Abstract
Background: Correct assignment of New York Heart Association Functional Classification (NYHA-FC) I-IV in patients with heart failure (HF) helps to promote evidence-based guideline directed care. Past research has shown difficulty with providers making consistent decisions about NYHA-FC due to its subjective nature. Therefore, we developed a NYHA-FC Guide to assist with promoting a more accurate NYHA-FC assignment by providers. Objective: Examine the validity, reliability, and accuracy of HF and primary care providers’ assignment of NYHA-FC in patients with HF using the NYHA-FC Guide. Methods: A cross-sectional design was used with validated vignettes after expert review. Advanced practice providers ( n =75) in HF and primary care (PC) utilized a newly developed NYHA-FC Guide to assist in the assignment of NYHA-FC. Known-group validity comparisons, interrater reliability and internal consistency were used to evaluate the validity and reliability of the NYHA-FC Guide. Results: Heart failure providers’ accuracy total mean scores were significantly higher compared to PC providers ( M = 6.0 vs. 5.4, p = 0.020). Primary care providers’ accuracy was higher than anticipated with no significant difference in accuracy of assignment for NYHA-FC II, III and IV relative to HF providers. A majority of HF providers (62%) and primary care providers (80%) reported that the NYHA-FC Guide assisted them with deciding NYHA-FC. Conclusion: Correct assignment of NYHA-FC can promote more objective decision-making regarding prescribing evidence-based treatment to patients with HF. The newly developed NYHA-FC Guide shows promise for facilitating accuracy of NYHA-FC assignment. Further research is warranted to evaluate the accuracy of using the NYHA-FC Guide compared to the gold standard 6 minute walk test and the applicability for use the NYHA-FC Guide in a busy clinical practice.
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