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J Card Fail. 2005 May;11(4):288-92.

Symptoms in patients with heart failure are prognostic predictors: insights from COMET.

Author information

1
Institute of Nursing, Sahlgrenska Academy at Göteborg University, SE 405-30 Göteborg, Sweden.

Erratum in

  • J Card Fail. 2005 Jun;11(5):404.

Abstract

BACKGROUND:

Although functional status, as assessed by the New York Heart Association classification, is known to be a powerful prognostic marker in chronic heart failure (CHF), the significance of individual symptoms such as breathlessness and fatigue are unknown.

OBJECTIVE:

To assess the relative importance of self-reported severity of symptoms as predictors of outcomes in CHF.

METHODS AND RESULTS:

All 3029 patients randomized in the Carvedilol or Metoprolol European Trial (ie, COMET) study were included in the analysis. Mean follow-up was 58 months. Symptoms were assessed by 5-point scales. In a univariate analysis, worse scores for breathlessness, orthopnea and fatigue were all significantly related to increased mortality (all P < .0001) and development of worsening heart failure. In a multivariate Cox regression analysis including 16 baseline covariates, only the symptom of breathlessness remained significantly related to mortality (risk ratio [RR] 1.14 per unit: 95% CI 1.04-1.26; P = .01). Fatigue, but not breathlessness, remained a significant predictor for developing worsening heart failure (RR 1.09 per unit; 95% CI 1.02-1.18; P = .02).

CONCLUSIONS:

Fatigue and breathlessness, common symptoms in CHF, have important and independent long-term prognostic implications. Accordingly, symptoms need to be effectively evaluated not only because symptom alleviation is a target for treatment, but also because they guide prognosis in patients with CHF.

PMID:
15880338
DOI:
10.1016/j.cardfail.2005.03.007
[Indexed for MEDLINE]

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