title: Symptoms in patients with heart failure are prognostic predictors: insights from COMET.
abstract: BACKGROUND
  Although functional status, as assessed by the New York Heart Association classification, is known to be a powerful prognostic marker in chronic heart failure (CHF), the significance of individual symptoms such as breathlessness and fatigue are unknown.
  
  
  OBJECTIVE
  To assess the relative importance of self-reported severity of symptoms as predictors of outcomes in CHF.
  
  
  RESULTS
  All 3029 patients randomized in the Carvedilol or Metoprolol European Trial (ie, COMET) study were included in the analysis. Mean follow-up was 58 months. Symptoms were assessed by 5-point scales. In a univariate analysis, worse scores for breathlessness, orthopnea and fatigue were all significantly related to increased mortality (all P < .0001) and development of worsening heart failure. In a multivariate Cox regression analysis including 16 baseline covariates, only the symptom of breathlessness remained significantly related to mortality (risk ratio [RR] 1.14 per unit: 95% CI 1.04-1.26; P = .01). Fatigue, but not breathlessness, remained a significant predictor for developing worsening heart failure (RR 1.09 per unit; 95% CI 1.02-1.18; P = .02).
  
  
  CONCLUSIONS
  Fatigue and breathlessness, common symptoms in CHF, have important and independent long-term prognostic implications. Accordingly, symptoms need to be effectively evaluated not only because symptom alleviation is a target for treatment, but also because they guide prognosis in patients with CHF.
authors.affiliation: Institute of Nursing, Sahlgrenska Academy at Göteborg University, SE 405-30 Göteborg, Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Ekman
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Andrew
authors.initials: A
authors.lastname: Charlesworth
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Philip A
authors.initials: PA
authors.lastname: Poole-Wilson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D018450:Disease Progression; D004311:Double-Blind Method; D004417:Dyspnea / Q000503:physiopathology; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000145:classification* / Q000188:drug therapy / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol