Abstract 12817: Comparison of New York Heart Association Classification and Patient-reported Outcomes Among Heart Failure Patients in U.S. Clinical Practice: CHAMP-HF

Abstract

Introduction: How the New York Heart Association classification system compares with patient-reported outcomes for HF patients in contemporary U.S. clinical practice is unclear. Methods: Among 2,872 U.S. outpatients with chronic HF with reduced ejection fraction (HFrEF) in the CHAMP-HF registry with complete NYHA class and Kansas City Cardiomyopathy Questionnaire Overall Score (KCCQ-OS) data at baseline and 12 months, longitudinal changes in the 2 measures and their correlation with each other were examined. Multivariable models landmarked at 12 months separately evaluated associations between improvement in NYHA and KCCQ-OS from baseline to 12 months with clinical outcomes occurring from months 12 through 24. Results: At 12-month follow-up, 65% of patients had no change in NYHA class, 18% had 1 class improvement, and 13% had 1 class worsening. For KCCQ-OS, 25% had no significant change (i.e., <5 point improvement or worsening), 48% had ≥5 point improvement, and 27% a ≥5 point worsening (Figure, Panel A) . NYHA class and KCCQ-OS showed modest correlation at baseline (r=0.33, p<0.01) and 12 months (r=0.33, p<0.01). After adjustment, improvement in NYHA class was not associated with 1-year mortality or composite mortality/ HF hospitalization ( Figure, Panel B) . For KCCQ-OS, ≥5-point improvement was independently associated with a 41% lower risk of mortality and a 27% lower risk of mortality/ HF hospitalization. Conclusions: In this contemporary U.S. outpatient HFrEF registry, as compared with NYHA class, the KCCQ-OS was substantially more likely to show meaningful change over 12-month follow-up and these changes had strong prognostic implications. These data support the advantages and relative importance of patient-reported outcomes for HFrEF, as compared with traditional clinician-reported functional assessments.