessed symptoms and ejection fraction (EF) to predict long-term survival in heart failure patients. METHOD: Patients (n=332) evaluated symptoms using a self-administered functional classification scale (Specific Activity Scale, SAS), which is equivalent to the NYHA scale. EF and NYHA functional class was also recorded. All patients were followed over a 3-year period. RESULTS: Approximately 50% of patients classified themselves into SAS class I. In contrast, the cardiologists classified only 9% of the patients as NYHA class I. In patients with severe left ventricular dysfunction (EF<or=0.35) SAS score (HR 1.48, 95% CI [1.03-2.12] p=0.03) and ACE inhibitor treatment (0.23 [0.11-0.51], p=0.0003) independently predicted 3-year mortality in a multivariable analysis. EF was not predictive of mortality in the low EF group. Only age predicted long-term outcome in patients with preserved systolic function. CONCLUSION: Patients' self-assessed symptoms and NYHA classification are not coherent. Left ventricular EF is of less importance in comparison with symptoms in chronic heart failure. Patients reporting less severe symptoms had a favourable 3-year prognosis, regardless of EF.
AIM: To compare the patients' self-assessment of the severity of their symptoms with a physicians assessment and to evaluate the ability of self-assessed symptoms and ejection fraction (EF) to predict long-term survival in heart failurepatients. METHOD:Patients (n=332) evaluated symptoms using a self-administered functional classification scale (Specific Activity Scale, SAS), which is equivalent to the NYHA scale. EF and NYHA functional class was also recorded. All patients were followed over a 3-year period. RESULTS: Approximately 50% of patients classified themselves into SAS class I. In contrast, the cardiologists classified only 9% of the patients as NYHA class I. In patients with severe left ventricular dysfunction (EF<or=0.35) SAS score (HR 1.48, 95% CI [1.03-2.12] p=0.03) and ACE inhibitor treatment (0.23 [0.11-0.51], p=0.0003) independently predicted 3-year mortality in a multivariable analysis. EF was not predictive of mortality in the low EF group. Only age predicted long-term outcome in patients with preserved systolic function. CONCLUSION:Patients' self-assessed symptoms and NYHA classification are not coherent. Left ventricular EF is of less importance in comparison with symptoms in chronic heart failure. Patients reporting less severe symptoms had a favourable 3-year prognosis, regardless of EF.
Authors: Sandra M Miranda; Samuel D Moscavitch; Larissa R Carestiato; Renata M Felix; Ronaldo C Rodrigues; Leandro R Messias; Jader C Azevedo; Antonio Cláudio L Nóbrega; Evandro Tinoco Mesquita; Claudio Tinoco Mesquita Journal: Arq Bras Cardiol Date: 2013-07 Impact factor: 2.000