title: Association of low body temperature and poor outcomes in patients admitted with worsening heart failure: a substudy of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial.
abstract: OBJECTIVE
  Risk stratification in patients admitted with worsening heart failure (HF) is essential for tailoring therapy and counselling. Risk models are available but rarely used, in part because many require laboratory and imaging results that are not routinely available. Body temperature is associated with prognosis in other illnesses, and we hypothesized that low body temperature would be associated with worse outcomes in patients admitted with worsening HF.
  
  
  RESULTS
  The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial was an event-driven, randomized, double-blind, placebo-controlled study of tolvaptan in 4133 patients hospitalized for worsening HF with an EF <40%. Co-primary endpoints were all-cause mortality and cardiovascular (CV) death or HF rehospitalization. Body temperature was measured orally at randomization and entered in analyses both as a continuous variable and categorized into three groups (<36 °C, 36-36.5 °C, and >36.5 °C) using Cox regression models. The composite of CV death or HF rehospitalization occurred in 1544 patients within 1 year. For every 1 °C decrease in body temperature, the risk of adverse outcomes increased by 16% [hazard raio (HR) 1.16, 95% confidence interval (CI) 1.04-1.28], after adjustment for age, gender, race, systolic blood pressure, EF, blood urea nitrogen, and serum sodium. In fully adjusted analysis, the risk of adverse outcomes in the lowest body temperature group (<36 °C) was 51% higher than that of the index group (>36.5 °C) (HR 1.35, 95% CI 1.15-1.58).
  
  
  CONCLUSIONS
  Low body temperature is an independent marker of poor cardiovascular outcomes in patients admitted with worsening HF and reduced EF.
authors.affiliation: University of Florida College of Medicine, Jacksonville, FL, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Payvar
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Alan B
authors.initials: AB
authors.lastname: Miller
authors.forename: S Ward
authors.initials: SW
authors.lastname: Casscells
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000627:therapeutic use*; D001831:Body Temperature; D002317:Cardiovascular Agents / Q000627:therapeutic use; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D018570:Risk Assessment; D013318:Stroke Volume; D016019:Survival Analysis; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D002317:Cardiovascular Agents; D000077602:Tolvaptan
keywords: Body temperature; Heart Failure; Prognosis