Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(7), 757–767. https://doi.org/10.1002/clc.24057 Dr. Ping Zhou et al.
Points
- Thyroid dysfunction, including low fT3, elevated TSH, LT3S, overt hyperthyroidism, subclinical hypothyroidism, and overt hypothyroidism, independently increases the risk of adverse outcomes in hospitalized heart failure (HF) patients, as demonstrated by hazard ratios ranging from 33% to 76%.
- Higher total cholesterol levels were identified as a protective factor, with a 36% reduced risk of adverse outcomes in HF patients.
- Combining thyroid function parameters with lipid profile data enhances prognostic accuracy, allowing for effective risk stratification among HF patients.
- A retrospective cohort study involving 3,733 HF patients between 2009 and 2018 provided the data for these findings.
- These results underscore the clinical significance of considering thyroid function as a vital aspect of HF patient assessment and treatment, potentially aiding clinicians in better managing and predicting patient outcomes.
Summary
In this retrospective cohort study encompassing 3,733 hospitalized heart failure (HF) patients between March 2009 and June 2018, the authors explored the prognostic implications of thyroid dysfunction and its interplay with lipid profiles. Their primary hypothesis posited that thyroid dysfunction would exhibit a strong correlation with the prognosis of HF patients and that combining this thyroid-related data with lipid profiles would enhance prognostic accuracy.
Analysis of the patient cohort revealed noteworthy results. Specifically, various forms of thyroid dysfunction, including low fT3, elevated TSH, LT3S, overt hyperthyroidism, subclinical hypothyroidism, and overt hypothyroidism, emerged as independent risk factors for a composite endpoint encompassing all-cause mortality, heart transplantation, or the need for a left ventricular assist device. Hazard ratios (HR) provided quantitative insights, indicating a 33% increased risk for low fT3 (HR 1.33, 95% CI: 1.15–1.54, p < .001), a 37% elevated risk for elevated TSH (HR 1.37, 95% CI 1.15–1.64, p < .001), a 39% heightened risk for LT3S (HR 1.39, 95% CI: 1.15–1.68, p < .001), and a 73% elevated risk for overt hyperthyroidism (HR 1.73, 95% CI: 1.00–2.98, p = .048). Subclinical hypothyroidism exhibited a 43% increased risk (HR 1.43, 95% CI: 1.13–1.82, p = .003), while overt hypothyroidism demonstrated a more substantial 76% risk elevation (HR 1.76, 95% CI: 1.33–2.34, p < .001).
Interestingly, the analysis also underscored the protective role of higher total cholesterol levels in HF patients, with an HR of 0.64 (95% CI: 0.49–0.83, p < .001). Additionally, when the patient cohort was stratified into four groups based on fT3 levels and median lipid profiles, Kaplan-Meier survival curves yielded statistically significant distinctions (p < .001), suggesting that the combination of fT3 and lipid profile data effectively stratifies the risk of adverse outcomes in HF patients.
In conclusion, this research illuminates the independent association between various forms of thyroid dysfunction and adverse outcomes in hospitalized HF patients, with specific hazard ratios delineating the extent of risk. Moreover, incorporating thyroid function parameters alongside lipid profile data enhances prognostic accuracy, potentially aiding clinicians in risk assessment and management strategies for HF patients. These findings emphasize the clinical relevance of considering thyroid function as a crucial component of HF patient evaluation and treatment.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24057
References Zhou, P., Huang, L., Zhai, M., Huang, Y., Zhuang, X., Liu, H., Zhang, Y., & Zhang, J. (2023). Prognostic role and relationship of thyroid dysfunction and lipid profile in hospitalized heart failure patients. Clinical Cardiology, 46(7), 757–767. https://doi.org/10.1002/clc.24057
