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Predictors of prognosis in patients with stable mild to moderate heart failure
P Bettencourt1, A Ferreira, P Dias
1Department of Internal Medicine, Hospital S. João, Faculdade de Medicina da Universidade do Porto, Portugal.
Insights
This study identifies key clinical factors for predicting outcomes in mild to moderate heart failure (HF). Noninvasive assessments, including functional capacity and brain natriuretic peptide (BNP) levels, help stratify patients for tailored HF management programs.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Prognostic indexes exist for severe heart failure (HF) but lack consensus for mild to moderate HF.
- This study addresses the need for validated prognostic tools in mild to moderate HF populations.
Purpose of the Study:
- To determine the prognostic value of selected clinical variables in patients with mild to moderate heart failure (HF).
- To identify independent prognostic factors for survival in this patient group.
Main Methods:
- Prospective evaluation of 139 consecutive patients with mild to moderate HF.
- Included clinical and echocardiographic examinations, 6-minute walk test, and serum levels of sodium, uric acid, and brain natriuretic peptide (BNP).
- Univariate and multivariate Cox regression analyses were used to identify prognostic factors.
Main Results:
- Univariate analysis identified NYHA class, HF origin, ejection fraction, deceleration time, 6-minute walk distance, sodium, uric acid, and BNP levels as related to survival.
- Multivariate analysis revealed ischemic HF origin, 6-minute walk distance, deceleration time, and BNP levels as independent prognostic factors.
- Clustering of these factors correlated with worse prognosis.
Conclusions:
- Noninvasive evaluation effectively identifies patients with the worst prognosis in mild to moderate HF.
- Selected variables aid in stratifying HF patients for optimized management programs.
- These findings support the use of these variables in clinical decision-making for HF patients.
Background:
A number of prognostic indexes have been developed to predict the outcome of patients with severe heart failure (HF). In patients with mild to moderate HF, however, there is no consensus regarding the usefulness of such indexes. The goal of this study is to determine the prognostic value of selected clinical variables in the latter group of patients.
Methods And Results:
We prospectively evaluated the prognostic value of the functional capacity evaluation, the ventricular function, biochemical metabolic indicators, and brain natriuretic peptide (BNP) levels in 139 consecutive patients with mild to moderate HF. A clinical and echocardiographic examination (M-mode, 2D and pulsed Doppler of the mitral inflow); a 6-minute walk test; and a determination of serum sodium, uric acid, and BNP levels were performed. Death by any cause was predefined as the study end-point. Variables found to be related with survival in a univariate Cox regression analysis were NYHA class; ischemic origin for HF; left ventricular ejection fraction; deceleration time of the E wave; and 6-minute walk distance, serum sodium, uric acid, and BNP levels. In a multivariate analysis, ischemic origin of HF, 6-minute walk distance, deceleration time of the E wave, and BNP levels were found to be independent prognostic factors. The clustering of the independent prognostic factors was associated with the worse prognosis.
Conclusions:
These results suggest that the noninvasive evaluation used in this study and in our population of patients with mild to moderate HF allows the identification of individuals with the worst prognosis. The selected variables might prove to be very helpful in stratifying HF patients and identifying those that might benefit the most from a HF management program.