Heart failure: ejection fraction, functional class, non ischaemic heart disease and frequency of ventricular fibrillation increase risk of death.

Clinical bottom line (level 1b)

  1. Patients with mild or moderate heart failure were at increased risk of death at 16 months if they had: a low left ventricular ejection fraction, a high New York Heart Association functional class, non ischaemic heart disease or a high frequency of ventricular fibrillation.
Gradman et al: Journal of the American College of Cardiology 1989; 14: 564-570
Expires October 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 27 centres, USA, Canada and New Zealand

295 patients (aged mean 57 years, 83% male) clinical diagnosis of mild (class IIS according to New York Heart Association criteria) or moderate (class IIM) congestive heart failure

Excluded if
  • = 75 years old
  • left ventricular ejection fraction >40%
  • normal treadmill exercise capacity
  • exercise tolerance limited by ischaemic chest pain
  • requiring antianginal drug therapy other than infrequent sublingual nitroglycerin
  • concomitant therapy with beta-adrenergic blocking agents, vasodilators or calcium antagonists
  • myocardial infarction within the preceding 8 weeks
  • significant arterial hypertension (blood pressure >160/90 mmHg) despite diuretic therapy
  • atrial fibrillation
  • significant renal impairment (serum creatinine >2.0 mg/dL


    • Patients were randomised to captopril (50 mg three times a day), digoxin (0.25 mg) or placebo in addition to furosemide.

    Logistic regression analyses were carried out.

    100% followed for mean 16 months
    Outcomes studied:

    The evidence


    • Ejection fraction (%): total mortality p= 0.006
    • New York Heart Association class: total mortality p= 0.02
    • Non ischaemic heart disease: total mortality p= 0.04
    • Ventricular tachycardia frequency: total mortality p= 0.008

    Comments

    1. No odds ratios were reported in this study.

    Citation

    1. Gradman A, Deedwania P, Cody R, et al: Predictors of total mortality and sudden death in mild to moderate heart failure. Journal of the American College of Cardiology 1989; 14: 564-570
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient heart failure
    Intervention or Exposure risk factors
    Comparison no risk factors
    Outcome mortality