Clinical studyA multivariate model for predicting mortality in patients with heart failure and systolic dysfunction
Section snippets
Study sample
The trial recruited 7788 patients from February 1991 through August 1993 in over 300 North American centers. The design and principal outcomes of this trial, which compared digoxin with placebo in patients with heart failure and normal sinus rhythm, have been published 7, 8. The diagnosis of heart failure was based on current or past symptoms and signs, or radiological evidence of pulmonary congestion. Patients were excluded from the trial if they had a serum creatinine level >3.0 mg/dL, age
Results
Patients in the derivation and validation samples had similar characteristics (Table 1). The mean (± SD) age in the derivation sample was 63.3 ± 11.0 years. Over half were known to have heart failure for at least 12 months. Virtually all had signs and symptoms of heart failure at randomization, and only a minority was in NYHA functional class I. The mean ejection fraction was 28% ± 9%, and the mean creatinine level was 1.3 ± 0.4 mg/dL.
Discussion
More than 50 demographic, clinical, biochemical, hemodynamic, electrophysiologic, and echocardiographic factors have been correlated with outcomes in heart failure patients; neurohormonal markers have perhaps the strongest association (10). However, most patients are diagnosed, treated, and followed in general medical practices and do not always have access to these markers. Therefore, we concentrated on predictors that are readily available, and demonstrated that they can be used to predict
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Dr. Brophy is a funded researcher from Le Fonds de la Recherche en Santé du Québec. Dr. Yusuf holds a Senior Scientist Award of the Canadian Institutes of Health Research and is an Endowed Chair of the Heart and Stroke Foundation of Ontario.