Self-assessed symptom severity using the Specific Activity Scale independently predicted 3-year mortality in heart failure patients with severe left ventricular dysfunction (HR 1.48; 95% CI 1.03-2.12; p=0.03).
Cohort (n=332)
Does patient self-assessment of symptoms predict long-term survival in chronic heart failure compared to physician assessment and ejection fraction?
Patient self-assessed symptoms using the Specific Activity Scale independently predict 3-year mortality in heart failure with severe LV dysfunction, highlighting the prognostic value of patient-reported outcomes over ejection fraction.
Effect estimate: HR 1.48 (95% CI 1.03-2.12)
p-value: p=0.03
Abstract Aim To compare the patients' self-assessment of the severity of their symptoms with a physicians assessment and to evaluate the ability of self-assessed symptoms and ejection fraction (EF) to predict long-term survival in heart failure patients. Method Patients (n=332) evaluated symptoms using a self-administered functional classification scale (Specific Activity Scale, SAS), which is equivalent to the NYHA scale. EF and NYHA functional class was also recorded. All patients were followed over a 3-year period. Results Approximately 50% of patients classified themselves into SAS class I. In contrast, the cardiologists classified only 9% of the patients as NYHA class I. In patients with severe left ventricular dysfunction (EF≤0.35) SAS score (HR 1.48, 95% CI 1.03−2.12 p=0.03) and ACE inhibitor treatment (0.23 0.11−.51, p=0.0003) independently predicted 3-year mortality in a multivariable analysis. EF was not predictive of mortality in the low EF group. Only age predicted long-term outcome in patients with preserved systolic function. Conclusion Patients' self-assessed symptoms and NYHA classification are not coherent. Left ventricular EF is of less importance in comparison with symptoms in chronic heart failure. Patients reporting less severe symptoms had a favourable 3-year prognosis, regardless of EF.
Ekman et al. (Fri,) conducted a cohort in Chronic Heart Failure (n=332). Self-assessed symptoms (Specific Activity Scale) vs. Physician assessment (NYHA) and Ejection Fraction was evaluated on 3-year mortality (HR 1.48, 95% CI 1.03-2.12, p=0.03). Self-assessed symptom severity using the Specific Activity Scale independently predicted 3-year mortality in heart failure patients with severe left ventricular dysfunction (HR 1.48; 95% CI 1.03-2.12; p=0.03).