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".)
FACTORS AFFECTING MORTALITY RATES
Morbidity and mortality rates after the onset of symptomatic heart failure (HF) are high, although variable mortality rates have been reported which likely reflect differences in disease severity and in rates of appropriate medical therapy [2-8].
Effect of hospitalization — 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 (hazard ratio [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 [9-13]. In a review of older adult patients, for example, 8 percent required readmission for HF within six months of the initial hospitalization .
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- FACTORS AFFECTING MORTALITY RATES
- Effect of hospitalization
- Effect of demographic factors
- - Effect of age
- - Effect of gender
- - Effect of race
- Effect of cause of heart failure
- - Natural history of recent onset IDC
- - Role of ischemia
- Seasonal variation
- Circadian rhythm
- EFFECT OF TREATMENT
- Evidence from clinical trials
- Impact of management strategies
- TRENDS IN MORTALITY RATES
- In-hospital mortality
- Long-term mortality
- Cause of death
- INFORMATION FOR PATIENTS