Mahon et al evaluated the impact of various risk factors on survival in ambulatory patients with chronic congestive heart failure. They demonstrated the importance of creatinine clearance on mortality. The authors are from the Cleveland Clinic.


Risk factors associated with increased mortality:

(1) reduced ejection fraction, especially when <= 25%

(2) elevated creatinine clearance (using the Cockcroft-Gault equation) < 64 mL per minute (with a further decline when < 40 mL/min)

(3) recent hospitalization for worsening congestive heart failure

(4) need for diuretic therapy

(5) 6 minute walk distance < 263 meters



• The serum creatinine may be normal or only slightly elevated yet the creatinie clearance significantly reduced.

• A creatinine clearance < 25 mL per minute appears to be associated with even worse survival according to Figures 2 and 3.

• The Cockcroft-Gault equation has a number of drawbacks. It uses ideal rather than actual body weight and may not function well in certain groups.

• Figure 3 shows the 4 year survival with various levels of ejection fraction with better survival with higher ejection fraction.


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