Trajectories in New York Heart Association functional class in heart failure across the ejection fraction spectrum: data from the Swedish Heart Failure Registry

Figure 1. Changes in New York Heart Association (NYHA) class in the full cohort (A), stratified by ejection fraction (EF) (B) and by inpatient/outpatient status (C), and to and from each NYHA class (D).

Figure 2. Predictors of New York Heart Association (NYHA) class improvement. *p < 0.05; **p < 0.01; ***p < 0.001. Multivariable multinomial model included the variables labelled with a dagger (†) in Table 1 , the time between NYHA class assessments, and NYHA class at baseline as covariates. The full model, including non‐significant predictors, is shown in online supplementary Table S5 . ARNi, angiotensin receptor–neprilysin inhibitor; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CRT, cardiac resynchronization therapy; eGFR, estimated glomerular filtration rate (calculated by the Chronic Kidney Disease Epidemiology Collaboration formula); HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; ICD, implantable cardioverter‐defibrillator; MRA, mineralocorticoid receptor antagonist; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; NYHA, New York Heart Association; OR, odds ratio; RASi, renin–angiotensin system inhibitor.

Figure 3. Predictors of New York Heart Association (NYHA) class worsening. *p < 0.05; **p < 0.01; ***p < 0.001. Multivariable multinomial model included the variables labelled with a dagger (†) in Table 1 , the time between NYHA class assessments, and NYHA class at baseline as covariates. The full model, including non‐significant predictors, is shown in online supplementary Table S6 . ARNi, angiotensin receptor–neprilysin inhibitor; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CRT, cardiac resynchronization therapy; eGFR, estimated glomerular filtration rate (calculated by the Chronic Kidney Disease Epidemiology Collaboration formula); HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; ICD, implantable cardioverter‐defibrillator; MRA, mineralocorticoid receptor antagonist; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; NYHA, New York Heart Association; OR, odds ratio; RASi, renin–angiotensin system inhibitor.

Figure 4. Kaplan–Meier curves for (A) all‐cause mortality, (B) cardiovascular mortality, and (C) first heart failure (HF) hospitalization by New York Heart Association (NYHA) class change trajectory. CI, confidence interval; HR, hazard ratio.

Figure 5. Association between New York Heart Association (NYHA) class change and outcomes. *p < 0.05; **p < 0.01; ***p < 0.001. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association between longitudinal change in NYHA class and outcomes were calculated by multivariable Cox regression. Baseline model: adjusted for variables labelled with a dagger (†) in Table 1 , the time between the NYHA class assessments, and NYHA class at baseline. Follow‐up model: adjusted for variables labelled with a dagger (†) in Table 1 , the time between the NYHA class assessments, and NYHA class at follow‐up. Stratified model: low = NYHA class I–II; high = NYHA class III–IV; adjusted for variables labelled with a dagger (†) in Table 1 , the time between the NYHA class assessments, and NYHA class at follow‐up. CV, cardiovascular; HFH, heart failure hospitalization.