Etiology-specific assessment of predictors of long-term survival in chronic systolic heart failure

Abstract

BackgroundWe sought to identify prognostic factors of long-term mortality, specific for the underlying etiology of chronic systolic heart failure (CHF).Methods and resultsBetween 1995 and 2009 baseline characteristics, treatment and follow-up data from 2318 CHF-patients due to ischemic (ICM; 1100 patients) or dilated cardiomyopathy (DCM; 1218 patients) were prospectively compared. To calculate hazard ratios with 95%-confidence intervals cox regression was used. We respectively established etiology-specific multivariable models of independent prognostic factors. During the follow-up period of up to 14.8 years (mean = 53.1 ± 43.5 months; 10,264 patient-years) 991 deaths (42.8%) occurred.In the ICM-cohort, 5-year-survival was 53.4% (95% CI: 49.9–56.7%), whereas in DCM-patients it was higher (68.1% (95% CI: 65.1–71.0%)). Age, ejection fraction, or hyponatremia were independent predictors for mortality in both cohorts, whereas diabetes, COPD, atrial fibrillation and a heart rate of ≥ 80/min carried independent predictive power only in ICM-patients.ConclusionThis study demonstrates the disparity of prognostic value of clinically derived risk factors between the two main causes of CHF. The effects of covariables in DCM-patients were lower, suggesting a less modifiable disease through risk factors considering mortality risk. An etiology-specific prognostic model may improve accuracy of survival estimations in CHF.

Delayed Improvement of Left Ventricular Function in Newly Diagnosed Heart Failure Depends on Etiology—A PROLONG-II Substudy

“…Differences in overall mortality between the other diagnoses were not statistically significant, although Kaplan-Meier curves suggested a worse survival in DCM patients. Other studies have suggested that DCM patients have an overall slightly better survival compared to ICM patients [80]. However, DCM patients in the present study often had renal disease, which is an important prognostic marker and may partly explain the poorer survival of DCM patients in our study [44].…”

Highlights from the International Journal of Cardiology Heart & Vasculature: Heart failure, atrial fibrillation, coronary artery disease and myocardial infarction

“…Although the prognosis of HF patients, notably in those patients with reduced ejection fraction, has improved over the years, likely as a result of improved pharmacological therapy limiting structural remodeling [4], current HF therapy remains suboptimal especially during the “vulnerable period” of hospital discharge. Identifying high-risk patients in HF cohorts is of clinical importance to reduce repeated hospitalizations and to predict patients with higher risk of early mortality [5]. Costa et al evaluated frailty in HF patients using the Clinical Frailty Scale and established a significant association with 1-year mortality [6].…”

Clinical Outcomes in Patients with Ischemic versus Non-Ischemic Cardiomyopathy after Angiotensin-Neprilysin Inhibition Therapy

“…Regarding the treatment with ACEI or ARB, one study has shown that ACEI or ARB was associated with a lower survival rate in ischemic cardiomyopathy (ICMP) compared with non-ischemic cardiomyopathy (NICMP) [ 9 ]. At long-term follow-up, another study presented a higher mortality rate in patients suffering from ICMP than in patients suffering from NICMP who were medicated with ACEI or ARB [ 10 ]. Furthermore, atrial fibrillation (AF) patients with ICMP showed a higher rate of cardiovascular death in comparison with AF patients with NICMP, under treatment with ACEI or ARB [ 11 ].…”