Differential clinical prognostic classifications in dilated and ischemic advanced heart failure: the EPICAL study.
BACKGROUND
The clinical management of severe congestive heart failure (CHF) should be graded according to the prognosis of each individual patient. Our objective was to elaborate a prognostic rating system for severe CHF.


METHODS
The EPICAL program (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) identified patients with severe CHF defined by hospitalization accompanied by class III/IV dyspnea, edema, or hypertension; an ejection fraction </=30% or a cardiothoracic index >/=60%. Baseline variables were tested in Cox multivariate models.


RESULTS
Patients with ischemic heart disease (n = 219) had a lower 1-year survival rate (57.6%) than patients with dilated cardiomyopathy (n = 182) (69. 1%). Multivariate analysis identified 5 prognostic factors for ischemic CHF and 7 for CHF caused by dilated cardiomyopathy. These variables were used to classify patients within prognostic subgroups of good (>75%), intermediate, or poor (</=25%) 1-year survival.


CONCLUSIONS
A score for prognostic prediction was further derived from readily available data to help physicians improve decision making and to assist in clinical trials as a stratification tool.
Alla
F
F
Department of Epidemiology and Cardiology, University Hospital, Nancy, France. f.alla@chu-nancy.fr
Briançon
S
S
Juillière
Y
Y
Mertes
P M
PM
Villemot
J P
JP
Zannad
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005602:France; D006333:Heart Failure / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis