Atrial natriuretic peptide levels in the prediction of congestive heart failure risk in frail elderly
K. M. Davis, L. C. Fish, D. Elahi, B. A. Clark and K. L. Minaker
Division on Aging, Harvard Medical School, Boston, Mass.
OBJECTIVE--To develop a noninvasive clinical predictive model for acute
congestive heart failure (CHF) in a frail elderly cohort using bedside
clinical assessment (medical history and physical examination) and venous
atrial natriuretic peptide (ANP) levels. DESIGN--One-year prospective
blinded cohort study. SETTING--Life care facility. PARTICIPANTS--Three
hundred thirty-one frail, elderly volunteers free of acute illness at study
entry (mean +/- SD age, 88 +/- 7 years; 23% male, 77% female). MAIN OUTCOME
MEASURE--Clinical episodes of CHF with confirmation of acute pulmonary
edema by chest roentgenogram. RESULTS--Fifteen percent of the elderly
cohort developed at least one episode of CHF during the 1-year follow-up
period. Those developing CHF had significantly higher mean +/- SE ANP
values at study entry: 493 +/- 55 vs 207 +/- 15 pmol/L. The risk for
development of CHF rose progressively with increasing ANP levels at study
entry. In multivariate analysis, only two independent variables
significantly predicted CHF: ANP value greater than 200 pmol/L (adjusted
odds ratio [OR], 7.9; 95% confidence interval [CI], 3.2 to 19.2) and
history of CHF in the previous year (adjusted OR, 7.0; 95% CI, 2.9 to 17).
Stratifying the cohort by these two variables results in three CHF risk
groups: 55% of the population at 3% annual risk of CHF, 37% of the
population at 20% to 24% annual risk of CHF, and 8% of the population at
66% annual risk of CHF. CONCLUSIONS--This simple clinical prediction model
identifies elderly subjects at risk for CHF and allows appropriate focusing
of medical resources for prevention, early detection, and treatment of this
highly morbid clinical syndrome.
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ABSTRACT
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Clerico and Emdin
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Ruskoaho
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COWIE
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Richards et al.
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ABSTRACT
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ABSTRACT
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