Red blood cell distribution width has emerged as a new prognostic biomarker in cardiovascular diseases. Its additional value in risk stratification of patients with chronic heart failure has not yet been established.

A total of 594 consecutive outpatients (Military hospitals of Algiers and Constantine) with chronic heart failure were studied (median-age 71 years [interquartile range, 62–77], 65% male, left-ventricular ejection fraction 40 [14]%).

On inclusion, the red cell distribution width was measured and clinical, biochemical, and echocardiographic variables were recorded. The median follow-up period was 2.3 years [interquartile range, 1.2–3.7].

A total of 187 patients died and 203 required hospitalization for decompensated heart failure. Kaplan-Meier analysis showed an increase in the probability of death and hospitalization for heart failure with red cell distribution width quartiles (log rank, P<001). A ROC analysis identified a red cell distribution width of 15.4% as the optimal cut-off point for a significantly higher risk of death (P<001; hazard ratio=2.63; 95% confidence interval, 2.01–3.45) and hospitalization for heart failure (P<001; hazard ratio=2.37; 95% confidence interval, 1.80–3.13). This predictive value was independent of other covariates, and regardless of the presence or not of anaemia. Importantly, the addition of red cell distribution width to the clinical risk model for the prediction of death or hospitalization for heart failure at 1 year had a significant integrated discrimination improvement of 33% (P<.001) and a net reclassification improvement of 10.3% (P=.001).

Red cell distribution width is an independent risk marker and adds prognostic information in outpatients with chronic heart failure. These findings suggest that this biological measurement should be included in the management of these patients.