The Reliability and Validity of Consistently Assess Signs and Symptoms of Heart Failure (CLASS-HF) Guide.
Marilyn A Prasun, Kelly D Stamp, Thomas P McCoy and 1 others
PMID 41693041WHAT IT FOUND
Providers using CLASS-HF Guide agreed moderately when assigning NYHA heart failure class.
Higher assigned classes matched shorter six-minute walks and more breathlessness or exertion. Classes II and III were hardest to agree on.
Key findings
01Provider agreement using the CLASS-HF Guide was moderate (kappa = 0.462), with the least agreement for classes II and III.
02Higher assigned NYHA classes matched shorter six-minute walk distances: class I averaged 367.1 m and class IV averaged 184.6 m.
03The association between assigned class and walk distance remained after controlling for age, sex, race/ethnicity, BMI, diagnosis, site, comorbidities, Borg scores, and stopping or pausing.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The patients were a convenience sample from three cardiology clinics, so the results may not apply to other heart failure populations. The sample was mostly male and non-Hispanic White. Only patients who could walk without assistance were enrolled, so the guide was not tested in patients needing walking aids or with more severe mobility problems. Only 4 patients were class IV, and class III was intentionally over-enrolled. Reliability was checked on only 30 clinic notes reviewed by 3 nurse practitioners and 1 physician. Overall agreement was moderate, and classes II and III were hardest to agree on. The study was funded by Abbott, although the authors declared no conflicts of interest.
Declared interests
Investigator-initiated and funded by Abbott Laboratories; authors reported no conflicts of interest.
The easy way to misread this
Do not read the CLASS-HF Guide as a definitive way to assign NYHA class. Agreement was only moderate, and classes II and III were hardest to agree on. The validity findings show association with walk distance and symptom scores, not perfect classification.