Agreement between heart failure patients and providers in assessing New York Heart Association functional class.

BACKGROUND: Uncertainty persists regarding whether patient assessment of New York Heart Association (NYHA) functional classification should be preferred over provider assessment among patients with heart failure (HF).

OBJECTIVES: To compare patient against provider NYHA assessments, and both to distance walked on a 6-minute walk test (6MWT) among patients with HF.

METHODS: In this prospective study, we enrolled 101 HF patients who self-assessed NYHA classification. Health care providers who were blinded to patient ratings of NYHA also rated NYHA. Patients completed a 6MWT according to a standardized protocol. We used Spearman coefficients (rs) to evaluate the correlations between variables.

RESULTS: Patient- and provider-determined NYHA class were poorly correlated, but the relationship was statistically significant (rs = 0.40, p < 0.001). Patients consistently reported better NYHA class (class I: 72% vs 15%) than providers. Provider-determined NYHA had a stronger correlation with 6MWT distance (rs = -0.36, p < 0.001 vs. rs = -0.22, p = 0.03). Providers assigned a worse class to older patients who had comorbidity; patients with dyspnea and longer HF duration assigned themselves a worse class.

CONCLUSION: Patients and providers exhibited poor agreement in NYHA assignment.