Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure.
OBJECTIVE
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 micromol/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.
Kearney
Mark T
MT
Department of Cardiology, GKT School of Medicine, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, United Kingdom. mark.kearney@kcl.ac.uk
Fox
Keith A A
KA
Lee
Amanda J
AJ
Prescott
Robin J
RJ
Shah
Ajay M
AM
Batin
Philip D
PD
Baig
Wazir
W
Lindsay
Stephen
S
Callahan
Timothy S
TS
Shell
William E
WE
Eckberg
Dwain L
DL
Zaman
Azfar G
AG
Williams
Simon
S
Neilson
James M M
JM
Nolan
James
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D006113:United Kingdom / Q000453:epidemiology