Initial Evaluation of Pulmonary Hypertension Functional Classification Self-Report Measurement Properties: A Patient-Focused Measure.

Abstract

Pulmonary hypertension (PH) is characterized by a high mean pulmonary artery pressure and an impaired health-related quality of life. The Pulmonary Hypertension Functional Class Self-Report (PH-FC-SR), a patient-reported version of the World Health Organization Functional Classification (WHO-FC), was developed to assess PH functional class from the patient perspective. Is the PH-FC-SR a suitable measure for capturing the patient perspective on PH functional class? Adults with PH (World Symposium on Pulmonary Hypertension [WSPH] groups 1-5) recruited from the Cleveland Clinic and Mayo Clinic completed an online survey capturing demographic information, the PH-FC-SR, study-specific PH symptom questions, and additional patient-reported outcome measures (the EmPHasis-10, and the SF-36 Health Survey Version 2 [SF-36v2]). Clinician-reported WHO-FC data were collected via a telehealth/in-person clinical visit. Concordance of the PH-FC-SR with the WHO-FC was investigated in addition to construct validity. The study sample included 89 patients (mean age, 61.5 years) who were mostly female (66.3%) and White (87.6%) and predominantly with pulmonary arterial hypertension (55.1%). Distribution of PH-FC-SR/WHO-FC scores indicated diversity in symptom severity. Nearly one-half of the PH-FC-SR and WHO-FC classifications matched, with concordance observed for class I (n = 11; 68.8%), class II (n = 14; 36.8%), and class III (n = 18; 56.3%). Correlations between the PH-FC-SR and most study-specific PH symptom items were moderate in magnitude (|r| ≥ 0.30 to < 0.70) and strong between the PH-FC-SR and EmPHasis-10 (|r| = 0.81) and some SF-36v2 subscales (Physical Functioning [|r| = 0.76], Role-physical [|r| = 0.75], and Physical Component Summary [|r| = 0.73]). The PH-FC-SR had larger correlations than the WHO-FC for all patient-reported outcome measures. The patient-reported PH-FC-SR was shown to be more strongly associated with PH symptoms and health-related quality of life than the physician-assigned WHO-FC.