Loss in body weight is an independent prognostic factor for mortality in chronic heart failure

Insights from the GISSI-HF and Val-HeFT trials

Patrick Rossignol, Serge Masson, Simona Barlera, Nicolas Girerd, Angelo Castelnovo, Faiez Zannad, Francesco Clemenza, Gianni Tognoni, Inder Anand, Jay N Cohn, Stefan D. Anker, Luigi Tavazzi, Roberto Latini

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Aims Uncertainties remain on the biological and prognostic significance and therapeutic implications of loss in body weight (W-LOSS) in chronic heart failure (HF) patients. We assessed whether W-LOSS added additional prognostic value to classical clinical risk factors in two separate and large cohorts of patients with chronic HF. The factors associated with W-LOSS were studied. Methods and results W-LOSS and estimated plasma volume changes were measured serially in the GISSI-HF (n = 6820) and Val-HeFT trials (n = 4892). In both studies, experiencing at least one episode of ≥5% W-LOSS during the first year of follow-up was considered a sign of wasting. In GISSI-HF, self-reported unintentional W-LOSS ≥2 kg between two consecutive clinical visits within 1 year was also considered a sign of wasting. W-LOSS occurred in 16.4% and 15.7% of the patients enrolled in GISSI-HF and Val-HeFT, respectively (unintentional ≥2 kg W-LOSS occurred in 18.9% in GISSI-HF). In multivariable analyses adjusting for a number of baseline covariates as well as for plasma volume changes, W-LOSS was found to be independently associated with mortality and adverse cardiovascular and non-cardiovascular outcomes, with a significant net reclassification improvement (cfNRI) and an increase in integrated discrimination improvement (IDI). W-LOSS was independently associated with several features representing the severity of HF, including baseline NT-proBNP and high sensitivity C-reactive protein (hsCRP) in Val-HeFT. Conclusions W-LOSS was a frequent finding in the GISSI-HF and Val-HeFT trials, associated with multiple patient features, and added additional prognostic information beyond clinical variables of HF severity, including estimated plasma volume changes.

Original languageEnglish (US)
Pages (from-to)424-433
Number of pages10
JournalEuropean Journal of Heart Failure
Volume17
Issue number4
DOIs
StatePublished - Apr 1 2015

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Heart Failure
Body Weight
Mortality
Plasma Volume
C-Reactive Protein
Uncertainty

Keywords

  • Cachexia
  • Heart failure
  • Plasma volume
  • Prognosis

Cite this

Loss in body weight is an independent prognostic factor for mortality in chronic heart failure : Insights from the GISSI-HF and Val-HeFT trials. / Rossignol, Patrick; Masson, Serge; Barlera, Simona; Girerd, Nicolas; Castelnovo, Angelo; Zannad, Faiez; Clemenza, Francesco; Tognoni, Gianni; Anand, Inder; Cohn, Jay N; Anker, Stefan D.; Tavazzi, Luigi; Latini, Roberto.

In: European Journal of Heart Failure, Vol. 17, No. 4, 01.04.2015, p. 424-433.

Research output: Contribution to journalArticle

Rossignol, P, Masson, S, Barlera, S, Girerd, N, Castelnovo, A, Zannad, F, Clemenza, F, Tognoni, G, Anand, I, Cohn, JN, Anker, SD, Tavazzi, L & Latini, R 2015, 'Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: Insights from the GISSI-HF and Val-HeFT trials', European Journal of Heart Failure, vol. 17, no. 4, pp. 424-433. https://doi.org/10.1002/ejhf.240
Rossignol, Patrick ; Masson, Serge ; Barlera, Simona ; Girerd, Nicolas ; Castelnovo, Angelo ; Zannad, Faiez ; Clemenza, Francesco ; Tognoni, Gianni ; Anand, Inder ; Cohn, Jay N ; Anker, Stefan D. ; Tavazzi, Luigi ; Latini, Roberto. / Loss in body weight is an independent prognostic factor for mortality in chronic heart failure : Insights from the GISSI-HF and Val-HeFT trials. In: European Journal of Heart Failure. 2015 ; Vol. 17, No. 4. pp. 424-433.
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title = "Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: Insights from the GISSI-HF and Val-HeFT trials",
abstract = "Aims Uncertainties remain on the biological and prognostic significance and therapeutic implications of loss in body weight (W-LOSS) in chronic heart failure (HF) patients. We assessed whether W-LOSS added additional prognostic value to classical clinical risk factors in two separate and large cohorts of patients with chronic HF. The factors associated with W-LOSS were studied. Methods and results W-LOSS and estimated plasma volume changes were measured serially in the GISSI-HF (n = 6820) and Val-HeFT trials (n = 4892). In both studies, experiencing at least one episode of ≥5{\%} W-LOSS during the first year of follow-up was considered a sign of wasting. In GISSI-HF, self-reported unintentional W-LOSS ≥2 kg between two consecutive clinical visits within 1 year was also considered a sign of wasting. W-LOSS occurred in 16.4{\%} and 15.7{\%} of the patients enrolled in GISSI-HF and Val-HeFT, respectively (unintentional ≥2 kg W-LOSS occurred in 18.9{\%} in GISSI-HF). In multivariable analyses adjusting for a number of baseline covariates as well as for plasma volume changes, W-LOSS was found to be independently associated with mortality and adverse cardiovascular and non-cardiovascular outcomes, with a significant net reclassification improvement (cfNRI) and an increase in integrated discrimination improvement (IDI). W-LOSS was independently associated with several features representing the severity of HF, including baseline NT-proBNP and high sensitivity C-reactive protein (hsCRP) in Val-HeFT. Conclusions W-LOSS was a frequent finding in the GISSI-HF and Val-HeFT trials, associated with multiple patient features, and added additional prognostic information beyond clinical variables of HF severity, including estimated plasma volume changes.",
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T1 - Loss in body weight is an independent prognostic factor for mortality in chronic heart failure

T2 - Insights from the GISSI-HF and Val-HeFT trials

AU - Rossignol, Patrick

AU - Masson, Serge

AU - Barlera, Simona

AU - Girerd, Nicolas

AU - Castelnovo, Angelo

AU - Zannad, Faiez

AU - Clemenza, Francesco

AU - Tognoni, Gianni

AU - Anand, Inder

AU - Cohn, Jay N

AU - Anker, Stefan D.

AU - Tavazzi, Luigi

AU - Latini, Roberto

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Aims Uncertainties remain on the biological and prognostic significance and therapeutic implications of loss in body weight (W-LOSS) in chronic heart failure (HF) patients. We assessed whether W-LOSS added additional prognostic value to classical clinical risk factors in two separate and large cohorts of patients with chronic HF. The factors associated with W-LOSS were studied. Methods and results W-LOSS and estimated plasma volume changes were measured serially in the GISSI-HF (n = 6820) and Val-HeFT trials (n = 4892). In both studies, experiencing at least one episode of ≥5% W-LOSS during the first year of follow-up was considered a sign of wasting. In GISSI-HF, self-reported unintentional W-LOSS ≥2 kg between two consecutive clinical visits within 1 year was also considered a sign of wasting. W-LOSS occurred in 16.4% and 15.7% of the patients enrolled in GISSI-HF and Val-HeFT, respectively (unintentional ≥2 kg W-LOSS occurred in 18.9% in GISSI-HF). In multivariable analyses adjusting for a number of baseline covariates as well as for plasma volume changes, W-LOSS was found to be independently associated with mortality and adverse cardiovascular and non-cardiovascular outcomes, with a significant net reclassification improvement (cfNRI) and an increase in integrated discrimination improvement (IDI). W-LOSS was independently associated with several features representing the severity of HF, including baseline NT-proBNP and high sensitivity C-reactive protein (hsCRP) in Val-HeFT. Conclusions W-LOSS was a frequent finding in the GISSI-HF and Val-HeFT trials, associated with multiple patient features, and added additional prognostic information beyond clinical variables of HF severity, including estimated plasma volume changes.

AB - Aims Uncertainties remain on the biological and prognostic significance and therapeutic implications of loss in body weight (W-LOSS) in chronic heart failure (HF) patients. We assessed whether W-LOSS added additional prognostic value to classical clinical risk factors in two separate and large cohorts of patients with chronic HF. The factors associated with W-LOSS were studied. Methods and results W-LOSS and estimated plasma volume changes were measured serially in the GISSI-HF (n = 6820) and Val-HeFT trials (n = 4892). In both studies, experiencing at least one episode of ≥5% W-LOSS during the first year of follow-up was considered a sign of wasting. In GISSI-HF, self-reported unintentional W-LOSS ≥2 kg between two consecutive clinical visits within 1 year was also considered a sign of wasting. W-LOSS occurred in 16.4% and 15.7% of the patients enrolled in GISSI-HF and Val-HeFT, respectively (unintentional ≥2 kg W-LOSS occurred in 18.9% in GISSI-HF). In multivariable analyses adjusting for a number of baseline covariates as well as for plasma volume changes, W-LOSS was found to be independently associated with mortality and adverse cardiovascular and non-cardiovascular outcomes, with a significant net reclassification improvement (cfNRI) and an increase in integrated discrimination improvement (IDI). W-LOSS was independently associated with several features representing the severity of HF, including baseline NT-proBNP and high sensitivity C-reactive protein (hsCRP) in Val-HeFT. Conclusions W-LOSS was a frequent finding in the GISSI-HF and Val-HeFT trials, associated with multiple patient features, and added additional prognostic information beyond clinical variables of HF severity, including estimated plasma volume changes.

KW - Cachexia

KW - Heart failure

KW - Plasma volume

KW - Prognosis

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U2 - 10.1002/ejhf.240

DO - 10.1002/ejhf.240

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