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Reasons why patients suffering from chronic heart failure at very low risk for mortality die

By Giulia Russo, Giovanni Cioffi, Giovanni Pulignano, Giulia Barbati, Luigi Tarantini, Donatella Del Sindaco, Carmine Mazzone, Antonella Cherubini, Giorgio Faganello, Carlo Stefenelli, Michele Senni and Andrea Di Lenarda


BACKGROUND:\ud 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%.\ud METHODS:\ud 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).\ud RESULTS:\ud 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).\ud CONCLUSIONS:\ud 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

Topics: Chronic heart failure, Male gender, Mortality, Older age, Prognosis, Renal dysfunction, Medicine (all), Cardiology and Cardiovascular Medicine
Year: 2016
DOI identifier: 10.1016/j.ijcard.2016.08.326
OAI identifier: oai:arts.units.it:11368/2882389
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