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Abstract
Two ways to evaluate the symptoms of heart failure are the New York Heart Association
(NYHA) classification and asking patients how far they can walk (walk distance). The
NYHA system is commonly used, although it is not clear how individual clinicians apply
it.
To investigate how useful these measures are to assess heart failure and whether other
questions might be more helpful.
30 cardiologists were asked what questions they used when assessing patients with
heart failure. To assess interoperator variability, two cardiologists assessed a series
of 50 patients in classes II and III using the NYHA classification. 45 patients who
had undergone cardiopulmonary testing were interviewed using a specially formulated
questionnaire. They were also asked how far they could walk before being stopped by
symptoms, and then tested on their ability to estimate distance.
The survey of cardiologists showed no consistent method for assessing NYHA class and
a literature survey showed that 99% of research papers do not reference or describe
their methods for assigning NYHA classes. The interoperator variability study showed
only 54% concordance between the two cardiologists. 70% of cardiologists asked patients
for their walk distance; however, this walk distance correlated poorly with actual
exercise capacity measured by cardiopulmonary testing (rho = 0.04, p = 0.82).
No consistent method of assessing NYHA class is in use and the interoperator study
on class II and class III patients gave a result little better than chance. Some potential
questions are offered for use in assessment. Walking distance, although frequently
asked, does not correlate with formally measured exercise capacity, even after correction
for patient perception of distance, and has never been found to have prognostic relevance.
Its value is therefore doubtful.