Takeaway
Thyroid dysfunction was associated with worse survival in patients with chronic heart failure (HF), but was not an independent predictor of mortality.
Why this matters
Subclinical thyroid dysfunction is very common in patients with chronic HF.
Studies reporting the association between thyroid dysfunction and outcomes in large populations of patients with HF have produced conflicting results.
Study design
This retrospective study included 2997 patients with HF with reduced ejection fraction (HFrEF) and 1995 patients with HF with normal ejection fraction (HFnEF).
Euthyroid state was defined as thyroid-stimulating hormone (TSH) level between 0.35 and 4.70 mIU/L, hypothyroid as TSH >4.70 mIU/L and hyperthyroid as TSH <0.35 mIU/L.
Primary outcome: all-cause mortality.
Funding: The Academy of Medical Sciences and the Wellcome Trust.
Key results
Overall, 4491 (90%) patients were euthyroid, 312 (6%) were hypothyroid and 189 (4%) were hyperthyroid.
In univariate analysis, both hypothyroid (HR, 1.25; 95% CI, 1.08-1.45) and hyperthyroid (HR, 1.21; 95% CI, 1.01-1.46) patients were at a higher risk of all-cause mortality vs euthyroid patients.
There was a U-shaped relation between TSH and mortality.
In patients with HFrEF, increasing TSH was associated with increased mortality in univariate analysis (HR, 1.02; 95% CI, 1.01-1.03), but the association disappeared in multivariate analysis.
In patients with HFnEF, a weak but significant association was seen between increasing TSH and mortality which persisted in multivariate analysis (HR, 1.02; 95% CI, 1.00-1.04; P=.02).
Increasing age, increasing N-terminal pro-B-type natriuretic peptide and higher New York Heart Association class were strongest predictors of mortality.
Limitations
Retrospective design.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Sarfaroj Khan. Thyroid Function and Mortality in Patients with Chronic Heart Failure - Medscape - Nov 03, 2020.
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