Heart failure: female sex reduced the risk of dying in severe disease

Clinical bottom line (level 2b)

  1. One in seven patients with severe heart failure were dead within 1.5 years.
  2. The risk of dying was increased with worsening NYHA class and increasing age.
  3. The risk was reduced with increased LV ejection fraction, higher blood pressure and female sex.
Simon et al: Circulation 2001; 103 : 375-380
Expires November 2003

The study

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

Setting:

2647 patients (aged mean 61, 80% male) with clinically stable NYHA class III or IV congestive heart failure treated with diuretics and ACE inhibitors (ejection fraction 35% or less)

Factors studied:
  • age, sex, body mass index, NYHA functional class, duration and cuase of heart failure, smoking status, diabetes, atrial fibrillation, blood pressure, bundle branch block, randomisation arm
  • NYHA class IV v. III
  • aged 68 or more
  • LV ejection fraction 32% or more
  • systolic blood pressure 140 mmHg or higher
  • female



    Cox regression multivariate analysis was used to adjust for confounding factors.

    ?100% followed for
    Outcomes studied:
  • death

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 1.5 years 384/2647 15%
    (13% to 16%)    		 7
    (6 to 8)

    prognostic factor for
    death     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    NYHA class IV v. III ? 1.65
    (1.30 to 2.10)     		11
    (6 to 23)
    aged 68 or more ? 1.59
    (1.21 to 2.08)     		12
    (6 to 33)
    LV ejection fraction 32% or more ? 1.59
    (1.21 to 2.08)     		-18
    (-34 to -13)
    systolic blood pressure 140 mmHg or higher ? 0.64
    (0.48 to 0.85)     		-19
    (-46 to -13)
    female ? 0.52
    (0.42 to 0.64)     		-19
    (-49 to -13)

    Comments

    1. Data taken from CIBIS-II randomised controlled trial

    Citation

    1. Simon T, Mary-Klause M, Funck-Brentano C, et al: sex differences in the prognosis of congestive heart failure: results from the cardiac insufficiency bisoprolol study (CIBIS II). Circulation 2001; 103 : 375-380
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient severe heart failure
    Intervention or Exposure clinical features
    Outcome death
    		•