3 research outputs found
Severe chronic heart failure in patients considered for heart transplantation in Poland*
Background: Based on the results of clinical trials, the prognosis for patients with severe
heart failure (HF) has improved over the last 20 years. However, clinical trials do not reflect ‘real
life’ due to patient selection. Thus, the aim of the POLKARD-HF registry was the analysis of
survival of patients with refractory HF referred for orthotopic heart transplantation (OHT).
Methods: Between 1 November 2003 and 31 October 2007, 983 patients with severe HF,
referred for OHT in Poland, were included into the registry. All patients underwent routine
clinical and hemodynamic evaluation, with NT-proBNP and hsCRP assessment. Death or an
emergency OHT were assumed as the endpoints. The average observation period was 601 days.
Kaplan-Meier curves with log-rank and univariate together with multifactor Cox regression
model the stepwise variable selection method were used to determine the predictive value of
analyzed variables.
Results: Among the 983 patients, the probability of surviving for one year was approximately
80%, for two years 70%, and for three years 67%. Etiology of the HF did not significantly
influence the prognosis. The patients in NYHA class IV had a three-fold higher risk of death or
emergency OHT. The univariate/multifactor Cox regression analysis revealed that NYHA
IV class (HR 2.578, p < 0.0001), HFSS score (HR 2.572, p < 0.0001) and NT-proBNP plasma
level (HR 1.600, p = 0.0200), proved to influence survival without death or emergency OHT.
Conclusions: Despite optimal treatment, the prognosis for patients with refractory HF is still
not good. NYHA class IV, NT-proBNP and HFSS score can help define the highest risk group.
The results are consistent with the prognosis of patients enrolled into the randomized trials.
(Cardiol J 2012; 19, 1: 36–44