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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Article info
Publication history
Published online: August 21, 2019
Accepted:
August 16,
2019
Received:
April 19,
2019
Footnotes
See editorial by Cai et al., pages 4–6 of this issue.
See page 35 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Sex-Specific Differences in New York Heart Association Classification and Outcomes of Decompensated Heart FailureCanadian Journal of CardiologyVol. 36Issue 1
- PreviewThe 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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