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−.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.