Development and validation of multivariable models to predict mortality and hospitalization in patients with heart failure

Voors, Adriaan A.; Ouwerkerk, Wouter; Zannad, Faı̈ez; Veldhuisen, Dirk J. van; Samani, Nilesh J.; Ponikowski, Piotr; Ng, Leong L.; Metra, Marco; Maaten, Jozine M. ter; Lang, Chim C.; Hillege, Hans L.; Harst, Pim van der; Filippatos, Gerasimos; Dickstein, Kenneth; Cleland, John G.F.; Anker, Stefan D.; Zwinderman, Aeilko H.

doi:10.1002/ejhf.785

Cited by 210 publications

(287 citation statements)

References 43 publications

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“…[21][22][23][24][25] Calculated PVS might be prognostic because it truly reflects fluid retention that could be a marker or mediator of CHF progression. Moreover, it did so after adjustment for treatment allocation implying that the associations elucidated here were not simply driven by FCM.…”

Section: Discussionmentioning

confidence: 99%

Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy

et al. 2019

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Aims Iron deficiency worsens symptoms, quality of life, and exercise capacity in chronic heart failure (CHF) and might do so by promoting fluid retention. We assessed whether iron repletion improved congestion in CHF and appraised the prognostic utility of calculated plasma volume status (PVS), a novel index of congestion, in the FAIR‐HF data set. Methods and results In FAIR‐HF, 459 iron deficient CHF patients were randomized to intravenous ferric carboxymaltose (FCM) or saline and assessed at 4, 12, and 24 weeks. Using weight and haematocrit, we calculated PVS in 436 patients. At baseline, PVS and weight were −5.5 ± 7.7% and 76.9 ± 14.3 kg, with peripheral oedema evident in 35% of subjects. Higher PVS values correlated to other congestion surrogates such as lower serum albumin. At 4 weeks, FCM was associated with greater reductions in weight (0.02) and PVS (P < 0.0001), and a trend for improved peripheral oedema at 24 weeks (0.07). Irrespective of treatment allocation, patients with a decrease in PVS from baseline to week 24 had higher increments in 6 min walking distance (61.4 m vs. 43.5 m, 0.02) and were more likely to improve their NYHA class (33.3% vs. 15.5%, 0.001). A PVS > −4% at baseline predicted worse outcomes even after adjustment for treatment assignment (hazard ratio 1.88, 95% confidence interval 1.01–3.51, 0.046). Conclusions Intravenous iron therapy with FCM is associated with early reductions in PVS and weight, implying that decongestion might be one mechanism via which iron repletion aids CHF patients. Calculated PVS is of prognostic utility in this cohort.

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Section: Discussionmentioning

confidence: 99%

Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy

et al. 2019

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“…The BIOSTAT‐CHF risk models used for adjustment throughout these analyses have been published and validated …”

Section: Methodsmentioning

confidence: 99%

Clinical correlates and outcome associated with changes in 6‐minute walking distance in patients with heart failure: findings from the BIOSTAT‐CHF study

Ferreira

Metra

Anker

et al. 2019

European J of Heart Fail

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Background The 6‐minute walk test (6MWT) is a simple and inexpensive way of measuring exercise capacity in patients with heart failure (HF) that predicts morbidity and mortality. However, there are few reports from large multicentre cohorts assessing the predictive value of baseline and changing walk distance. Methods and results In BIOSTAT‐CHF, a 6MWT was performed at baseline (n = 1714) and 9 months (n = 1520). Cox proportional hazards models were used to assess the associations between 6MWT distance and the composite of HF hospitalization and/or death. Median follow‐up was 21 months. The median (pct25‐75) of the 6MWT distance at baseline was 300 m (200–388 m). Independent predictors of a shorter 6MWT distance included older age, female sex, higher heart rate, New York Heart Association class III/IV, orthopnoea, ischaemic heart disease, a previous stroke, current malignancy, and higher N‐terminal pro‐B‐type natriuretic peptide (all P < 0.05). Patients in the lowest baseline 6MWT tertile (≤ 240 m) were less likely to receive guideline‐recommended doses of disease‐modifying therapies (P < 0.05). Compared to patients in the highest baseline 6MWT tertile (> 360 m), those in the lowest and middle tertiles had a worse prognosis [adjusted hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.38–2.18]. Patients with a decrease in the distance walked had a worse prognosis (adjusted HR for each 50 m decrease 1.09, 95% CI 1.06–1.12). 6MWT distance was not modified by treatment up‐titration nor the 6MWT improved the BIOSTAT‐CHF prognostic models. Conclusions The 6‐minute walk test distance at baseline and a decline in walking distance were both associated with worse prognosis but did not improve the prognostic models. 6MWT distance was not modified by treatment up‐titration and its use for assessing the benefits of pharmacologic treatment up‐titration may be limited.

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“…All parameters were previously found to be independently associated with the outcomes in the BIOSTAT cohort and were used to build the risk models derived from this cohort (URL: https://biostat-chf.shinyapps.io/calc/). 9 …”

Section: Methodsmentioning

confidence: 99%

Coronary angiography in worsening heart failure: determinants, findings and prognostic implications

Ferreira

Rossignol

Demissei

et al. 2017

Heart

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Development and validation of multivariable models to predict mortality and hospitalization in patients with heart failure

Abstract: A small number of variables, which are usually readily available in the routine clinical setting, provide useful prognostic information for patients with HF. Predictors of mortality were remarkably different from predictors of hospitalization owing to HF.

Cited by 210 publications

References 43 publications

Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy

Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy

Clinical correlates and outcome associated with changes in 6‐minute walking distance in patients with heart failure: findings from the BIOSTAT‐CHF study

Coronary angiography in worsening heart failure: determinants, findings and prognostic implications

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