39 Does NYHA class predict health-related quality of life?

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Improving quality of life (QoL) in heart failure patients is a key objective of management. Assessment of health-related QoL is recommended, however, there is a lack of clarity on the best method. Despite the use of validated health-related QoL assessments in clinical trials, their use in routine practice is yet to be widely adopted. Conversely, functional assessment using New York Heart Association (NYHA) classification is standard procedure in the monitoring of heart failure patients.


152 patients attending two heart failure clinics at the Royal Brompton Hospital, between May 2015 and May 2017 were invited to complete three QoL assessments, comprising of the Minnesota Living with Heart Failure questionnaire (MLHFQ), the EuroQoL 5D-3L (EQ5D-3L) and the Kansas City Cardiomyopathy questionnaire (KCCQ). Data on the patient demographics, co-morbidities, NYHA class, BNP (Brain natriuretic peptide) level, renal function and cardiac function were recorded.


94% of patients were willing to participate. The EQ 5D-3L questionnaire had all questions answered by 92%, compared to 86% for the MLHFQ and 49% for the KCCQ. 32% of patients requested assistance in completing the questionnaires. NYHA class was the only variable to significantly correlate with each of the QoL assessment tools (MLHFQ r=0.588, p=0.01; KCCQ r=−0.613, p=0.01; EQ5D-3L r=−0.436, p=0.01). However, there was a wide spread of QoL outcome scores for each NYHA class (figures 1 and 2).


Although NYHA class correlated significantly with QoL scores, in each class there was high variability in the QoL scores between individual patients. NYHA classification is a focused functional assessment made from the perspective of the clinician as opposed to the patient, limiting its usefulness. Therefore, the incorporation of validated methods to assess health-related QoL into clinical practice is required. Based on completion rates, ease of scoring and the disease-specific design, the MLHFQ was the preferred choice.

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