PMID- 9107242
OWN - NLM
STAT- MEDLINE
DCOM- 19970430
LR  - 20220330
IS  - 0140-6736 (Print)
IS  - 0140-6736 (Linking)
VI  - 349
IP  - 9058
DP  - 1997 Apr 12
TI  - Wasting as independent risk factor for mortality in chronic heart failure.
PG  - 1050-3
AB  - BACKGROUND: Wasting in chronic heart failure (CHF) has long been known but is 
      little investigated. We sought to find out whether the cachectic state in CHF 
      provides additional prognostic information about all-cause mortality. METHODS: 
      Between June, 1993, and May, 1995, we studied 171 consecutive patients with CHF 
      (mean age 60 years [SD 11; range 27-86]; 17 female). We assessed exercise 
      capacity (peak oxygen consumption; mean 17.5 mL kg-1 min-1 [6.7]), functional 
      status (New York Heart Association [NYHA] class: 21 class I, 63 class II, 68 
      class III, 19 class IV), and left-ventricular ejection fraction (mean 30% [SD 
      15]; n = 115). The cachectic status was defined prospectively as a 
      non-intentional documented weight loss of at least 7.5% of previous normal weight 
      (28 patients; range 9-36% or 6-30 kg) during at least 6 months. The Cox 
      proportional-hazards model was used to assess the association of variables with 
      survival, and Kaplan-Meier cumulative survival plots were constructed to estimate 
      the influence of risk factors. FINDINGS: At the end of follow-up in November, 
      1996, 49 patients had died (after a mean 324 days [SD 283]). The mean follow-up 
      of the survivors was 834 days (SD 186; range 549-1269). The cachectic state was 
      predictive of 18-month mortality independent of age, NYHA class, left-ventricular 
      ejection fraction, and peak oxygen consumption. Mortality in the cachectic 
      patients (n = 28) was 18% at 3 months, 29% at 6 months, 39% at 12 months, and 50% 
      at 18 months. Patients who had a peak oxygen consumption below 14 mL kg-1 min-1 
      (n = 53) had mortality at 3, 6, 12, and 18 months of 19%, 30%, 40%, and 51%. 
      18-month survival was 23% (95% CI 0-46) for the 13 patients with both of these 
      risk factors (cachexia and low peak oxygen consumption) compared with 93% (88-98) 
      in those (n = 103) with neither risk factor (p < 0.0001). INTERPRETATION: The 
      cachectic state is a strong independent risk factor for mortality in patients 
      with CHF. Combined with a low peak oxygen consumption, it identifies a subset of 
      patients at extremely high risk of death. Assessment of cachexia should be 
      included in transplant programmes and studies that investigate the effect of 
      interventions by survival analyses.
FAU - Anker, S D
AU  - Anker SD
AD  - Department of Cardiac Medicine, National Heart and Lung Institute, London. 
      s.anker@ic.ac.uk
FAU - Ponikowski, P
AU  - Ponikowski P
FAU - Varney, S
AU  - Varney S
FAU - Chua, T P
AU  - Chua TP
FAU - Clark, A L
AU  - Clark AL
FAU - Webb-Peploe, K M
AU  - Webb-Peploe KM
FAU - Harrington, D
AU  - Harrington D
FAU - Kox, W J
AU  - Kox WJ
FAU - Poole-Wilson, P A
AU  - Poole-Wilson PA
FAU - Coats, A J
AU  - Coats AJ
LA  - eng
PT  - Journal Article
PL  - England
TA  - Lancet
JT  - Lancet (London, England)
JID - 2985213R
SB  - IM
EIN - Lancet 1997 Apr 26;349(9060):1258
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cachexia/*complications
MH  - Chronic Disease
MH  - Female
MH  - Heart Failure/complications/*mortality/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Factors
MH  - Survival Analysis
EDAT- 1997/04/12 00:00
MHDA- 1997/04/12 00:01
CRDT- 1997/04/12 00:00
PHST- 1997/04/12 00:00 [pubmed]
PHST- 1997/04/12 00:01 [medline]
PHST- 1997/04/12 00:00 [entrez]
AID - S0140-6736(96)07015-8 [pii]
AID - 10.1016/S0140-6736(96)07015-8 [doi]
PST - ppublish
SO  - Lancet. 1997 Apr 12;349(9058):1050-3. doi: 10.1016/S0140-6736(96)07015-8.