Patients report more severe daily limitations than recognized by their physicians

Abstract

BackgroundPatient limitations guide selection of heart failure therapies, for which indications often specify New York Heart Association Class.ObjectivesTo determine the extent of patient‐reported limitations during daily activities and compare to New York Heart Association class assigned by providers during the same visit, and to left ventricular ejection fraction (LVEF) group.Methods and ResultsWhile waiting for their appointment, 948 patients on return visits to an ambulatory HF clinic completed a written questionnaire assessing specific activity limitations, which were compared to physician‐assigned NYHA class during the same visit. Patient‐reported limitation to perform daily activity ranged from 25% for bathing to 61% for yardwork or housework and 71% for jogging or hurrying. Most patients who did not report limitations to perform daily life activities were correctly classified as NYHA I by the physicians (76%), but 12% of the 376 patients classified as NYHA I reported limitations to showering or bathing and 73% reported limitations while doing yardwork or house work. Limitation to walking was reported by 172 patients (50%) classified as class II. Limitations to walking one block were most common in patients with LVEF ≥40% compared to patients with LVEF <40%, and least commonly, in HF with better EF (improved from 31 ± 13 to 52 ± 7).ConclusionsActivity limitations are commonly reported by ambulatory HF patients, but underestimated by physicians. It is not clear how this should guide therapy validated for NYHA class but focused activity questions may merit wider use to track limitations and improvement in ambulatory HF.

Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey

“…Much of the burden related to HFpEF can typically be attributed to a high prevalence of co‐morbidities, such as diabetes, obesity, hypertension, anaemia, chronic kidney disease (CKD), atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) ( Table 2 ). 1,9,23–29 Patients with HFpEF often have poor QoL, similar to patients with end‐stage renal disease, and have substantial limitations to their daily activities 22,30 . However, despite the established negative effect on QoL, variability exists in how these co‐morbidities can affect patient outcomes.…”

“… 1 , 9 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Patients with HFpEF often have poor QoL, similar to patients with end‐stage renal disease, and have substantial limitations to their daily activities. 22 , 30 However, despite the established negative effect on QoL, variability exists in how these co‐morbidities can affect patient outcomes. For example, data from a large registry study in the Middle East showed no difference in mortality or rehospitalization rates between patients with HFpEF with or without diabetes.…”

Índice Hemodinâmico Agudo Prediz Mortalidade Intra-Hospitalar de Pacientes com Insuficiência Cardíaca Aguda Descompensada

“…6 Apesar da praticidade, a avaliação da perfusão feita pelo médico não é suficientemente confiável 7 e depende da experiência do profissional, 8,9 posto que fornece informações subjetivas. 10 Logo, parâmetros prognósticos objetivos que podem ser facilmente obtidos em um atendimento de emergência seriam úteis no manejo da IC aguda.…”