Prognosis of heart failure
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
Aging of the population and prolongation of the lives of cardiac patients by modern therapeutic innovations has led to an increasing incidence of heart failure (HF). Despite improvements in therapy, the mortality rate in patients with HF has remained unacceptably high . (See "Epidemiology and causes of heart failure".)
The prognosis of patients with in patients with HF with reduced ejection fraction (HFrEF) will be reviewed here. The many factors that can be used to predict survival in HFrEF and the prognosis in patients with asymptomatic left ventricular systolic or heart failure with preserved ejection fraction (HFpEF) are discussed separately. (See "Predictors of survival in heart failure due to systolic dysfunction" and "Management and prognosis of asymptomatic left ventricular systolic dysfunction" and "Treatment and prognosis of heart failure with preserved ejection fraction".)
The need for hospitalization is an important marker for poor prognosis. The association of nonfatal hospitalization and subsequent mortality rates was studied using data on 7572 chronic heart failure (HF) patients with reduced or preserved left ventricular ejection fraction (LVEF) in the CHARM trials . Mortality rate was increased after HF hospitalizations, even after adjustment for baseline predictors of death (HR 3.2; 95% CI 2.8-3.5). The increased risk of death was highest within one month of discharge and declined progressively over time.
There is an appreciable readmission rate for decompensated HF and patients hospitalized longer or more frequently have a higher mortality rate [2-6]. In a review of elderly patients, for example, 8 percent required readmission for HF within six months of the initial hospitalization .
Poor compliance is an important contributing factor in many patients requiring readmission [3-5]. In one series, lack of adherence to the medical program (drug or diet) was the most common reason for readmission, occurring in 41 percent of cases; another 12 percent received inadequate preadmission treatment . It has been estimated that more than one-half of readmissions are preventable .
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- SURVIVAL IN HF
- In-hospital mortality
- Long-term mortality
- Effect of demographic factors
- - Effect of age
- - Effect of gender
- - Effect of race
- Effect of cause of cardiomyopathy
- - Natural history of recent onset IDC
- Seasonal variation
- Circadian rhythm
- EFFECT OF TREATMENT
- Evidence from clinical trials
- Impact of management strategies
- CAUSES OF DEATH IN HF
- SCD and progressive HF
- Role of ischemia
- INFORMATION FOR PATIENTS