title: Reasons why patients suffering from chronic heart failure at very low risk for mortality die.
abstract: BACKGROUND
  A proper prognostic stratification is crucial for organizing an effective clinical management and treatment decision-making in patients with chronic heart failure (CHF). In this study, we selected and characterized a sub-group of CHF patients at very low risk for death aiming to assess predictors of death in subjects with an expected probability of 1-year mortality near to 5%.
  
  
  METHODS
  We used the Cardiac and Comorbid Conditions HF (3C-HF) Score to identify CHF patients with the best mid-term prognosis. We selected patients belonging to the lowest quartile of 3C-HF score (≤9 points).
  
  
  RESULTS
  We recruited 1777 consecutive CHF patients at 3 Italian Cardiology Units (age 76±10years, 43% female, 32% with preserved ejection fraction). Subjects belonging to the lowest quartile of 3C-HF score were 609. During a median follow-up of 21 [12-40] months, 48 of these patients (8%) died, and 561 (92%) survived. The variables that contributed to death prediction by Cox regression multivariate analysis were older age (HR 1.03[CI 1.00-1.07]; p=0.04), male gender (HR 2.93[CI 1.50-5.51]; p=0.002) and a higher degree of renal dysfunction (HR 0.96[CI 0.94-0.98]; p<0.001).
  
  
  CONCLUSIONS
  The prognostic stratification of CHF patients by 3C-HF score allows one to select patients at different outcome and to identify the factors associated with death in outliers with a very low mortality risk at mid-term follow-up. The reasons why these patients do not outlive the matching part of subjects who expectedly survive are related to a declined renal function and unmodifiable conditions including older age and male gender.
authors: Cardiovascular Center, ASUITS, Italy. Electronic address: giulia.russo@asuits.sanita.fvg.it.
authors: Giulia
authors: G
authors: Russo
authors: Cardiology Department, Villa Bianca Hospital Trento, Italy.
authors: Giovanni
authors: G
authors: Cioffi
authors: Heart Failure Clinic, Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy.
authors: Giovanni
authors: G
authors: Pulignano
authors: Cardiovascular Center, ASUITS, Italy.
authors: Giulia
authors: G
authors: Barbati
authors: Cardiology Department, St. Martino Hospital. Azienda Sanitaria Locale n. 1, Belluno, Italy.
authors: Luigi
authors: L
authors: Tarantini
authors: Department of Cardiocirculatory Diseases, San Giovanni-Addolorata Hospital, Rome, Italy.
authors: Donatella
authors: D
authors: Del Sindaco
authors: Cardiovascular Center, ASUITS, Italy.
authors: Carmine
authors: C
authors: Mazzone
authors: Cardiovascular Center, ASUITS, Italy.
authors: Antonella
authors: A
authors: Cherubini
authors: Cardiovascular Center, ASUITS, Italy.
authors: Giorgio
authors: G
authors: Faganello
authors: Cardiology Department, Villa Bianca Hospital Trento, Italy.
authors: Carlo
authors: C
authors: Stefenelli
authors: Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy.
authors: Michele
authors: M
authors: Senni
authors: Cardiovascular Center, ASUITS, Italy.
authors: Andrea
authors: A
authors: Di Lenarda
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007677:Kidney Function Tests; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume
keywords: Chronic heart failure; Male gender; Mortality; Older age; Prognosis; Renal dysfunction