Impact Of NYHA Functional Classification On Clinical Outcomes In Heart Failure With Stable Mid-range Ejection Fraction

Abstract

<h3>Background</h3> Heart failure with mid-range ejection fraction (HFmrEF) of 40-49% is an under-recognized class of CHF. The impact of NYHA functional classification on clinical outcomes in patients with HFmrEF with stable ejection fraction of 1 year is unclear. <h3>Methods</h3> We screened 7668 echo studies to identify patients with stable HFmrEF. Follow up was for 60.3 ± 25.7 months. One-way ANOVA and chi-square tests were used to assess baseline differences between NYHA classes. Kaplan Meier survival analysis was conducted and Log-rank <i>p</i> values were calculated to assess the association of NYHA classes with all-cause mortality, cardiac mortality, and HF hospitalizations. Multivariate Cox regression analysis was adjusted for significant baseline differences. <h3>Results</h3> A total of 201 patients were included with NYHA I (n=31), NYHA II (n=85), NYHA III (n=79), or NYHA IV (n=6) class. Higher NYHA class was associated with higher all-cause mortality, cardiac mortality, and HF hospitalization with Log-rank P = 0.023, P = 0.028, and P = 0.002 respectively. After adjustments for baseline differences in COPD, loop diuretics, statin along with other major comorbidities, higher NYHA class continued to be associated with higher HF hospitalizations with HR 1.84 (95% CI = 1.25 - 2.71) P = 0.002 whereas the other 2 associations became insignificant <b>figure 1</b>. <h3>Conclusion</h3> We found that higher NYHA class in patients with stable HFmrEF of 1 year results in higher HF hospitalizations and no effect on mortality outcomes.