Clinician-assessed NYHA and EHRA symptom classifications only moderately reflect patient-reported quality of life in heart failure and atrial fibrillation

Background
Clinician-assessed symptoms are expected to agree with patient-perceived symptoms. However, patients may value the impact of symptoms on their health-related quality of life (HRQoL) differently from clinicians. This study aimed to evaluate the relationship between patient-perceived HRQoL and clinician-assessed symptom severity in patients with Heart Failure (HF) and Atrial Fibrillation (AF).

Methods
Newly diagnosed HF and AF patients were prospectively included. Information on symptoms and HRQoL was collected at diagnosis and after 12 months during routine HF- and AF-outpatient clinic visits. Symptom severity was assessed by clinicians using the NYHA classification for HF and EHRA score for AF. HRQoL was assessed using the CaReQol- CHF (HF) and AFEQT (AF).

Results
Complete baseline and 12-month follow-up information was available for 254 HF patients and 765 AF patients. Moderate correlations were observed between NYHA classification and CaReQoL-CHF at diagnosis and follow-up (Spearman’s ρ : HF social : 0.202 and 0.426, HF physical : 0.317 and 0.421, respectively), and between EHRA score and AFEQT (Spearman’s ρ : –0.363 and –0.305). Clinician-assessed improvement in HF or AF symptoms from diagnosis to 12 months was associated with patient-reported improvement in HRQoL (HF social : F(250.2) = 3.11, p < 0.046; HF physical : F(251.2) = 11.19, p < 0.001; and AF: F(762.2) = 25.86, p < 0.001). When clinicians reported unchanged or worsening symptoms, no significant HRQoL changes were reported by patients.

Conclusion
Clinician-assessed symptoms correlate moderately with patient-reported HRQoL, with large inter-individual variation in HRQoL. NYHA and EHRA classifications may not accurately reflect patient-perceived burden of disease over time. Incorporating patient-reported outcomes into routine care may better guide treatment, improve the identification of patients’ needs, and support informed clinical and shared decision-making.