2013年美国心力衰竭管理指南(心衰指南)-英文

classification gauges the severity of symptoms in those with structural heart disease, primarily stages C and D. It is a subjective assessment by a clinician and can change frequently over short periods of time. Although reproducibility and validity may be problematic (48), the NYHA functional classification is an independent predictor of mortality (49). It is widely used in clinical practice and research and for determining the eligibility of patients for certain healthcare services.

Table 4. Comparison of ACCF/AHA Stages of HF and NYHA Functional Classifications

A

B

ACCF/AHA Stages of HF (38) At high risk for HF but without structural heart disease or symptoms of HF Structural heart disease but without signs or symptoms of HF current symptoms of HF None I II

III

IV

D Refractory HF requiring specialized

interventions NYHA Functional Classification (46) No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF. physical activity does not cause symptoms of HF. Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF. Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of HF. Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest.

ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; HF, heart failure; and NYHA, New York Heart Association.

See Online Data Supplement 2 for additional data on ACCF/AHA stages of HF and NYHA functional classifications.

4. Epidemiology

The lifetime risk of developing HF is 20% for Americans ≥40 years of age (50). In the United States, HF incidence has largely remained stable over the past several decades, with >650,000 new HF cases diagnosed annually (51-53). HF incidence increases with age, rising from approximately 20 per 1,000 individuals 65 to 69 in the United States have clinically manifest HF, and the prevalence continues to rise (51). In the Medicare-eligible population, HF prevalence increased from 90 to 121 per 1,000 beneficiaries from 1994 to 2003 (52). HFrEF and HFpEF each make up about half of the overall HF burden (54). One in 5 Americans will be >65 years of age by 2050 (55). Because HF prevalence is highest in this group, the number of Americans with HF is expected to significantly worsen in the future. Disparities in the epidemiology of HF have been identified. Blacks have the highest risk for HF (56). In the ARIC (Atherosclerosis Risk in Communities) study, incidence rate per 1,000 person-years was lowest among white women (52, 53) and highest among black men (57), with