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Predictors of clinical outcomes in elderly patients with heart failure
Author(s) -
Manzano Luis,
Babalis Daphne,
Roughton Michael,
Shibata Marcelo,
Anker Stefan D.,
Ghio Stefano,
Veldhuisen Dirk J.,
CohenSolal Alain,
Coats Andrew J.,
PooleWilson Philip P.A.,
Flather Marcus D.
Publication year - 2011
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfr030
Subject(s) - medicine , heart failure , myocardial infarction , cardiology , ejection fraction , cohort , diabetes mellitus , framingham risk score , population , heart failure with preserved ejection fraction , coronary artery disease , body mass index , disease , environmental health , endocrinology
Aims Heart failure (HF) in the elderly carries a poor prognosis. We used the SENIORS dataset of elderly HF patients aged ≥70 years in order to develop a risk model for this population. Methods and results The SENIORS trial evaluated the effects of nebivolol and enrolled 2128 patients ≥70 years with HF (ejection fraction ≤35%, or recent HF admission). We randomly selected 1400 patients from the full dataset to produce a derivation cohort and the remaining 728 patients were used as a validation cohort. Baseline variables were entered into a bootstrap model with 200 iterations to determine their association with two outcomes, the composite of all‐cause mortality or cardiovascular hospitalization, or all‐cause mortality alone. Variables retaining a significant association with these outcomes in a multivariate model were used to develop a risk prediction score tested in the validation cohort. Five factors were associated with increased risk of both outcomes in the multivariate model: higher New York Heart Association class, higher uric acid level, lower body mass index, prior myocardial infarction, and larger left atrial (LA) dimension. For the composite outcome, peripheral arterial disease, years with heart failure, right bundle branch block, diabetes mellitus, and orthopnoea were also retained. For all‐cause mortality, creatinine, 6 min walk test distance, coronary artery disease, and age were retained. Conclusion In addition to conventional prognostic markers, uric acid and LA dimension appear to be important novel risk prediction markers in elderly patients with heart failure, and could be useful in guiding management.