title: Poor self-rated health predicts mortality in patients with stable chronic heart failure.
abstract: In heart failure, a holistic approach incorporating the patient's perspective is vital for prognosis and treatment. Self-rated health has strong associations with adverse events and short-term mortality risk, but long-term data are limited. We investigated the predictive value of two consecutive self-rated health assessments with regard to long-term mortality in a large, well characterised sample of elderly patients with stable chronic heart failure.
  
  
  
  We measured self-rated health by asking 'In general, would you say your health is: 1, excellent; 2, very good; 3, good; 4, fair; 5, poor?' twice: at baseline and the end of a 12-week beta-blocker up-titration period in the CIBIS-ELD trial. Mortality was assessed in an observational follow-up after 2-4 years. A total of 720 patients (mean left ventricular ejection fraction 45±12%, mean age 73±5 years, 36% women) rated their health at both time points. During long-term follow-up, 144 patients died (all-cause mortality 20%). Fair/poor self-rated health in at least one of the two reports was associated with increased mortality (hazard ratio 1.42 per level; 95% confidence interval 1.16-1.75; P<0.001). It remained independently significant in multiple Cox regression analysis, adjusted for N-terminal pro B-type natriuretic peptide (NTproBNP), heart rate and other risk prediction covariates. Self-rated health by one level worse was as predictive for mortality as a 1.9-fold increase in NTproBNP.
  
  
  
  Poor self-rated health predicts mortality in our long-term follow-up of patients with stable chronic heart failure, even after adjustment for established risk predictors. We encourage clinicians to capture patient-reported self-rated health routinely as an easy to assess, clinically meaningful measure and pay extra attention when self-rated health is poor.
authors.affiliation: Department of Internal Medicine - Cardiology, Charité-Universitätsmedizin Berlin, Germany simone.inkrot@charite.de.
authors.forename: Simone
authors.initials: S
authors.lastname: Inkrot
authors.affiliation: University Department of Cardiology, General Hospital Celje, Slovenia.|Faculty of Medicine, University of Ljubljana, Slovenia.
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.affiliation: Department of Internal Medicine - Cardiology, Charité-Universitätsmedizin Berlin, Germany.|Department of Cardiology and Pneumology, University of Göttingen, Germany.|German Center for Cardiovascular Research, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Edelmann
authors.affiliation: Department of Cardiology, Clinical Hospital Zvezdara, Serbia.|School of Medicine, University of Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Loncar
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Serbia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Stankovic
authors.affiliation: School of Medicine, University of Belgrade, Serbia.|Cardiology Department, University Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia.
authors.forename: Vera
authors.initials: V
authors.lastname: Celic
authors.affiliation: Faculty of Medicine, University of Nis, Serbia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Apostolovic
authors.affiliation: Department of Internal Medicine - Cardiology, Charité-Universitätsmedizin Berlin, Germany.
authors.forename: Elvis
authors.initials: E
authors.lastname: Tahirovic
authors.affiliation: Department of Internal Medicine - Cardiology, Charité-Universitätsmedizin Berlin, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Trippel
authors.affiliation: German Center for Cardiovascular Research, Germany.|Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany.|Clinical Trial Center, University Hospital Würzburg, Germany.
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.affiliation: Department of Internal Medicine - Cardiology, Charité-Universitätsmedizin Berlin, Germany.
authors.forename: Hans-Dirk
authors.initials: HD
authors.lastname: Düngen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D020097:Natriuretic Peptide, Brain; D011379:Prognosis; D016016:Proportional Hazards Models; D057566:Self Report
chemical_list: D000319:Adrenergic beta-Antagonists; D020097:Natriuretic Peptide, Brain
keywords: Heart failure; elderly; mortality; risk prediction; self-rated health