title: Clinical characteristics and long-term prognosis in patients with chronic heart failure and reduced ejection fraction in China.
abstract: OBJECTIVE
  Chronic heart failure with reduced ejection fraction (CHF-REF) remains a major public health problem with high morbidity and mortality, but the data on current treatment status and long-term prognosis in China were still missing.
  
  
  METHODS
  Among prospectively recruited 2368 patients with CHF-REF in 10 hospitals, 2154 patients provided complete followed data. Two aetiology subgroups (dilated cardiomyopathy, DCM and ischaemic cardiomyopathy, ICM) were classified. Clinical data and long-term prognosis were analysed.
  
  
  RESULTS
  After a median follow-up of 52 months, 850 (39.46%) patients died, of whom 302 (35.53%) were sudden cardiac death (SCD). Unadjusted rates of all-cause mortality and SCD were higher in DCM than those in ICM (p<0.001 for both modes of death), but mortalities were comparable after adjustment for co-variables (p=0.387 and p=0.483 respectively). ACEIs/ARBs, aldosterone receptor antagonists, β-blockers and diuretics were dominant prescribed drugs with the prescription rates of 65.97%, 74.61%, 68.29% and 74.37% respectively. Multivariable analysis identified co-morbidities (eg, hypertension), NHYA class, ventricular tachycardia/fibrillation (VT/VF), QRS duration, left ventricular EF and creatinine as independent predictors of mortalities, whereas ACEIs/ARB, β-blockers and statins were associated with better prognosis. Survived from sustained VT/VF episodes had the highest predictive value for SCD (HR, 4.230; 95% CI, 2.500-7.157; p<0.001). The predictors for mortalities in DCM and ICM were different.
  
  
  CONCLUSIONS
  Patients with CHF-REF had a poor prognosis in China despite being under current standard therapies, especially patients with DCM. Predictors for all-cause mortality and SCD might be identified for evaluating the prognosis of these patients.
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Arrhythmia Diagnosis and Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Arrhythmia Diagnosis and Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
authors.forename: Haiyun
authors.initials: H
authors.lastname: Yu
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Arrhythmia Diagnosis and Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
authors.forename: Juanhui
authors.initials: J
authors.lastname: Pei
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Arrhythmia Diagnosis and Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Chu
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Arrhythmia Diagnosis and Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China. Electronic address: jielinpu@yahoo.com.
authors.forename: Jielin
authors.initials: J
authors.lastname: Pu
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Arrhythmia Diagnosis and Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
authors.forename: Shu
authors.initials: S
authors.lastname: Zhang
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000401:mortality*; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D003404:Creatinine
keywords: Chronic heart failure; Dilated cardiomyopathy; Ischaemic cardiomyopathy; Prognosis; Treatment