Elucidation of the Strongest Predictors of Cardiovascular Events in Patients with Heart FailureResearch in Context
Hiroki Fukuda,
Kazuhiro Shindo,
Mari Sakamoto,
Tomomi Ide,
Shintaro Kinugawa,
Arata Fukushima,
Hiroyuki Tsutsui,
Shin Ito,
Akira Ishii,
Takashi Washio,
Masafumi Kitakaze
Affiliations
Hiroki Fukuda
Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan; Department of Cell Biology, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan
Kazuhiro Shindo
Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan; Department of Cell Biology, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan
Mari Sakamoto
Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan; Department of Cell Biology, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan
Tomomi Ide
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
Shintaro Kinugawa
Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Japan
Arata Fukushima
Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Japan
Hiroyuki Tsutsui
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan; Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Japan
Shin Ito
Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan
Akira Ishii
The Institute of Scientific and Industrial Research, Osaka University, 1-1 Yamadaoka, Suita, Osaka, Japan
Takashi Washio
The Institute of Scientific and Industrial Research, Osaka University, 1-1 Yamadaoka, Suita, Osaka, Japan
Masafumi Kitakaze
Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan; Corresponding author at: Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita 565-8565, Japan.
Background: In previous retrospective studies, we identified the 50 most influential clinical predictors of cardiovascular outcomes in patients with heart failure (HF). The present study aimed to use the novel limitless-arity multiple-testing procedure to filter these 50 clinical factors and thus yield combinations of no more than four factors that could potentially predict the onset of cardiovascular events. A Kaplan–Meier analysis was used to investigate the importance of the combinations. Methods: In a multi-centre observational trial, we prospectively enrolled 213 patients with HF who were hospitalized because of exacerbation, discharged according to HF treatment guidelines and observed to monitor cardiovascular events. After the observation period, we stratified patients according to whether they experienced cardiovascular events (rehospitalisation or cardiovascular death). Findings: Among 77,562 combinations of fewer than five clinical parameters, we identified 151 combinations that could potentially explain the occurrence of cardiovascular events. Of these, 145 combinations included the use of inotropic agents, whereas the remaining 6 included the use of diuretics without bradycardia or tachycardia, suggesting that the high probability of cardiovascular events is exclusively determined by these two clinical factors. Importantly, Kaplan–Meier curves demonstrated that the use of inotropes or of diuretics without bradycardia or tachycardia were independent predictors of a markedly worse cardiovascular prognosis. Interpretation: Patients treated with either inotropic agents or diuretics without bradycardia or tachycardia were at a higher risk of cardiovascular events. The uses of these drugs, regardless of heart rate, are the strongest clinical predictors of cardiovascular events in patients with HF. Keywords: Heart failure, Data mining, Cardiovascular events, Combinational factors, Inotropic agents, Diuretics
