Usefulness of Peak Exercise Oxygen Consumption and the Heart Failure Survival Score to Predict Survival in Patients >65 Years of Age With Heart Failure

• Published in: The American journal of cardiology Vol. 103; no. 7; pp. 998 - 1002
• Main Authors: Parikh, Mona N., MD, Lund, Lars H., MD, PhD, Goda, Ayumi, MD, Mancini, Donna, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2009; Elsevier; Elsevier Limited
• Subjects: Age Factors; Aged; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Exercise; Exercise - physiology; Female; Follow-Up Studies; Gerontology; Heart; Heart failure; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Rate - physiology; Humans; Male; Medical sciences; Medicin och hälsovetenskap; New York City - epidemiology; Older people; Oxygen; Oxygen Consumption - physiology; Predictive Value of Tests; Retrospective Studies; Risk Factors; Studies; Survival analysis; Survival Rate - trends; New York City; Physical exercise; Human; Heart failure; Prognosis; Prediction; Cardiovascular disease; Oxygen consumption; Survival; Heart disease; Exercise tolerance test; Peak; Circulatory system; Cardiology; Age
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2008.12.010

Peak exercise oxygen consumption (V o2 ) and the Heart Failure (HF) Survival Score (HFSS) were developed in middle-aged patient cohorts referred for heart transplantation with HF. The prognostic value of V o2 in patients >65 years has not been well studied. Accordingly, the prognostic value of peak V o2 was evaluated in these patients with HF. A retrospective analysis of 396 patients with HF >65 years with cardiopulmonary exercise testing was performed. Peak V o2 and components of the HFSS (presence of coronary artery disease, left ventricular ejection fraction, heart rate, mean arterial blood pressure, presence of intraventricular conduction defects, and serum sodium) were collected. Follow-up averaged 1,038 ± 983 days. Outcome events were defined as death, implantation of a left ventricular assist device, or urgent transplantation. Patients were divided into risk strata for peak V o2 and HFSS based on previous cut-off points. Survival curves were derived using Kaplan-Meier analysis and compared using log-rank analysis. Survival differed markedly by V o2 stratum (p <0.0001), with significantly better survival rates for the low- (>14 ml/kg/min) versus medium- (10 to 14 ml/kg/min), low- versus high- (<10 ml/kg/min), and medium- versus high-risk strata (all p <0.05). Survival also differed markedly by HFSS stratum (p <0.0001), with significantly better survival rates for the low- (≥8.10) versus medium- (7.20 to 8.09), low- versus high- (≤7.19), and medium- versus high-risk strata (all p <0.0001). In conclusion, peak V o2 and the HFSS were both excellent parameters to predict survival in patients >65 years with HF.