Specific Activity Scale Improves The Detection Of Symptomatic Heart Failure Patients As Compared To Nyha Classification

Background Accurate assessment of the physical capacity limitation is a pivotal issue during evaluation of chronic heart failure patients, as symptomatic patients are candidates to medical therapy optimization and devices implantation. Purpose We tested the hypothesis that use of Specific Activity Scale (SAS) is more accurate in identifying patients with mild functional class (FC) limitation as compared to the classical NYHA FC assessment approach. Methods We prospectively investigated 101 adult patients with chronic heart failure with reduced ejection fraction followed in an outpatient clinic of a tertiary hospital [age = 56.0±12.3 y; 59% males; LVEF = 29.2 ± 9.2%; with different etiologies: dilated cardiomyopathy (30%), ischemic (28%), hypertension (20%) and Chagas disease (10%)]. Patients underwent FC evaluation by using the NYHA classification and the SAS approach, and to cardio-pulmonar exercise test (CPET), with measurement of peak-VO2. Different experienced investigators separately performed each test and were blinded regarding the results of other evaluations. We calculated the Net Reclassification index comparing the SAS and NYHA, taking as gold-standard the result of the peak-VO2 in the CPET. Results Table 1 summarizes the results. We observed a higher proportion of FC I detection by using NYHA method, as compared to the other approaches. According to the results of the NYHA, 24 patients (24%) were deemed as FC I. The use of SAS in this same group patient group detected a significantly smaller proportion of FC I patients [n = 6 (6%), McNemar test, p = 0,00002]. Among the 18 patients reclassified as non-FC I, by using of SAS, most of them (N=16; 89%) were in accordance with the CPT results. Conclusions In an outpatient cohort of chronic HF patients, FC assessment by NYHA overestimates the proportion of asymptomatic FC I patients, as compared to the results of the CPET. The use of SAS approach may correctly reclassify most of those patients, providing more accurate identification of symptomatic patients that are candidates to medical therapy optimization and/or device implantation. Accurate assessment of the physical capacity limitation is a pivotal issue during evaluation of chronic heart failure patients, as symptomatic patients are candidates to medical therapy optimization and devices implantation. We tested the hypothesis that use of Specific Activity Scale (SAS) is more accurate in identifying patients with mild functional class (FC) limitation as compared to the classical NYHA FC assessment approach. We prospectively investigated 101 adult patients with chronic heart failure with reduced ejection fraction followed in an outpatient clinic of a tertiary hospital [age = 56.0±12.3 y; 59% males; LVEF = 29.2 ± 9.2%; with different etiologies: dilated cardiomyopathy (30%), ischemic (28%), hypertension (20%) and Chagas disease (10%)]. Patients underwent FC evaluation by using the NYHA classification and the SAS approach, and to cardio-pulmonar exercise test (CPET), with measurement of peak-VO2. Different experienced investigators separately performed each test and were blinded regarding the results of other evaluations. We calculated the Net Reclassification index comparing the SAS and NYHA, taking as gold-standard the result of the peak-VO2 in the CPET. Table 1 summarizes the results. We observed a higher proportion of FC I detection by using NYHA method, as compared to the other approaches. According to the results of the NYHA, 24 patients (24%) were deemed as FC I. The use of SAS in this same group patient group detected a significantly smaller proportion of FC I patients [n = 6 (6%), McNemar test, p = 0,00002]. Among the 18 patients reclassified as non-FC I, by using of SAS, most of them (N=16; 89%) were in accordance with the CPT results. In an outpatient cohort of chronic HF patients, FC assessment by NYHA overestimates the proportion of asymptomatic FC I patients, as compared to the results of the CPET. The use of SAS approach may correctly reclassify most of those patients, providing more accurate identification of symptomatic patients that are candidates to medical therapy optimization and/or device implantation.