A Secondary Analysis of the PARADIGM-HF Trial Luis E. Rohde, MD, ScD1,2; André Zimerman, MD, PhD1,2; Muthiah Vaduganathan, MD, MPH3; Brian L. Claggett, PhD3; Milton Packer, MD4; Akshay S. Desai, MD3; Michael Zile, MD5; Jean Rouleau, MD6; Karl Swedberg, MD7; Martin Lefkowitz, MD8; Victor Shi, MD8; John J. V. McMurray, MD9; Scott D. Solomon, MD3 Article Information JAMA Cardiol. 2023;8(2):150-158. doi:10.1001/jamacardio.2022.4427 Key Points Question In patients with mild heart failure with reduced ejection fraction, how does NYHA classification vary over time and how does it relate to long-term prognosis? Findings In this secondary analysis of the parallel-design double-blind trial PARADIGM-HF, the NYHA classification for 8326 patients dynamically changed over time. Association between NYHA class and cardiovascular outcomes was ambiguous: while higher NYHA classification was associated with worse prognosis, NYHA class I patients with high natriuretic peptides presented higher event rates than patients with low natriuretic peptides from any NYHA class.