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. CONCLUSION: 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.
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. CONCLUSION: 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.
Authors: Eileen Hsich; Eiran Z Gorodeski; Eugene H Blackstone; Hemant Ishwaran; Michael S Lauer Journal: Circ Cardiovasc Qual Outcomes Date: 2010-11-23
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