OR3. Practitioners' Inaccuracy in Decision-Making with Assessing NYHA Functional Class of Patients with Heart Failure

Abstract

<h3>Background</h3> Timely evidence-based guideline directed treatment is essential to ensure optimal outcomes when managing patients with heart failure (HF). Identifying HF patient's New York Heart Association (NYHA) functional class is a clinically important as it relates to treatment recommendations. <h3>Purpose</h3> The purpose of this study was to examine HF providers' decision making and ability to correctly assign NYHA functional class. <h3>Methods</h3> We conducted a cross-sectional, correlational study using survey methods with 244 providers practicing in the United States in acute and ambulatory care settings that treat adult patients with HF. Providers completed 8 validated clinical vignettes focused on decision making related NYHA functional classes I-IV. Descriptive statistics and multivariable regression were used to analyze the data. <h3>Results</h3> Participants were on average 51 years of age (<i>SD</i>=11), predominately female (83%) and Caucasian (87%). 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 (<i>SD</i>=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. <h3>Conclusions</h3> When patients are incorrectly classed, then 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 I-IV to ensure appropriate treatment at the right time in the patient's trajectory of HF to improve patient outcomes.