Heart failure: reduced activity and general health increased the risk of dying or being hospitalised

Clinical bottom line (level 2b)

  1. Patients with severe heart failure were more likely to be hospitalised or die if they have
    • symptoms of heart failure
    • reduced activities of daily living
    • reduced general health
Konstam et al: American Journal of Cardiology 1996; 78: 890-895
Expires October 2003

The study

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

Setting: 23 acute hospitals, USA

5025 patients (aged 21 to 80, ?% male)

Excluded if
  • aged <21 or >80 years old



    • Factors studied:
  • ejection fraction, age, treatment, NYHA classification and health-related quality-of-life index scores


    • .

    Cox proportional hazard models performed to adjust for confounding factors.

    67% followed for mean of 36 months
    Outcomes studied:

    The evidence


    • independent predictors of mortality
      • chronic heart failure symptoms: RR 1.21; p-value < 0.025
      • reduced activities of daily living: RR 1.41; p-value 0.0001
      • reduced general health: RR 1.21; p-value 0.0001
    • independent predictors for hospitalisation
      • symptoms of chronic heart failure: RR 1.03; p-value 0.004
      • reduced general health: RR 1.16; p-value 0.013
      • reduced activities of daily living: RR 1.43: p-value 0.002

    Comments

    1. Patients were participating in a randomised controlled study comparing enalapril and placebo.
    2. Confidence intervals were not given, and the prognostic factors were not clearly defined, therefore reducing the clinical utility of this information.
    3. The multivariate analysis was based on a model of 3,375 patients because of missing data.

    Citation

    1. Konstam V, Salem D, Pouleur H, et al: baseline quality of life as a predictor of mortality and hospitalization in 5,025 patients with congestive heart failure. American Journal of Cardiology 1996; 78: 890-895
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient heart failure
    Intervention or Exposure clinical factors
    Outcome mortality, readmission