What does this research mean for the field?

Q: What does this research mean for the field?

A prognostic index comprising eight non-invasive clinical and electrocardiographic variables accurately stratifies patients with mild to moderate chronic heart failure into high and low risk for long-term mortality. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 30, 2003

A Prognostic Index to Predict Long-Term Mortality in Patients with Mild to Moderate Chronic Heart Failure Stabilised on Angiotensin Converting Enzyme Inhibitors

Structured PICO

Does a prognostic index using 8 non-invasive measurements predict long-term mortality in outpatients with mild to moderate chronic heart failure stabilized on ACE inhibitors?

Population

553 outpatients with symptoms of mild to moderate chronic heart failure stabilized on angiotensin converting enzyme inhibitors, mean age 63 years, mean NYHA functional class 2.3.

Intervention

Prognostic index using 8 non-invasive measurements (serum sodium, creatinine, cardiothoracic ratio, SDNN, maximum corrected QT interval, QRS dispersion, non-sustained ventricular tachycardia, and voltage criteria for left ventricular hypertrophy).

Outcome

Long-term mortality (at 5 years)hard clinical

A simple 8-point prognostic index using non-invasive measurements can effectively stratify outpatients with mild to moderate chronic heart failure into high and low risk for long-term mortality.

Abstract

BACKGROUND: Mortality in patients with mild to moderate chronic heart failure remains high. At present there is no easy way of identifying patients within this population at increased risk of death in the medium to long term. AIMS: To develop a prognostic index to identify outpatients with mild to moderate chronic heart failure at increased risk of death. METHODS AND RESULTS: Five hundred and fifty-three outpatients mean (S.D.) age 63(+/-10) years with symptoms of chronic heart failure (mean New York Heart Association functional class, 2.3(+/-0.5)), were recruited between December 1993 and April 1995. By April 2000, 201 patients had died. Using data from non-invasive measurements of cardiac size, electrical and autonomic function, renal function and plasma biochemistry we identified eight independent predictors of mortality (all P/=111 micromol/l (1 point), cardiothoracic ratio >/=0.52 (1 point), SDNN /=487 ms (1 point), QRS dispersion>/=42.7 ms (1 point), the presence of non-sustained ventricular tachycardia (1 point) and voltage criteria for left ventricular hypertrophy on 12-lead ECG (1 point). We calculated risk scores for patients by adding the points of each independent risk factor. In the low-risk group (0-3 points) mortality at 5 years was 20% and in the high-risk group (4-8 points) 53%. The area under the receiver-operator characteristic curve using dichotomised variables was 0.74 and for continuous model 0.78. CONCLUSIONS: Our prognostic index which uses eight non-invasive measurements and a straightforward additive points system, has good discrimination and stratifies outpatients with chronic heart failure into high and low risk. This index may be useful in clinical care and risk stratification.

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