Usefulness of Combined Risk Stratification With Heart Rate and Systolic Blood Pressure in the Management of Chronic Heart Failure

Abstract

on behalf of the CHART-2 Investigators Background: The appropriate target ranges of heart rate (HR) and systolic blood pressure (SBP) for the management of chronic heart failure (CHF) patients remain to be elucidated in a large-scale cohort study. Methods and Results:We examined 3,029 consecutive CHF patients with sinus rhythm (SR) (mean age, 67.9 years) registered in the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 Study (CHART-2; NCT00418041). There were 357 deaths (11.8%) during the median follow-up of 3.1 years. We first performed the classification and regression tree analysis for mortality, identifying SBP <89 mmHg, HR >70 beats/min and SBP <115 mmHg as the primary, secondary and tertiary discriminators, respectively. According to these, we divided the patients into low-(n=1,131), middle-(n=1,624) and high-risk (n=274) groups with mortality risk <10%, 10-20% and >20%, respectively. The low-risk group was characterized by SBP >115 mmHg and HR <70 beats/min and the highrisk group by SBP <89 mmHg regardless of HR values or SBP 89-115 mmHg and HR >76 beats/min. Multivariate Cox regression analysis revealed that the hazard ratio of all-cause death for low-, middle-and high-risk groups was 1.00 (reference), 1.48 (95% confidence interval (CI): 1.10-1.99, P=0.009) and 2.44 (95% CI 1.66-3.58, P<0.001), respectively. Subgroup analysis revealed that age ≥70 years, diabetes, or reduced left ventricular function had higher hazard ratios in the high-risk group. Conclusions:The results demonstrate the usefulness of combined risk stratification of HR and SBP in CHF patients with SR. (Circ J 2013; 77: 2954 -2962

Prognostic Impact of Atrial Fibrillation and New Risk Score of Its Onset in Patients at High Risk of Heart Failure ― A Report From the CHART-2 Study ―

“…[30][31][32][33][34] Patients aged ≥20 years with significant CAD or in Stage B/C/D HF, as defined according to the ACCF/AHA guidelines, 14 were consecutively enrolled from October 2006 to March 2010. 30-34 Clinical information was recorded at the time of enrollment and thereafter reviewed annually by trained clinical research coordinators.…”

Current Status of Primary Prevention of Sudden Cardiac Death With Implantable Cardioverter Defibrillator in Patients With Chronic Heart Failure

“…The details of the design, purpose and clinical characteristics of the patients have been previously reported in detail (NCT00418041). 13- 16 The CHART-2 study was approved by the local ethics committee in each participat- 3 Structural heart disease (IHD or NIDCM) Class I LVEF ≤35%, NYHA II-III, NSVT LVEF ≤35%, NYHA I, NSVT, Positive EPS Class IIa LVEF ≤35%, NYHA II-III ACC/AHA, American College of Cardiology/American Heart Association; ESC, European Society of Cardiology; EPS, electrophysiological study; IHD, ischemic heart disease; JCS, Japanese Circulation Society; LVEF, left ventricular ejection fraction; MI, myocardial infarction; NIDCM, non-ischemic dilated cardiomyopathy; NSVT, non-sustained ventricular tachycardia; NYHA, New York Heart Association; SCD, sudden cardiac death. Figure 1.…”

Prognostic Impact of Anemia in Patients With Chronic Heart Failure – With Special Reference to Clinical Background: Report From the CHART-2 Study –

“…Briefly, patients aged 20 years or older with significant coronary artery disease or Stage B HF (n=5,483) and those with Stage C/D CHF (n=4,736) according to the definition of the ACCF/AHA guidelines were enrolled between October 2006 and March 2010. [16][17][18][19][20] All information, including medical history, laboratory data and echocardiography data, was recorded at the time of registration, and thereafter annually by trained clinical research coordinators. [16][17][18][19][20] …”