title: Characteristics of patients who die with heart failure and a low ejection fraction in the new millennium.
abstract: BACKGROUND
  Therapies for heart failure (HF) with a low ejection fraction (EF) have delayed disease progression and prolonged survival, but the implications of these therapies on the end stages of HF have not been examined.
  
  
  RESULTS
  Patients seen by the Brigham and Women's cardiomyopathy service with an EF < or =35%, at least 1 outpatient visit or at least 30 days of follow-up who died between January 1, 2000, and October 20, 2003, were evaluated retrospectively. Of the 160 patients who died since 2000, 80 (50%) were outpatients. In the 6 months before death, 93% of patients had New York Heart Association (NYHA) class III or IV symptoms. The NYHA class, clinical characteristics, medications, and comorbidities differed little between inpatient and outpatient deaths. Renal insufficiency and hyponatremia were worse in the months preceding death than at the time of death (creatinine: 3.2 versus 2.3 mg/dL, P < .0001; sodium: 128 versus 135 mmol/L, P < .0001, respectively). Death was considered sudden in only 21% of patients.
  
  
  CONCLUSIONS
  Deaths in the current era of HF management occur in patients with long-standing HF characterized by biventricular dysfunction and advanced symptoms. Most deaths are heralded by hyponatremia, acute on chronic renal insufficiency, and frequent hospitalizations.
authors.affiliation: University of Pittsburgh, Cardiovascular Institute, Pennsylvania, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Teuteberg
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: Anju
authors.initials: A
authors.lastname: Nohria
authors.forename: Sui W
authors.initials: SW
authors.lastname: Tsang
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: John A
authors.initials: JA
authors.lastname: Jarcho
authors.forename: Gilbert H
authors.initials: GH
authors.lastname: Mudge
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Baughman
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
mesh_terms: D002303:Cardiac Output, Low / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D013318:Stroke Volume