Functional Class 1

[Rainey]

Hey, when I did go to the Clinic, I remember now that he called me "Functional Class 1." I assume that this is like getting an "A" in a project in school - am I correct? I think that I'm doing really well with this condition so I can't imagine that it's bad but just wanted some feedback. I also didn't ask for a prognosis for me assuming that he couldn't tell me a thing.

[Bucky]

I think it has to do with the degree of CHF at the time.......I think there are four classes and as I recall Class I is good.

I am in and out of Class III and even IV on occasion if I am reading it right. I think it is based on some New York something or other rating. I know someone here can respond with more knowledge.

bucky

[gfox42]

Bucky got it right: you got an A in heart failure. The teacher gave you a gold star.


http://en.wikipedia.org/wiki/New_York_Heart_Association_Functional_Classificati on
is a link to the definition of classes; this is more or less what I remember seeing before, though I don't recommend Wikipedia as a source on a lot of things.

I think there are other schemes for classification out there too; Pam probably knows them.

Gordon

[Bucky]

Hi Gordon:

Yea, I read the list...I am II to III depending on the day and what's going on. Don't know if I'll ever see I again, but it would be nice.

bucky

[Rainey]

Does that mean that I shouldn't expect to be at a Class I for long??? Does this always progress? I'm scared because it seems like everyone is so much worse off than I am - I feel like I'm just going to eventually move up in the line I never wanted to be in .....

[Bucky]

I THINK that is does not necessarily mean you will progress. If you had heart failure from say a damaged heart muscle from a heart attack, you might progress. It is my understanding that with HCM you may not progress at all , or if you do you won't necessarily end up in stage IV..

I'll let Leon or Pam or someone in the know give you the best answer.

bucky

[Reenie]

As long as you continue to get proper care you may not progress to other degrees of heart failure. That's the importance of early detection and treatment. The key is keeping on top of things and making sure you take your medicine and follow doctors' orders. Some people will have progression regardless of their regimen, but I think so much can be avoided if you take good care of yourself.

[gfox42]

Just to add a comment to Reenie's . . . I'd be surprised if those contributing to this board were a representative sample of those with HCM. There's probably over-representation of those with more serious symptoms.

I know that after I was diagnosed, I read some things, but then I realized that my symptoms weren't very bad and I was handling the medications well, so I really stopped reading (and worrying) about HCM for a number of years. I didn't run across this board until I took a sudden turn for the worse and needed to think about a myectomy.

That said, I suspect there are quite a few people on this board who, like you, have a relatively low degree of heart failure. I'd say that for me, class I is a bit of an overstatement -- I've had no shortness of breath at all since my myectomy.

Gordon

[Pam Alexson]

Also.. those classes will vary back and forth over the years. I have clearly been in IV ( before myectomy ), and now mostly in II and III depending on how well my CHF is behaving / responding to treatment and how well my heart feels rested and not overtaxed. This speaks to the fact that CHF is a manageable disease and not a death sentence.

I think you will see that many respond to treatment very well, keeping them from progressing and as Reenie has stated some will progress irregardless. There are specific gene patterns that seem to denote this probability of progression in some.

Another fact I have recently been looking at is women with HF often present with better numbers but more measurable deficiencies/symptoms, greater then men BUT (sorry guys) do better and have less morbitity and mortality as a result of their heart failure. Of course as it appears women get heart failure later then men do.

This area it seems, needs more investigation so that it can be fathomed as to why this is true. Maybe this accounts to the fact that there are more women with heart failure in their 70's and beyond and the men do not equal those numbers in survival with HF at those ages. Gender clearly separates the 2 as seen in the literature. There are definite differences in Diastolic Failure between the sexes as well.

Maybe we are better at BACKING off when we do not feel well and not pushing the heart that has degrees of HF. Future research will help and will be enlightening.

[Rainey]

Wow. All good information. Thanks. I would like to think that I will be one of those who never progresses and just has this pesky heart problem I can't get rid of. I am right now researching getting a treadmill so that I can commit to walking every day whether or not I can get to the gym (which is right next to our neighborhood but you know - it's just sometimes timing). I'm hoping that will help counteract any weight gain that I'll have now being on 3x the meds I was on a couple days ago. I must say, I have very little energy right now having a pulse only in the 40's. I hope that improves some and levels off. Hoping I can get the house cleaned!

[Pam Alexson]

This article is specific to gender and HCM differences.( not specific to heart failure differences between genders) Now here is eye opening parting of the waters!

http://content.onlinejacc.org/cgi/reprint/46/3/480.pdf

[Srmartinson]

Pam, Thank you for sharing the article you posted. After reading it, I had a few questions to ask:
1. "women showed greater likelihood of marked symptom progression or death due to heart failure or stroke, often associated with LV outflow obstruction." If a HCM patient does not have obstruction, would this be a better longer term prognostic indicator?
2. "risk for heart failure-related clinical deterioration and death was greater among those female patients age 50 years or older (average age, 65 years), as compared with those 50 years, or with male patients, suggesting that postmenopausal endocrine changes may impact clinical
course in HCM, as previously shown in coronary artery disease (41). However, we observed no differences in management strategies between the genders after the diagnosis of HCM with regard to pharmacologic or invasive treatments" I wonder how many of our HCM women population have requested treatment changes after age 50. I have never heard about possible postmenopausal endocrine changes impacting the course of HCM but this would definately make sense pragmatically. Is there any additional research currently going on in this area???

Thank you again for sharing your knowledge with all of us.

[Rainey]

I must be in a bad place because after I read that article I slipped into a deep depression. I read that to mean that basically, this is the best I'm ever going to be and I shouldn't expect it to last long.

[Pam Alexson]

Oh Rainey ..I am sorry this effected you this way.. I should add a disclaimer that this information could cause anxiety and sadness and may not be suitable for all to read.

We must always be careful not to personalize the info too directly .. remember all cases are different and we can not generalize how we may be effected by the results of a study with which we were not a part . We can only hypothesize . Read carefully the section on Discussion.

Emphasis is on early treatment and intervention for all especially women who often get delayed treatment for the reasons pointed out here in this research paper.

To answer those questions I do not know if we can draw thorough and complete conclusions except the facts are interesting to say the least. Differences in all HCM patients makes it impossible to apply directly this information to each and every HCM women in this category.
My feelings have always been, and it does seem acceptable in the research that if someone has an obstruction or an entity to their HCM that should be corrected or can be corrected by medication or mechanical or surgical intervention that it should be sooner then later. This also relates to those who are diagnosed and have minimal to no symptoms. There is a point that treatment should start to help prevent negative outcomes from developing. Obstructions clearly impact the HCM heart very negatively and therefore may drastically and negatively effect outcomes...LONG TERM; irregardless of an intervention. There is the individual unique expression of the disease that can lead to negative progression. This study speaks to this in this population of women studied. SOOO ..if you need a myectomy women and you have been symptomatic ..you need to get IT DONE.

Wouldn't you rather say later down the road if you do negatively progress that you did do all you could to try and stop it? Isn't this the one thing we all harp on when someone assumes we have CVD and we were responsible for our heart disease related to diet and life style. When we educate people about the differences in HCM and CVD we also have to realize that there is some control we can have w/ regards to HCM. WE CAN get a specialists opinion and follow it expediently and stop delaying and stop making excuses. IF you are diagnosed you need the BEST TREATMENT AVAILABLE.

"These gender-specific differences suggest that social, endocrine, or
genetic factors may affect the diagnosis and clinical course of HCM. A heightened suspicion
for HCM in women may allow for timely implementation of treatment strategies, including
relief of obstruction and prevention of sudden death or stroke. (J Am Coll Cardiol 2005;46:
480 –7) © 2005 by the American College of Cardiology Foundation"


Certainly someone at the conference could ask one of the specialists( The Marons..who were 2 of the contributors of the study) more specifics regarding this study,and any more research being conducted in this area.

Pam

[gfox42]

Rainey, as I said in another discussion about this study, what we don't know from this study is the extent to which the gender differences are explained by innate biological differences or to social factors. For example, are women typically diagnosed with HCM at greater age because they become symptomatic at greater age, or because they go to the doctor less often or complain less?

Statistics can be hard to interpret; I know this especially because a lot of what I do for a living is statistical analysis. The key thing to remember is that these statistics are mainly dealing with what happens on average -- the mean. While this is obviously useful to know about, it can actually be deceptive in some cases. You're not an "average" woman (you knew that already), you're yourself -- you have characteristics that may well distinguish you from the average.

A simple example is this: we all know that smoking is bad for you. And most of us know people who've come to grief from smoking. But we've probably also run across people who smoke for decades and seem to be fine. There are two possible explanations:
1. It could just be random chance -- they took risks and got away
with it.
2. They might have genes that make lung cancer or emphysema, etc.,
less likely for them.
If the 2nd explanation is true, then it's still true that on average smoking is bad, but it's also true that they, and people like them, can do it with much less risk than the rest of us. Why they'd want to, I dunno.

The point is that we are a heterogeneous group, and I mean that in both the ordinary sense and in a technical sense that any statistician will understand. I certainly can't tell you that only good things lie ahead, but I think it's wrong to conclude that disaster and decline are ahead, and especially for women.

What the study points to is the need to understand why there are these gender differences.

Hope this helps.

Gordon

[EmilysDad]

Another way to look at these prognostic studies is that if you over about 30 you are the best you are going to be and face a long downhill slide, with or without HCM. If you have HCM it's likely that the disease will progress, but the rate of that progression is not known. You may have many other diseases that could progress faster, so your future is still as unknown as anybody else. I have osteoarthritis and I know that it will progress to the point that if I live long enough I'll be in a wheel chair. Rather than dwell on the inevitability of aging I try to have a good life now, and at least I have memories of running a sub-40 minute 10K.

[Rainey]

I'm 41 (as of last Monday) and I thought that I would level out and stay there until I was about 60, frankly. Before I was diagnosed with this 6 months ago I had never considered for a minute that I was going downhill since hitting 30 - I always just assumed that I was getting better and smarter! I've always been a very optimistic, high-energy person so this has just hit me sort of hard. I can't settle for the going downhill fast thing. This has put a crimp in my plans, no doubt, and I am in a depressed state right now but I totally plan to snap out of it - and soon!

[gfox42]

When I was 27 I sprained my ankle. Went to the doctor after a while and complained that it wasn't healing fast enough. He examined me and then said, more or less, "What do you expect at your age{/I]?" That was the first time anyone said anything like that to me, and I didn't much like it.

EmilysDad is more or less right. We all acquire various problems over time. Some of them go away (like colds), some turn out not to be as important as we thought, and some turn out to be big deals. If you look at things like charts that tell people their optimal heart rate for exercise, they decline continuously from some age. Yes, there are sudden drops in our performance, but those are usually due to injuries or onset of serious problems (like HCM), not turning 60.

I don't like it any better than you do. But that's how it is. The key thing, it seems to me, is to have some understanding of that so we don't get too depressed about declines in functioning, and to treat the things we can treat so that we make those declines as slow as we can. You're doing the right things -- coming to grips with HCM, getting exercise, etc.

The one compensation is that you probably [I]are smarter, and certainly wiser, than at 30. Most people would be pretty insufferable if that weren't true! But in general, we ( Homo sapiens,, that is) are slower, weaker, and the like, starting even before we're 30. That's why athletes --the ones who haven't already ended their careers because of injuries -- retire around then, if not sooner.

Gordon