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Initial evaluation of the pulmonary hypertension functional classification self-report (PH-FC-SR) measurement properties
A patient-focused measure
Crawford, R., McLeod, L., Yarr, S., Morrison, R., Wu, B., Nelsen, A. C., Classi, P., DuBrock, H., Mathai, S. C., & Highland, K. B. (2025). Initial evaluation of the pulmonary hypertension functional classification self-report (PH-FC-SR) measurement properties: A patient-focused measure. Chest. Advance online publication. https://doi.org/10.1016/j.chest.2025.11.024
BACKGROUND: 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 recently developed to assess PH functional class from the patient perspective.
RESEARCH QUESTION: Is the PH-FC-SR a suitable measure for capturing the patient perspective on PH functional class?
STUDY DESIGN AND METHODS: 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.
RESULTS: The study sample included 89 patients (mean age 61.5 years) who were mostly female (66.3%) and White (87.6%) predominantly with pulmonary arterial hypertension (55.1%). Distribution of PH-FC-SR/WHO-FC scores indicated diversity in symptom severity. Nearly half of the PH-FC-SR and WHO-FC classifications matched, with concordance observed for Class I (n = 11; 68.8%), II (n = 14; 36.8%), and 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.
INTERPRETATION: The patient-reported PH-FC-SR is more strongly associated with PH symptoms and health-related quality of life than the physician-assigned WHO-FC.
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