Symptoms in patients with heart failure are prognostic predictors: insights from COMET

J Card Fail. 2005 May;11(4):288-92. doi: 10.1016/j.cardfail.2005.03.007.


Background: Although functional status, as assessed by the New York Heart Association classification, is known to be a powerful prognostic marker in chronic heart failure (CHF), the significance of individual symptoms such as breathlessness and fatigue are unknown.

Objective: To assess the relative importance of self-reported severity of symptoms as predictors of outcomes in CHF.

Methods and results: All 3029 patients randomized in the Carvedilol or Metoprolol European Trial (ie, COMET) study were included in the analysis. Mean follow-up was 58 months. Symptoms were assessed by 5-point scales. In a univariate analysis, worse scores for breathlessness, orthopnea and fatigue were all significantly related to increased mortality (all P < .0001) and development of worsening heart failure. In a multivariate Cox regression analysis including 16 baseline covariates, only the symptom of breathlessness remained significantly related to mortality (risk ratio [RR] 1.14 per unit: 95% CI 1.04-1.26; P = .01). Fatigue, but not breathlessness, remained a significant predictor for developing worsening heart failure (RR 1.09 per unit; 95% CI 1.02-1.18; P = .02).

Conclusions: Fatigue and breathlessness, common symptoms in CHF, have important and independent long-term prognostic implications. Accordingly, symptoms need to be effectively evaluated not only because symptom alleviation is a target for treatment, but also because they guide prognosis in patients with CHF.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Angina Pectoris / physiopathology
  • Carbazoles / therapeutic use
  • Carvedilol
  • Disease Progression
  • Double-Blind Method
  • Dyspnea / physiopathology
  • Fatigue / physiopathology
  • Female
  • Follow-Up Studies
  • Forecasting
  • Heart Failure / classification*
  • Heart Failure / drug therapy
  • Heart Failure / physiopathology
  • Hospitalization
  • Humans
  • Male
  • Metoprolol / therapeutic use
  • Middle Aged
  • Prognosis
  • Propanolamines / therapeutic use
  • Severity of Illness Index
  • Survival Rate


  • Adrenergic beta-Antagonists
  • Carbazoles
  • Propanolamines
  • Carvedilol
  • Metoprolol