Abstract 13936: Practitioners’ Inaccuracy in Decision-making With Assessing NYHA Functional Class of Patients With Heart Failure

Abstract

Introduction: Heart failure (HF) is a major public health problem and timely evidence-based guideline directed treatment is essential to ensure optimal patient outcomes. New York Heart Association (NYHA) functional class of HF patients is a clinically important assessment as it relates to treatment recommendations. Purpose: The purpose of this study was to examine HF providers’ decision making and ability to correctly assign NYHA functional class. Methods: A cross-sectional, correlational study using survey methods with 244 physicians, advanced practice nurses and physician assistants practicing in the United States in acute and ambulatory care settings that treat adult patients with HF was conducted. Providers completed 8 validated clinical vignettes focused on decision making that related to the four NYHA functional classes. Descriptive statistics and multivariable regression were used to analyze the data. Results: Participants were predominately female (83%), Caucasian (87%) and were on average 51 years of age (SD=11). Sixty-five percent were nurse practitioners and 18% physicians, most were certified in HF (59%) and on average worked with HF patients for 15.1 years (SD=9.6). Providers reported assigning NYHA class to 83% of their patients, with 39% reporting it was useful. Accurate identification of NYHA Class I was 78.7%, for Class II 57.4%, for Class III 59.8% and for Class IV 36.9%. Correct NYHA class scores were associated with providers who typically reported assigning HF stage (p<0.001), increased number of HF patients seen per week (p=0.024) and MD/DO providers relative to other advanced practice providers (p=0.021). Correct NYHA class scores were not associated with years working in a healthcare role, years working in HF, or years of certification adjusting for other provider and practice characteristics. Conclusions: Advanced practice providers who saw fewer HF patients had greater difficulty with accurately assigning NYHA Functional Class. When patients are incorrectly classed, they may not be recommended for evidence-based therapies at the optimal time, thus decreasing patient outcomes. Future research should focus on ways to improve accuracy in assigning NYHA Functional Class to improve patient outcomes.