A multivariate model for predicting mortality in patients with heart failure and systolic dysfunction.
BACKGROUND
Heart failure is a leading cause of morbidity and mortality, but there are no reliable models based on readily available clinical variables to predict outcomes in patients taking angiotensin-converting enzyme (ACE) inhibitors.


METHODS
A multivariate statistical model to predict mortality was developed in a random sample (n = 4277 patients [67%]) of the 6422 patients enrolled in the Digitalis Investigation Group trial who had a depressed ejection fraction (<or=45%), were in sinus rhythm, and were taking ACE inhibitors. The model was then validated in the remaining 2145 patients.


RESULTS
Total mortality in the derivation sample was 11.2% (n = 480) at 12 months and 29.9% (n = 1277) at 36 months. Lower ejection fraction, worse renal function, cardiomegaly, worse functional class, signs or symptoms of heart failure, lower blood pressure, and lower body mass index were associated with reduced 12-month survival. This model provided good predictions of mortality in the verification sample. The same variables, along with age and the baseline use of nitrates, were also predictive of 36-month mortality.


CONCLUSIONS
Routine clinical variables can be used to predict short- and long-term mortality in patients with heart failure and systolic dysfunction who are treated with ACE inhibitors.
Division of Cardiology and Clinical Epidemiology, McGill University Health Center, Montréal, Quebec, Canada. jbroph@po-box.mcgill.ca
James M
JM
Brophy
Gilles R
GR
Dagenais
Frances
F
McSherry
William
W
Williford
Salim
S
Yusuf
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D013318:Stroke Volume; D015996:Survival Rate; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000150:complications*
D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004077:Digoxin