title: Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure.
abstract: 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.
authors.affiliation: 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
authors.forename: Mark T
authors.initials: MT
authors.lastname: Kearney
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Prescott
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Shah
authors.forename: Philip D
authors.initials: PD
authors.lastname: Batin
authors.forename: Wazir
authors.initials: W
authors.lastname: Baig
authors.forename: Stephen
authors.initials: S
authors.lastname: Lindsay
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Callahan
authors.forename: William E
authors.initials: WE
authors.lastname: Shell
authors.forename: Dwain L
authors.initials: DL
authors.lastname: Eckberg
authors.forename: Azfar G
authors.initials: AG
authors.lastname: Zaman
authors.forename: Simon
authors.initials: S
authors.lastname: Williams
authors.forename: James M M
authors.initials: JM
authors.lastname: Neilson
authors.forename: James
authors.initials: J
authors.lastname: Nolan
mesh_terms: 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