© 2007 European Society of Cardiology
Self-assessed symptoms in chronic heart failure — Important information for clinical management
a Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University Box 457, SE 405 30 Göteborg, Sweden
b Department of Cardiology, Sahlgrenska University Hospital Sweden
c Department of Cardiology, Sahlgrenska University Hospital The Sahlgrenska Academy at Göteborg University Göteborg, Sweden
* Corresponding author. Fax: +46 317736050. E-mail address: inger.ekman{at}fhs.gu.se
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Abstract |
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Aim: To compare the patients' self-assessment of the severity of their symptoms with a physicians assessment and to evaluate the ability of self-assessed symptoms and ejection fraction (EF) to predict long-term survival in heart failure patients.
Method: Patients (n=332) evaluated symptoms using a self-administered functional classification scale (Specific Activity Scale, SAS), which is equivalent to the NYHA scale. EF and NYHA functional class was also recorded. All patients were followed over a 3-year period.
Results: Approximately 50% of patients classified themselves into SAS class I. In contrast, the cardiologists classified only 9% of the patients as NYHA class I. In patients with severe left ventricular dysfunction (EF
0.35) SAS score (HR 1.48, 95% CI [1.03–2.12] p=0.03) and ACE inhibitor treatment (0.23 [0.11–.51], p=0.0003) independently predicted 3-year mortality in a multivariable analysis. EF was not predictive of mortality in the low EF group. Only age predicted long-term outcome in patients with preserved systolic function.
Conclusion: Patients' self-assessed symptoms and NYHA classification are not coherent. Left ventricular EF is of less importance in comparison with symptoms in chronic heart failure. Patients reporting less severe symptoms had a favourable 3-year prognosis, regardless of EF.
Key Words: Symptoms • Heart failure • Mortality • SAS • NYHA
Received June 1, 2006; Revised September 14, 2006; Accepted October 30, 2006
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