Heart failure: elderly: a previous history and a raised ANP increased the risk of congestive heart failure

Clinical bottom line (level 1b)

  1. One in seven frail elderly patients developed congestive heart failure in one year.
  2. Patients were at increased risk of developing heart failure if they had
    • congestive heart failure in previous year
    • an elevated atrial natriuretic peptide (ANP) level
Davis et al: Journal of the American Medical Association 1992; 267 (19): 2625-2629
Expires October 2003

The study

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

Setting: rehabilitation centre, USA

310 patients (aged range 70 to 102 years, mean 88, 77% female)

Excluded if
  • died without heart failure before 6 months of follow-up
  • clinically unstable
  • pulmonary oedema



    • Factors studied:
  • age, level of nursing care, ECG findings, artificial pacemaker, mean arterial pressure, central venous pressure, third heart sound, pedal edema
  • atrial natriuretic peptide > 200 pmol/l
  • congestive heart failure in previous year




    • Multivariate regression analysis performed on prognostic factors.

    94% followed for 12 months
    Outcomes studied:
  • congestive heart failure

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    congestive heart failure 12 months 46/310 15%
    (11% to 19%)    		 7
    (5 to 9)

    prognostic factor for
    congestive heart failure     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    atrial natriuretic peptide > 200 pmol/l 12 months 46/310
    (14.8%)     		7.9
    (3.2 to 19.2)     		2
    (2 to 5)
    congestive heart failure in previous year 12 months 46/310
    (14.8%)     		7.0
    (2.9 to 17)     		2
    (2 to 5)

    Citation

    1. Davis KM, Fish LC, Elahi D: atrial natriuretic peptide levels in the prediction of congestive heart failure risk in frail elderly. Journal of the American Medical Association 1992; 267 (19): 2625-2629
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient elderly
    Intervention or Exposure clinical factors, ANP
    Outcome heart failure