title: Reasons why patients suffering from chronic heart failure at very high risk for death survive.
abstract: BACKGROUND
  An accurate prognostic stratification is essential for optimizing the clinical management and treatment decision-making of patients with chronic heart failure (HF). Among the best available models, we used the Cardiac and Comorbid Conditions HF (3C-HF) Score, to predict all-cause mortality in patients with CHF.
  
  
  METHODS
  we selected and characterized the subgroup of patients at very high risk with the worst mid-term prognosis belonging to the highest decile of 3C-HF score with the aim to assess predictors of survival in subjects with an expected probability of 1-year mortality near to 45%.
  
  
  RESULTS
  We recruited 1777 consecutive chronic HF patients at 3 Italian Cardiology Units. Median age was 76 ± 10 years, 43% were female, and 32% had preserved ejection fraction. Subjects belonging to the highest decile of 3C-HF score were 246 (13.8% of total population). During a median follow-up of 21 [12-40] months, 110 of these patients (45%) survived and 136 (55%) died. The variables that contributed to survival prediction emerged by Cox regression multivariate analysis were the lower degree of renal dysfunction and higher body mass index.
  
  
  CONCLUSIONS
  The prognostic stratification of chronic HF patients allows in daily practice to select patients at different risk for death and identify prognosticators of survival in outliers at very high risk of death. The reasons why these patients outlive the matching part of subjects who expectedly die are related to the maintenance of a satisfactory renal function and body mass index.
authors.affiliation: Cardiology Department, Villa Bianca Hospital Trento, Italy. Electronic address: gcioffi@villabiancatrento.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.affiliation: Heart Failure Clinic, Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.affiliation: Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Cardiology Department, St. Martino Hospital Azienda Sanitaria Locale n. 1, Belluno, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.affiliation: Department of Cardiocirculatory Diseases, San Giovanni-Addolorata Hospital, Rome, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Del Sindaco
authors.affiliation: Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.affiliation: Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Russo
authors.affiliation: Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cherubini
authors.affiliation: Cardiovascular Center, Health Authority no. 1 and University of Trieste, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Faganello
authors.affiliation: Cardiology Department, Villa Bianca Hospital Trento, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Stefenelli
authors.affiliation: Cardiology Department, Villa Bianca Hospital Trento, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ognibeni
authors.affiliation: Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Heart Failure Clinic, Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D003657:Decision Making; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Body mass index; Chronic heart failure; Prognosis; Renal dysfunction