[Survival and prognostic factors in systolic heart failure with recent symptom onset].
OBJECTIVE
To study survival and prognostic factors associated with mortality in patients with systolic heart failure followed up since symptom onset.


METHODS
We carried out a study with a cohort of 204 consecutive patients with systolic heart failure, whose symptom onset occurred within the 6 weeks preceding the first medical visit. They were followed up for 46 months. The prognostic variables analyzed were collected when the patients were included in the study and were correlated with cardiovascular mortality. An EF < or =40% on echocardiography characterized systolic ventricular dysfunction.


RESULTS
The overall survival rates according to the Kaplan-Meier technique were 98.0%, 90.6%, and 70.2% at 3, 12, and 48 months of follow-up, respectively. The multivariate analysis identified the independent effect of 6 variables on the risk of cardiovascular death. Functional classes III and IV increased risk 2.7 times as compared with class II; 10-mmHg increments in systolic blood pressure reduced the risk of death by 25%; each 10-bpm increase in heart rate increased the risk of death 1.6 times; and each 0.25-mg/dL increment in serum creatinine caused a 60% increase in risk. The presence of the third cardiac sound caused a 3-fold increase in the risk of death, and chagasic etiology was also associated with cardiovascular mortality (P<0.0001).


CONCLUSIONS
Evidence shows that mortality in the initial phase is not elevated, and that etiology, advanced functional class, arterial hypotension, tachycardia, presence of the third cardiac sound, and elevated serum creatinine lead to a worse prognosis.
Rassi
Salvador
S
Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO. srassi@cardiol.br
Barretto
Antônio Carlos Pereira
AC
Porto
Celmo Celeno
CC
Pereira
Crésio Romeu
CR
Calaça
Bárbara Wosjunk
BW
Rassi
Daniela C
DC
D000368:Aged; D001938:Brazil / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis