CLINICAL STUDY: HEART FAILURE
Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure
Mark T. Kearney, DM*,*,
Keith A. A. Fox, FRCP ,
Amanda J. Lee, MSc ,
Robin J. Prescott, PhD,
Ajay M. Shah, FRCP*,
Philip D. Batin, DM||,
Wazir Baig, MD¶,
Stephen Lindsay, MD#,
Timothy S. Callahan, PhD**,
William E. Shell, MD,
Dwain L. Eckberg, MD,
Azfar G. Zaman, MD ,
Simon Williams, MRCP||||,
James M. M. Neilson, PhD and
James Nolan, MD¶¶
* King’s College, London, United Kingdom
Department of Cardiology, Edinburgh, United Kingdom
Medical Statistics Unit, Edinburgh, United Kingdom
Department of Medical Physics, University of Edinburgh, Edinburgh, United Kingdom
|| Pontefract and Wakefield Hospitals, Pontefract and Wakefield, United Kingdom
¶ Doncaster Royal Infirmary, Doncaster, United Kingdom
# Bradford Royal Infirmary, Bradford, United Kingdom
** Phase5 Sciences, Los Angeles, California, USA
NETT Foundation, Los Angeles, California, USA
Medical College of Virginia at Virginia Commonwealth University, Richmond, Virginia, USA
Freeman Hospital, Newcastle, United Kingdom
|||| Arrow Park Hospital, Liverpool, United Kingdom
¶¶ North Staffordshire Cardiac Centre, Stoke-on-Trent, United Kingdom
Manuscript received February 25, 2002;
revised manuscript received May 31, 2002,
accepted July 24, 2002.
* Reprint requests and correspondence: Dr. Mark T. Kearney, Department of Cardiology, GKT School of Medicine, Kings College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
mark.kearney{at}kcl.ac.uk
OBJECTIVES: The aim of this study was to explore the value of noninvasive predictors of death/mode of death in ambulant outpatients with chronic heart failure (HF).
BACKGROUND: Mortality in chronic HF remains high, with a significant number of patients dying of progressive disease. Identification of these patients is important.
METHODS: We recruited 553 ambulant outpatients age 63 ± 10 years with symptoms of chronic HF (New York Heart Association functional class, 2.3 ± 0.5) and objective evidence of left ventricular dysfunction (ejection fraction <45%, cardiothoracic ratio >0.55, or pulmonary edema on chest radiograph). After 2,365 patient-years of follow-up, 201 patients had died, with 76 events due to progressive HF.
RESULTS: Independent predictors of all-cause mortality assessed with the Cox proportional hazards model were as follows: a low standard deviation of all normal-to-normal RR intervals (SDNN); lower serum sodium and higher creatinine levels; higher cardiothoracic ratio; nonsustained ventricular tachycardia; higher left ventricular end-systolic diameter; left ventricular hypertrophy; and increasing age. Independent predictors of death specific to progressive HF were SDNN, serum sodium and creatinine levels. The hazard ratio of progressive HF death for a 10% decrease in SDNN was 1.06 (95% confidence interval [CI], 1.01 to 1.12); for a 2 mmol/l decrease in serum sodium, 1.22 (95% CI, 1.08 to 1.38); and for a 10 µmol/l increase in serum creatinine, 1.14 (95% CI, 1.09 to 1.19) (all p < 0.01).
CONCLUSIONS: In ambulant outpatients with chronic HF, low serum sodium and SDNN and high serum creatinine identify patients at increased risk of death due to progressive HF.
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Abbreviations and Acronyms
| | ACE | | angiotensin-converting enzyme | | CI | | confidence interval | | EF | | ejection fraction | | eGFR | | estimated glomerular filtration rate | | HF | | heart failure | | HFP | | high-frequency power | | HR | | hazards ratio | | HRV | | heart rate variability | | LFP | | low-frequency power | | NYHA | | New York Heart Association | | ROC | | receiver operating characteristic | | SDNN | | standard deviation of all normal-to-normal RR intervals | | TP | | total power | | UK-HEART | | United Kingdom Heart failure Evaluation and Assessment of Risk Trial | | VLFP | | very low-frequency power |
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