After excluding the patients who died within 90 days of
diagnosis (likely to contain many with NYHA class IV disease)
the mortality rates fell to 65% for men and 47% for women. The
authors of this study^4 emphasise the grim prognosis of this
disease by making comparison to the mortality rate for all cancers,
which, between 1979 and 1984 was reported as 50%.
The overall prognosis for a patient diagnosed with heart failure
is therefore really rather wretched. The application of the NYHA
functional score provides a simple but meaningful way of
stratifying such patients to help formulate management priorities.
Many objective prognostic variables with equal or greater weight
in predicting heart failure mortality have been elucidated,^5
however, and account of these should be acknowledged.
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I Patients with cardiac disease, but without resulting
limitation of physical activity. Ordinary physical activity
does not cause undue fatigue, palpitation, dyspnea, or
anginal pain.
II Patients with cardiac disease resulting in slight
limitation of physical activity. They are comfortable at
rest. Ordinary physical activity results in fatigue,
palpitation, dyspnea, or anginal pain.
III Patients with marked limitation of physical activity.
They are comfortable at rest. Less than ordinary activity
causes fatigue, palpitation, dyspnea, or anginal pain.
IV Patients with cardiac disease resulting in inability to
carry on any physical activity without discomfort.
Symptoms of heart failure or of the anginal syndrome
may be present even at rest. If any physical activity is
undertaken, discomfort is increased.RReeffeerreenncceess
1 The Criteria Committee of the New York Heart Association. Criteria for
diagnosis and treatment of heart disease, 9th edition, Little, Brown and
Company, 1994.
2 Keogh AM, Baron DW, Hickie JB. Prognostic guides in patients with
idiopathic or ischemic dilated cardiomyopathy assessed for cardiac
transplantation. Am J Cardiol1990; 6655 : 903–8.