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Physical examination remains key to predicting death in heart failure with AF

Four physical signs of congestion in patients with heart failure and atrial fibrillation are key to predicting death and three offer prognostic information beyond standard clinical, echo and ECG findings, say US researchers.

Their study – published today in the Journal of the American College of Cardiology: Heart Failure – is based on a follow-up of the AF-CHF trial which originally studied 1376 patients with both conditions between 2005 and 2009.

They looked at the prognostic value of a physical examination in appropriately-managed patients who went on to die and found almost a third of patients had peripheral oedema (31%), 22% had jugular venous distension, 15% a third heart sound and 13% pulmonary rales.

All four signs were associated with cardiovascular mortality in the primary analysis. But after standard clinical, ECG and echo measures were accounted for they found:

– Peripheral oedema and pulmonary rales were still independent predictors of all-cause and CV mortality and were linked with a two-fold greater risk of heart failure-related death.

– Pulmonary rales independently predicted hospitalisation for heart failure.

– Jugular venous distension was associated with a 48% increased risk of heart-failure–related death.

– A third heart sound did not independently predict any cardiovascular outcome.

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