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CLINICAL RESEARCH: HEART FAILURE

Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure

Data From the CHARM Program and the Duke Databank

G. Michael Felker, MD, MHS, FACC^_*,_*, Larry A. Allen, MD^_*, Stuart J. Pocock, PhD^1,, Linda K. Shaw, MS^_*, John J.V. McMurray, MD, FACC^1,, Marc A. Pfeffer, MD, PhD, FACC^1,, Karl Swedberg, MD, PhD, FACC^1,||, Duolao Wang, PhD, Salim Yusuf, DPhil, FACC^1,¶, Eric L. Michelson, MD, FACC^2,#, Christopher B. Granger, MD, FACC^1,_* for the CHARM Investigators

^_* Duke Clinical Research Institute, Durham, North Carolina
London School of Hygiene and Tropical Medicine, London, United Kingdom
University of Glasgow, Glasgow, United Kingdom
Brigham and Women’s Hospital, Boston, Massachusetts
^|| Department of Medicine, Sahlgrenska University Hospital/Östra, Göteburg, Sweden
^¶ McMaster University, Hamilton, Ontario, Canada
^# AstraZeneca LP, Wilmington, Delaware.

Manuscript received January 9, 2007; revised manuscript received February 23, 2007, accepted February 25, 2007.

^_* Reprint requests and correspondence: Dr. G. Michael Felker, Duke Clinical Research Institute, 2400 Pratt Street, Room 0311 Terrace Level, DUMC Box 3850, Durham, North Carolina 27715. (Email: michael.felker{at}duke.edu).

Objectives: The goal of this study was to identify potentially novel laboratory markers of risk in chronic heart failure patients.

Background: Although a variety of prognostic markers have been described in heart failure, a systematic assessment of routine laboratory values has not been reported.

Methods: All 2,679 symptomatic chronic heart failure patients from the North American CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) program had a wide range of laboratory measures performed at a core facility, enabling us to assess the relationship between routine blood tests and outcomes using a Cox proportional hazards model. We then replicated our findings in a cohort of 2,140 heart failure patients from the Duke Databank.

Results: Among 36 laboratory values considered in the CHARM program, higher red cell distribution width (RDW) showed the greatest association with morbidity and mortality (adjusted hazard ratio 1.17 per 1-SD increase, p < 0.001). Higher RDW was among the most powerful overall predictors, with only age and cardiomegaly showing a better independent association with outcome. This finding was replicated in the Duke Databank, in which higher RDW was strongly associated with all-cause mortality (adjusted hazard ratio 1.29 per 1 SD, p < 0.001), second only to age as a predictor of outcome.

Conclusions: In 2 large contemporary heart failure populations, RDW was found to be a very strong independent predictor of morbidity and mortality. Understanding how and why this marker is associated with outcome may provide novel insights into heart failure pathophysiology.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   HR = hazard ratio   NYHA = New York Heart Association   RDW = red cell distribution width

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