Predictors of mortality in patients with heart failure and preserved systolic function in the Digitalis Investigation Group trial.

OBJECTIVES: We identified predictors of mortality in patients with preserved ejection fraction (EF) and clinical heart failure (HF).
BACKGROUND: Although diastolic HF is common, the factors that predict mortality have not been clearly defined.
METHODS: We studied 988 patients with HF and preserved EF enrolled in the Digitalis Investigation Group (DIG) trial. Survival analyses were employed to identify variables associated with mortality.
RESULTS: During 3.1 years of follow-up, 231 (23%) patients died. Among 18 variables considered, the strongest independent predictors of death were glomerular filtration rate (adjusted hazard ratio for one standard deviation decrease 1.50, 95% confidence interval [CI] 1.35 to 1.67, p < 0.0001), New York Heart Association functional class III or IV (adjusted hazard ratio 1.64, 95% CI 1.20 to 2.18, p = 0.0011), male gender (adjusted hazard ratio 1.71, 95% CI 1.26 to 2.32, p = 0.0005), and older age (adjusted hazard ratio for one standard deviation increase of age2 1.28, 95% CI 1.08 to 1.50, p = 0.0019). A risk score was developed to estimate long-term mortality.
CONCLUSIONS: Diastolic HF is associated with a high death rate. Important predictors of death include impaired renal function, worse functional class, male gender, and older age.