title: Improved survival in patients with chronic mild/moderate systolic heart failure followed up in a specialist clinic.
abstract: OBJECTIVE
  To relate therapeutic issues, comorbidities and functional parameters to mortality/morbidity of mild/moderate heart failure patients.
  
  
  METHODS
  From our heart failure clinic, 372 heart failure patients (269 men, aged 66 ± 11 years), with stable heart failure and ejection fraction 45% or less were recruited. Survival curves were estimated according to the Kaplan-Meier method. Associations of protective/risk factors with cardiovascular mortality/morbidity were also evaluated.
  
  
  RESULTS
  One hundred and two patients (27%) died (aged 70 ± 10 years at diagnosis, 76 ± 10 at death) during follow-up (overall mortality at 60 months: 19.2%; mean follow-up period: 67 ± 44 months). Cardiovascular deaths were 64 (63% of total deaths, 44 men, age at diagnosis 70 ± 9). Cardiovascular mortality at 60 months was 12%; standardized mortality ratio was 5.9 for women and 6.8 for men. The remaining 38 patients (37% of total deaths, 30 men, age at diagnosis 70 ± 10) died of noncardiovascular causes. Overall, noncardiovascular mortality at 60 months was 7.2%; mean survival time from diagnosis to death was 63 ± 69 months (median 42, Q1 = 27.5, Q3 = 77.7). Average cardiovascular admission rate was 1.63 ± 1.84 admissions/patient. At multivariate analysis, only previous history of myocardial infarction [hazard ratio: 3.62 (1.70-7.73)], class of ejection fraction at diagnosis [hazard ratio: 0.36 (0.32-0.60)], acute cardiac decompensation at any time [hazard ratio: 1.55 (1.32-1.84)], implanted defibrillator [hazard ratio: 0.11 (0.01-0.83)] and use of statins [hazard ratio: 0.08 (0.007-0.42)] were independently associated with cardiovascular mortality. Factors associated to higher annual cardiovascular morbidity were age at diagnosis, chronic renal failure, diabetes, cardiac decompensation at any time, female sex and diuretic therapy. Angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin-receptor-blockers reduced annual cardiovascular morbidity.
  
  
  CONCLUSIONS
  Survival in mild/moderate heart failure patients has consistently improved. Further improvements are warranted in terms of morbidity reduction.
authors.affiliation: Clinical Cardiology, Heart Failure Unit, Istituto Scientifico San Raffaele, Milano, Italy. gabriele.fragasso@hsr.it
authors.forename: Gabriele
authors.initials: G
authors.lastname: Fragasso
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marinosci
authors.forename: Giliola
authors.initials: G
authors.lastname: Calori
authors.forename: Roberto
authors.initials: R
authors.lastname: Spoladore
authors.forename: Francesco
authors.initials: F
authors.lastname: Arioli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bassanelli
authors.forename: Anna
authors.initials: A
authors.lastname: Salerno
authors.forename: Amarild
authors.initials: A
authors.lastname: Cuko
authors.forename: Patrizia
authors.initials: P
authors.lastname: Puccetti
authors.forename: Carmela
authors.initials: C
authors.lastname: Silipigni
authors.forename: Altin
authors.initials: A
authors.lastname: Palloshi
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000188:drug therapy / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists