National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
JAMA Netw Open. 2023 Oct 2;6(10):e2339458. doi: 10.1001/jamanetworkopen.2023.39458.
Sparse data exist regarding how clinician-assigned New York Heart Association (NYHA) class compares with heart failure (HF)-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) in acute HF.
To compare concordance between NYHA class and KCCQ overall summary score (KCCQ-OS) in acute HF and investigate associations of changes in NYHA class and KCCQ-OS with long-term outcomes.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, patients with HF were enrolled from 52 hospitals in China between August 2016 and May 2018. Among patients with NYHA class and KCCQ-OS at admission and 1 month, levels of each scale were categorized into 4 groups from worst to best. Mild and moderate to severe discordance were defined as NYHA class and KCCQ-OS differing by 1 level or 2 or more levels, respectively. Multivariable models evaluated associations between improvements in the 2 measures and outcomes. Analysis was conducted from January to March 2023.
Changes in NYHA class and KCCQ-OS from admission to 1 month.
All-cause mortality, cardiovascular death, or first HF rehospitalization.
A total of 2683 patients (1709 [63.7%] male; median [IQR] age, 66 [56-75] years) were included. NYHA class II, III, and IV were presented in 374 patients (13.9%), 1179 patients (44.0%), and 1130 patients (42.1%), respectively, and the median (IQR) KCCQ-OS was 44.4 (28.3-61.9). Concordance, mild discordance, and moderate to severe discordance between admission NYHA class and KCCQ-OS occurred in 954 patients (35.6%), 1203 patients (44.8%), and 526 patients (19.6%), respectively. For KCCQ-OS, kernel density overlaps were 73.6% between NYHA II and III, 63.8% between NYHA II and IV, and 88.3% between NYHA III and IV. Most patients experienced improvements in NYHA and KCCQ-OS from admission to 1 month. After adjustment, there was no significant association between improvements in NYHA class and 4-year all-cause mortality, whereas 5 or more point improvements in KCCQ-OS were independently associated with a lower risk of 4-year mortality (hazard ratio, 0.84; 95% CI, 0.74-0.96; P = .01). NYHA class and KCCQ-OS improvements were both associated with decreased risk of 1-year composite cardiovascular death or HF rehospitalization.
In this cohort study of acute HF, discordance between NYHA class and KCCQ was common, and KCCQ was more relevant to subsequent mortality than NYHA class.
关于临床医生分配的纽约心脏协会（NYHA）心功能分级与急性心力衰竭（HF）特异性堪萨斯城心肌病问卷（KCCQ）在急性 HF 中的比较，相关数据稀疏。
比较急性 HF 中 NYHA 心功能分级与 KCCQ 总概括评分（KCCQ-OS）的一致性，并探讨 NYHA 心功能分级和 KCCQ-OS 变化与长期结局的关系。
设计、设置和参与者：在这项队列研究中，从 2016 年 8 月至 2018 年 5 月，在中国的 52 家医院招募了 HF 患者。在有 NYHA 心功能分级和入院及 1 个月时的 KCCQ-OS 的患者中，将各量表的水平分为从最差到最好的 4 组。轻度和中重度至重度不匹配分别定义为 NYHA 心功能分级和 KCCQ-OS 相差 1 级或 2 级或更多级。多变量模型评估了这两个指标的改善与结局之间的关系。分析于 2023 年 1 月至 3 月进行。
从入院到 1 个月时 NYHA 心功能分级和 KCCQ-OS 的变化。
全因死亡率、心血管死亡或首次 HF 再住院。
共纳入 2683 例患者（1709 例[63.7%]为男性；中位[IQR]年龄，66[56-75]岁）。374 例（13.9%）、1179 例（44.0%）和 1130 例（42.1%）患者分别表现为 NYHA 心功能 II 级、III 级和 IV 级，中位（IQR）KCCQ-OS 为 44.4（28.3-61.9）。入院时 NYHA 心功能分级与 KCCQ-OS 之间存在一致性、轻度不匹配和中重度不匹配的患者分别为 954 例（35.6%）、1203 例（44.8%）和 526 例（19.6%）。对于 KCCQ-OS，NYHA II 与 III 之间的核密度重叠度为 73.6%，NYHA II 与 IV 之间为 63.8%，NYHA III 与 IV 之间为 88.3%。大多数患者从入院到 1 个月时 NYHA 和 KCCQ-OS 均有改善。调整后，NYHA 心功能分级的改善与 4 年全因死亡率之间无显著相关性，而 KCCQ-OS 改善 5 分或以上与 4 年死亡率降低独立相关（危险比，0.84；95%CI，0.74-0.96；P=0.01）。NYHA 心功能分级和 KCCQ-OS 的改善均与 1 年复合心血管死亡或 HF 再住院风险降低相关。
在这项急性 HF 的队列研究中，NYHA 心功能分级与 KCCQ 之间存在明显不匹配，与 NYHA 心功能分级相比，KCCQ 与后续死亡率相关性更高。
