Abstract 16715: Symptoms as Predictors of Outcome in Patients With Heart Failure in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA)
Introduction: Although fatigue and dyspnea are common in patients with heart failure (HF), few studies have looked at their relationship with prognosis. We examined the association between fatigue and dyspnea and outcomes CORONA.
Methods: 5011 patients ≥60 years with symptomatic ischemic HF and LVEF ≤40% (≤35% in NYHA class II) were enrolled in CORONA. Fatigue and dyspnea “during the past few days” were measured at baseline using a five point scale for fatigue and a four point scale for dyspnea - all patients were required to have dyspnea at entry.
Patients were grouped into 3 categories: fatigue score 0-1 (n=535), 2 (n=1,632) and 3-4 (n=1663); dyspnea score 1 (n=292), 2 (n=1695), and 3-4 (n=1843). We examined the association between fatigue and dyspnea and the composite outcome of cardiovascular (CV) death or HF hospitalization using Kaplan-Meier analysis and Cox proportional-hazard models in patients with a LVEF ≤35% (n=3830). Other outcomes examined included CV death, HF hospitalization and all-cause mortality. Median follow-up was 32.8 months
Results: Higher fatigue and dyspnea were associated with higher rates of CV death or HF hospitalization (fatigue score 3-4 49% vs. 0-1 30%; dyspnea score 3-4 50% vs. 1 28%), and all cause mortality (fatigue score 3-4 37% vs. 0-1 24%; dyspnea score 3-4 37% vs.1 23%) (log rank p<0.0001 for all). After adjustment, higher dyspnea score was independently associated with a higher risk of the composite of CV death or HF hospitalization, its components and all-cause mortality (Table). Higher fatigue scores were associated with higher rates of HF hospitalization. (Table). These associations persisted despite adjustment for variables known to be associated with prognosis (see Table footnote), including NT-proBNP.
Discussion: Higher dyspnea and fatigue scores are independent predictors of worse outcomes in HFrEF. Symptoms are not only a key treatment target in HF but also an important prognostic indicator.
- © 2013 by American Heart Association, Inc.