Death in heart failure: a community perspective.
BACKGROUND
Mortality in heart failure (HF) remains high but causes of death are incompletely defined. As HF is heterogeneous syndrome categorized according to ejection fraction (EF), the association between EF and causes of death is important, yet elusive.


RESULTS
Community subjects with HF were classified according to preserved (> or =50%) and reduced EF (<50%). Deaths were classified as coronary heart disease (CHD), other cardiovascular and non-cardiovascular. Among 1063 persons with HF, 45% had preserved EF with less cardiovascular risk factors and less coronary disease than those with reduced EF. At 5 years, survival was 45% (95% CI 43%-49%) and 43% of the deaths were non-cardiovascular. The leading cause of death in subjects with preserved EF was non-cardiovascular (49%) vs CHD (43%) for subjects with reduced EF. The proportion of cardiovascular deaths decreased from 69% in 1979-1984 to 40% in 1997-2002 (p=0.007) among subjects with preserved EF contrasting with a modest change among those with reduced EF (77% in to 64%, p=0.08). Advanced age, male sex, diabetes, smoking and kidney disease were associated with an increase risk of all cause and cardiovascular death. After adjustment, preserved EF was associated with a lower risk of cardiovascular death but not all cause death.


CONCLUSIONS
Community subjects with HF experience a persistently high mortality and a large proportion of deaths are non-cardiovascular. Subjects with preserved EF have less cardiovascular disease before death, are less likely to experience cardiovascular deaths than those with reduced EF and the proportion of cardiovascular deaths declined over time.
Henkel
Danielle M
DM
Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Redfield
Margaret M
MM
Weston
Susan A
SA
Gerber
Yariv
Y
Roger
Véronique L
VL
D000368:Aged; D002423:Cause of Death / Q000639:trends; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends