Clinical variables affecting survival in patients with decompensated diastolic versus systolic heart failure.
BACKGROUND
The impact of various clinical variables on long-term survival of patients with acutely decompensated diastolic heart failure (DHF) compared to systolic heart failure (SHF) has not been sufficiently investigated.


METHODS
Clinical, laboratory, electrocardiographic and echocardiographic data were collected and analyzed for all-cause mortality in 473 furosemide-treated patients aged >or=60 years, hospitalized for acutely decompensated HF.


RESULTS
Diastolic heart failure patients (n = 183) were more likely to be older, female, hypertensive, obese, with shorter preexisting HF duration, atrial fibrillation, lower New York Heart Association (NYHA) class, lower maintenance furosemide dosages, and to receive calcium antagonists. The SHF group (290 patients) demonstrated prevailing coronary artery disease, nitrate or digoxin treatment, and electrocardiographic conduction disturbances (P <or= 0.01 in all comparisons). On median 35-month follow-up, the respective one-, three- and five-year survival rates were 82%, 48% and 33% in DHF versus 74%, 46% and 30% in SHF (P = 0.3). Higher furosemide daily dosage at discharge (OR = 1.24, 95% CI = 1.11-1.37, P < 0.001), increasing age (OR = 1.29, 95% CI = 1.09-1.54, P = 0.003), peripheral arterial disease (OR = 1.47, 95% CI = 1.02-2.13, P = 0.043), and a history of stroke (OR = 1.44, 95% CI = 0.98-2.1, P = 0.066) were most significantly associated with shorter survival in SHF. DHF, in turn, demonstrated higher NYHA class (OR = 2.52, 95% CI = 1.48-4.29, P < 0.001), history of non-advanced malignancy (OR = 2.51, 95% CI = 1.3-4.85, P = 0.012), and atrial fibrillation (OR = 1.6, 95% CI = 0.97-2.64, P = 0.066). Antilipid treatment (OR = 0.56, 95% CI = 0.3-1.02, P = 0.049) predicted better survival.


CONCLUSIONS
In-patients with acutely decompensated DHF differ from similar SHF subjects with respect to prognostic significance of a number of clinical variables. This observation might carry practical implications.
Gorelik
Oleg
O
Department of Internal Medicine F, Assaf Harofeh Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University), Zerifin, Israel. internal6@asaf.health.gov.il
Almoznino-Sarafian
Dorit
D
Shteinshnaider
Miriam
M
Alon
Irena
I
Tzur
Irma
I
Sokolsky
Ilya
I
Efrati
Shai
S
Babakin
Zoanna
Z
Modai
David
D
Cohen
Natan
N
D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000008:administration & dosage*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage*; D054144:Heart Failure, Diastolic / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D054143:Heart Failure, Systolic / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors
D004232:Diuretics; D000960:Hypolipidemic Agents; D005665:Furosemide