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July 8, 2026Netherlands Heart JournalOpen Access

Clinician-assessed NYHA and EHRA scores correlate only moderately with patient-reported HRQoL in HF and AF.

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Why the study?

Do clinician-assessed NYHA and EHRA symptom classifications accurately reflect patient-reported quality of life in heart failure and atrial fibrillation?

Population

1,019 newly diagnosed patients with Heart Failure (n=254) and Atrial Fibrillation (n=765)

Design

Cohort

Follow-up

12 months

Key result

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

Authors

JPJeroen A. A. van de PolFHFrederique J. HafkampPVP H van der Voort

Discussion

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Overview

Symptom discordance may exist between clinicians and new HF/AF patients; leaves open whether routine HRQoL integration improves care or trial design.

Key Points

  • This study assesses the relationship between clinician-assessed symptom severity and patient-reported health-related quality of life (HRQoL) in heart failure (HF) and atrial fibrillation (AF).
  • Newly diagnosed HF and AF patients were prospectively included and assessed for symptoms and HRQoL at diagnosis and after 12 months.
  • Symptom severity was measured using NYHA classification for HF and EHRA score for AF, while HRQoL was assessed using CaReQol-CHF and AFEQT instruments.
  • Moderate correlations were found between NYHA classification and CaReQol-CHF (Spearman’s ρ: 0.202 to 0.426) and between EHRA score and AFEQT (Spearman’s ρ: −0.363 to −0.305).
  • Improvement in clinician-assessed symptoms correlated with patient-reported improvement in HRQoL (HF physical: F(251.2) = 11.19, p < 0.001; AF: F(762.2) = 25.86, p < 0.001).
  • No significant HRQoL changes were reported by patients when clinicians noted unchanged or worsening symptoms.

Study Design

Type

Observational (n=1,019)

Structured PICO

Do clinician-assessed NYHA and EHRA symptom classifications accurately reflect patient-reported quality of life in heart failure and atrial fibrillation?

P
Population
1,019 newly diagnosed patients with heart failure (n=254) or atrial fibrillation (n=765) followed for 12 months.
E
Exposure
Clinician-assessed symptom severity using NYHA classification for HF and EHRA score for AF
O
Outcome
Relationship between patient-perceived health-related quality of life (HRQoL) and clinician-assessed symptom severity at diagnosis and 12 monthspatient reported

Main Result

Effect estimate: Spearman's ρ: 0.202 to 0.426 (HF) and -0.363 to -0.305 (AF)

Clinician-assessed NYHA and EHRA classifications correlate only moderately with patient-reported quality of life, highlighting the potential value of incorporating patient-reported outcomes into routine care to better capture disease burden.

Cite This Study

Pol et al. (2026) conducted an observational in Heart Failure and Atrial Fibrillation (n=1,019). Clinician-assessed symptom severity (NYHA and EHRA classifications) was evaluated on Correlation between clinician-assessed symptom severity and patient-reported health-related quality of life (HRQoL) (Spearman's ρ: 0.202 to 0.426 (HF) and -0.363 to -0.305 (AF)). Clinician-assessed NYHA and EHRA symptom classifications correlated only moderately with patient-reported quality of life in heart failure and atrial fibrillation.

synapsesocial.com/papers/6a4de804d2ea289ef6282d85https://doi.org/10.1007/s12471-026-02051-9
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