Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI-HF and Val-HeFT trials

• Published in: European journal of heart failure 2015-04, Vol.17 (4), p.424-433
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers; Biomarkers - blood; C-Reactive Protein; C-Reactive Protein - metabolism; Cachexia; Cachexia - metabolism; Cardiology and cardiovascular system; Clinical Trials as Topic; Female; Heart Failure; Heart Failure - mortality; Heart Failure - physiopathology; Human health and pathology; Humans; Life Sciences; Male; Middle Aged; Natriuretic Peptide, Brain; Natriuretic Peptide, Brain - blood; Peptide Fragments; Peptide Fragments - blood; Plasma Volume; Plasma Volume - physiology; Prognosis; Prospective Studies; Weight Loss; Weight Loss - physiology
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.240

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.