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 S. Anand, Jay N. Cohn, Stefan D. Anker, Luigi Tavazzi, Roberto Latini

Research output: Contribution to journalArticle

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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

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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 S.; 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, IS, 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 S. ; 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 S.

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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