Self-assessed symptoms in chronic heart failure -: Important information for clinical management

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 [0.11-0.51], 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. (c) 2006 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.