ABC Heart Fail Cardiomyop 2024; 4(4): 20240036

Comparative Analysis between the NYHA and CCS Classification and Performance in the 6-Minute Walk Test

Luiz Carlos Santana Passos , Roberval Prado dos Santos Junior , Laís Fernanda Duarte Sampaio , Clara Sales Figueiredo, Caio Rebouças Fonseca Cafezeiro

DOI: 10.36660/abchf.20240036i

Abstract

Background

Functional classification is a critical predictor to establish a prognosis for heart failure (HF) and Coronary Artery Disease (CAD). However, recent research has questioned the reproducibility of the New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) classifications, and their ability to discriminate patient prognosis at an individual level.

Objective

To investigate the discordance rate between the NYHA/CCS class assigned by the physician during outpatient consultation and the 6-minute walk test (6MWT) performance to refine the assessment of patients with HF/CAD.

Methods

A retrospective cohort study collected data from medical records of patients referred for cardiovascular rehabilitation. The 6MWT was performed with the aim of evaluating the functional capacity and associated symptoms of patients with HF and CAD. The correlation between variables was assessed using the correlation coefficient and agreement was assessed using the kappa coefficient.

Results

A total of 65 patients were selected, with 50.8% male, and a mean age of 57.3 ± 11 years. The median left ventricular ejection fraction was 45%, with 13.8% of patients presenting ischemic cardiomyopathy. Discordance in functional class was observed in 54% of HF patients by NYHA and 55% of angina patients by CCS.

Conclusion

The present study identified discordance between the functional class assigned by the attending physician and that determined by the 6MWT, indicating that NYHA/CCS functional classification and 6MWT provide complementary information that is more accurate when used in concomitance.