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Canadian Journal of Cardiology

Sex Differences in New York Heart Association Functional Classification and Survival in Acute Heart Failure Patients With Preserved or Reduced Ejection Fraction

  • Katsuya Kajimoto
    Correspondence
    Corresponding author: Dr Katsuya Kajimoto, Division of Cardiology, Sekikawa Hospital, 1-4-1, Nishi-Nippori, Arakawa-ku, Tokyo, 116-0013, Japan. Tel.: +81-3-3803-5151; fax: +81-3-3806-6808.
    Affiliations
    Division of Cardiology, Sekikawa Hospital, Tokyo, Japan
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  • Naoki Sato
    Affiliations
    Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
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  • on behalf of theInvestigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry
Published:August 21, 2019DOI:https://doi.org/10.1016/j.cjca.2019.08.020

      Abstract

      Background

      The aim of this study was to evaluate the influence of sex on the relationship between the New York Heart Association (NYHA) functional classification and survival in acute decompensated heart failure (HF) patients with preserved or reduced ejection fraction (EF).

      Methods

      Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4717 (2730 men and 1987 women) were investigated to assess the association of sex, NYHA functional class, and preserved or reduced EF with all-cause death. Men and women were divided into 6 groups based on left ventricular EF (preserved or reduced) and NYHA functional class (II, III, or IV) at admission.

      Results

      Among both sexes with preserved EF, multivariable analysis confirmed that NYHA functional class IV was associated with a significantly higher risk of all-cause death than NYHA functional class II. Similarly, in women with reduced EF, NYHA functional class IV was a significant predictor of all-cause death compared with class II. However, in men with reduced EF, the adjusted risk of all-cause death was similar for those in NYHA functional classes II, III, and IV. Furthermore, the interaction between sex and NYHA functional classes II to IV was statistically significant for all-cause death in reduced EF patients (P for interaction = 0.037), but not in preserved EF patients (P for interaction = 0.711).

      Conclusions

      NYHA functional class IV was a significant predictor of all-cause death in both sexes with preserved EF, whereas NYHA functional class IV was a significant predictor of all-cause death in women, but not in men, with reduced EF.

      Résumé

      Contexte

      L’étude visait à évaluer l’influence du sexe sur le lien entre la classification fonctionnelle de la New York Heart Association (NYHA) et la survie chez les patients atteints d’insuffisance cardiaque (IC) aiguë décompensée avec fraction d’éjection (FE) préservée ou réduite.

      Méthodologie

      Sur les 4 842 patients inscrits au registre ATTEND (Acute Decompensated Heart Failure Syndromes), 4 717 (2 730 hommes et 1 987 femmes) ont fait l’objet d’une évaluation de l’association entre le sexe, la classe fonctionnelle de la NYHA et la FE préservée ou réduite d’une part, et le décès toutes causes d’autre part. Les hommes et les femmes ont été répartis en 6 groupes en fonction de la FE ventriculaire gauche (préservée ou réduite) et de la classe fonctionnelle de la NYHA (II, III ou IV) à l’admission.

      Résultats

      Chez les hommes et les femmes présentant une FE préservée, une analyse multivariable a confirmé que la classe fonctionnelle IV de la NYHA était associée à un risque significativement plus élevé de décès toutes causes que la classe fonctionnelle II. De même, chez les femmes présentant une FE réduite, la classe fonctionnelle IV de la NYHA constituait un facteur de prédiction important du décès toutes causes comparativement à la classe II. Toutefois, chez les hommes présentant une FE réduite, le risque corrigé de décès toutes causes était comparable pour toutes les classes fonctionnelles de la NYHA (II, III et IV). En outre, l’interaction entre le sexe et les classes fonctionnelles II à IV de la NYHA était statistiquement significative à l’égard du décès toutes causes chez les patients présentant une FE réduite (p pour l’interaction = 0,037), mais pas chez les patients présentant une FE préservée (p pour l’interaction = 0,711).

      Conclusions

      La classe fonctionnelle IV de la NYHA était un facteur de prédiction important du décès toutes causes chez les patients des deux sexes présentant une FE préservée et chez les femmes présentant une FE réduite, mais pas chez les hommes présentant une FE réduite.
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      Linked Article

      • Sex-Specific Differences in New York Heart Association Classification and Outcomes of Decompensated Heart Failure
        Canadian Journal of CardiologyVol. 36Issue 1
        • Preview
          The New York Heart Association (NYHA) classification is widely used for grading heart failure (HF) symptom severity. Since its conception in 1928,1 NYHA classification has undergone multiple revisions and has been used as a tool for phenotypic ordering in a variety of settings such as risk prediction models, clinical trials, and determination of eligibility for therapies in evidence-based practice guidelines.2 For chronic HF, NYHA class is a strong predictor of mortality and forms a component in mortality risk prediction models such as the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) and Seattle Heart Failure model.
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