Author + information
- Received October 23, 2002
- Revision received January 29, 2003
- Accepted February 6, 2003
- Published online May 21, 2003.
- Anju Nohria, MD*,
- Sui W Tsang, BS*,
- James C Fang, MD*,
- Eldrin F Lewis, MD*,
- John A Jarcho, MD*,
- Gilbert H Mudge, MD* and
- Lynne W Stevenson, MD*,* ()
- ↵*Reprint requests and correspondence:
Dr. Lynne W. Stevenson, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.
Objectives This study was designed to determine the relevance of a proposed classification for advanced heart failure (HF). Profiles based on clinical assessment of congestion and perfusion at the time of hospitalization were compared with subsequent outcomes.
Background Optimal design of therapy and trials for advanced HF remains limited by the lack of simple clinical profiles to characterize patients.
Methods Prospective analysis was performed for 452 patients admitted to the cardiomyopathy service at the Brigham and Women’s Hospital with a diagnosis of HF. Patients were classified by clinical assessment into four profiles: profile A, patients with no evidence of congestion or hypoperfusion (dry-warm, n = 123); profile B, congestion with adequate perfusion (wet-warm, n = 222); profile C, congestion and hypoperfusion (wet-cold, n = 91); and profile L, hypoperfusion without congestion (dry-cold, n = 16). Other standard predictors of outcome were included and patients were followed for the end points of death (n = 117) and death or urgent transplantation (n = 137) at one year.
Results Survival analysis showed that clinical profiles predict outcomes in HF. Profiles B and C increase the risk of death plus urgent transplantation by univariate (hazard ratio [HR] 1.83, p = 0.02) and multivariate analyses (HR 2.48, p = 0.003). Moreover, clinical profiles add prognostic information even when limited to patients with New York Heart Association (NYHA) class III/IV symptoms (profile B: HR 2.23, p = 0.026; profile C: HR 2.73, p = 0.009).
Conclusions Simple clinical assessment can be used to define profiles in patients admitted with HF. These profiles predict outcomes and may be used to guide therapy and identify populations for future investigation.
☆ Dr. Nohria received salary support from the Clinical Investigator Training Program, Boston, Massachusetts, co-sponsored by Beth Israel Deaconess Medical Center, Harvard-M.I.T. Division of Health Sciences and Technology, and Pfizer, Inc. The Brigham and Women’s Hospital Heart Failure/Transplant Program received financial support from the William T. Young Corporation of Lexington, Kentucky, and the Fannie Rippel Foundation, Baskin Ridge, New Jersey.
- Received October 23, 2002.
- Revision received January 29, 2003.
- Accepted February 6, 2003.
- American College of Cardiology Foundation