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Physical examination continues to provide useful prognostic information in congestive HF
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Assessment of congestive signs on physical examination continues to provide important prognostic information on patients with congestive HF in the modern era, researchers wrote in the Journal of the American College of Cardiology: Heart Failure.
With the goal of assessing the prognostic value of the physical examination, researchers performed a post-hoc analysis on 1,376 patients enrolled in the Atrial Fibrillation and Chronic Heart Failure trial. All participants had symptomatic left ventricular systolic dysfunction and nonpermanent AF. Eighty-one percent of the cohort was male and the mean age was 67 ± 11 years.
The baseline physical examination included assessment of peripheral edema, jugular venous distension, third heart sound and pulmonary rales. Mean follow-up was 37 months. CV-related mortality was the primary outcome; secondary outcomes included all-cause and HF-related mortality, HF-related hospitalization and sudden cardiac death.
Upon physical examination, 30.9% of patients had peripheral edema in 30.9%, 21.6% had jugular venous distension, 15% had a third heart sound and 12.9% had pulmonary rales.
Nearly one-third (32.3%) of patients died during follow-up, with CV-related death reported in 25.9% of patients. HF-related hospitalization occurred in 25.2%.
Univariate analysis indicated significant associations between CV-related mortality and all four findings from physical examination (P<.01). However, only peripheral edema (HR=1.25; 95% CI, 1-1.57) and pulmonary rales (HR=1.41; 95% CI, 1.07-1.86) were independently associated with CV mortality on multivariate analysis. The researchers also reported associations between peripheral edema and all-cause and HF-related mortality and between pulmonary rates and HF-related mortality and HF-related hospitalization. There was no association between jugular venous distension and a third heart sound with any secondary outcomes.
“Sophisticated laboratory techniques provide the contemporary clinician with a wealth of diagnostic and prognostic information that calls into question the residual value of a thoughtful physical examination,” Guillem Caldentey, MD, from the Montreal Heart Institute, University of Montreal, and colleagues wrote. “Our analyses in this cohort of patients with congestive HF and history of AF suggest that each of the four congestive signs on physical examination continue to provide relevant prognostic information.”
Disclosure: Cardiology Today could not confirm disclosures at the time of publication.
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