Relative survival in dilated cardiomyopathy: a stratification study of long-term outcome to evaluate life insurance cover.
OBJECTIVE
The aim of this study was to compare mortality of dilated cardiomyopathy (DCM) patients with the mortality in the background Italian population, taking into account demographic characteristics and clinical stratification of long-term outcome, ie, "reverse remodelling" within the first 2 years of follow-up.


BACKGROUND
DCM is a myocardial disease, characterized by left and/or right ventricular dilation and dysfunction and poor outcome. Evidence-based treatment with ACE inhibitors, beta-blockers and, in the last decade, implantable cardioverter defibrillators have been demonstrated to improve significantly heart failure symptoms and prognosis. At present, DCM patients are unlikely to be accepted for life insurance.


METHODS
A cohort of 577 DCM patients consecutively enrolled from 1988 to 2004 in the Heart Muscle Disease Registry of Trieste, Italy, was matched by sex, age and registry data entry with the mortality data of the Italian population. Relative survival has been estimated by means of Kaplan-Meier technique, and mortality ratios (MR) with corresponding 95% confidence intervals have been computed.


RESULTS
DCM patients who showed a significant reverse remodelling within the first 2 years of treatment showed comparable survival with respect to the control population, and therefore could be taken into consideration for life insurance coverage, at least for a short or medium-term of years.


CONCLUSIONS
The data illustrate that survival probability strongly depend on the individual treatment and evolution of the disease and could be easily measured within the first 2 years of follow-up. If this information is collected at the time of evaluation of an applicant for life cover, the insurance company could possibly improve its risk stratification.
Barbati
Giulia
G
Dept. of Public Health and Microbiology, University of Torino and Cardiovascular Department, AOU "Ospedali Riuniti", Trieste. giulia_barbati@yahoo.it
Merlo
Marco
M
Marocco
Patrizia
P
Gregori
Dario
D
Sabbadini
Gastone
G
Lattuada
Luca
L
Ginanneschi
Ugo
U
Sinagra
Gianfranco
G
Di Lenarda
Andrea
A
D000367:Age Factors; D002311:Cardiomyopathy, Dilated / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007352:Insurance, Life; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D015993:Life Tables; D011379:Prognosis; D012042:Registries; D012306:Risk; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome