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- Title
Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI-HF and Val- HeFT trials.
- Authors
Rossignol, Patrick; Masson, Serge; Barlera, Simona; Girerd, Nicolas; Castelnovo, Angelo; Zannad, Faiez; Clemenza, Francesco; Tognoni, Gianni; Anand, Inder S.; Cohn, Jay N.; Anker, Stefan D.; Tavazzi, Luigi; Latini, Roberto
- Abstract
Aims Uncertainties remain on the biological and prognostic significance and therapeutic implications of loss in body weight (W- LOSS) in chronic heart failure ( HF) patients. We assessed whether W- LOSS added additional prognostic value to classical clinical risk factors in two separate and large cohorts of patients with chronic HF. The factors associated with W- LOSS were studied. Methods and results W- LOSS and estimated plasma volume changes were measured serially in the GISSI-HF ( n = 6820) and Val- HeFT trials ( n = 4892). In both studies, experiencing at least one episode of ≥5% W- LOSS during the first year of follow-up was considered a sign of wasting. In GISSI-HF, self-reported unintentional W- LOSS ≥2 kg between two consecutive clinical visits within 1 year was also considered a sign of wasting. W- LOSS occurred in 16.4% and 15.7% of the patients enrolled in GISSI-HF and Val- HeFT, respectively (unintentional ≥2 kg W- LOSS occurred in 18.9% in GISSI-HF). In multivariable analyses adjusting for a number of baseline covariates as well as for plasma volume changes, W- LOSS was found to be independently associated with mortality and adverse cardiovascular and non-cardiovascular outcomes, with a significant net reclassification improvement ( cfNRI) and an increase in integrated discrimination improvement ( IDI). W- LOSS was independently associated with several features representing the severity of HF, including baseline NT-proBNP and high sensitivity C-reactive protein ( hsCRP) in Val- HeFT. Conclusions W- LOSS was a frequent finding in the GISSI-HF and Val- HeFT trials, associated with multiple patient features, and added additional prognostic information beyond clinical variables of HF severity, including estimated plasma volume changes.
- Subjects
WEIGHT loss; HEART failure; CLINICAL trials; ESTIMATION theory; FOLLOW-up studies (Medicine); C-reactive protein; DIAGNOSIS
- Publication
European Journal of Heart Failure, 2015, Vol 17, Issue 4, p424
- ISSN
1388-9842
- Publication type
Article
- DOI
10.1002/ejhf.240