Predictors of short term mortality in heart failure - insights from the Euro Heart Failure survey.
OBJECTIVE
To identify factors associated with short term mortality in hospitalised patients with heart failure.


BACKGROUND
Hospitalisation is frequent in patients with heart failure and is associated with a high mortality.


METHODS
The Euro Heart Failure survey collected data from patients with suspected heart failure. We searched this data for predictors of short term mortality.


RESULTS
Of 10,701 patients, 1404 (13%) died within 12 weeks of admission. On univariate analysis, increasing age, hyponatraemia, renal impairment, hyperkalaemia, anaemia, severe mitral regurgitation, severe LV systolic dysfunction(LVSD), increasing QRS and female sex carried adverse prognosis. ACEI, beta-blockers, nitrates, anti-thrombotic and lipid lowering drugs were associated with a better prognosis. On multivariable analysis the following provided independent prognostic information: increasing age (OR per SD=1.5, 95% CI 1.4-1.6), severe LVSD (1.8, 1.5-2.1), serum creatinine (1.2, 1.2-1.3), sodium (0.9, 0.8-0.9), Hb (0.9, 0.8-0.9) and treatment with ACEI (0.5, 0.5-0.6), beta-blockers (0.7, 0.6-0.8), statins (0.6, 0.5-0.7), calcium channel blockers (0.7, 0.6-0.8), warfarin (0.5, 0.4-0.6), heparin (1.7, 1.4-1.9), anti-platelet drugs (0.6, 0.5-0.6) and need for inotropes (5.5, 4.6-6.6). A simple risk score (range 0-11) identified cohorts with a 12 week mortality ranging from 2% to 44%.


CONCLUSIONS
Simple and readily available clinical variables and a risk score based on medical history and routine tests that all patients admitted with heart failure have, can identify patients with good, intermediate and high short term mortality.
Velavan
Periaswamy
P
Department of Academic Cardiology, University of Hull, UK. drvelavan@hotmail.com
Khan
Nasrin K
NK
Goode
Kevin
K
Rigby
Alan S
AS
Loh
Poay H
PH
Komajda
Michel
M
Follath
Ferenc
F
Swedberg
Karl
K
Madeira
Hugo
H
Cleland
John G F
JG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006306:Health Surveys; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol