Cardiology Letters 2012, 21(6):474-481

Characteristics and long-term survival in patients with advanced heart failure.

Lesný P¹, Luknár M¹, Varga I¹, Solík P¹, Šoóšová I¹, Wimmerová S²

¹ Národný ústav srdcových a cievnych chorôb, a.s. v Bratislave

² Slovenská zdravotnícká univerzita v Bratislave, Slovenská republika

Background: The prognosis of patients with advanced heart failure (HF) is unfavourable. Patients who are heart transplant candidates constitute a selected group of patients with advanced HF.

Aim: To analyze the demographic and descriptive characteristics, long-term course and survival in patients with advanced heart failure hospitalized at the Heart Failure and Transplant Department (OZaT) of the National Cardiovascular Institute in Bratislava.

Patients and methods: Consecutive patients (pts) with HF hospitalized at the OZaT from January 1, 1998, to January 1, 2010, were included in the follow-up and evaluation. All pts were referred by regional cardiologists in order to evaluate the eligibility of heart transplantation. Selected demographic, clinical, laboratory, treatment, and other parameters were recorded for each patient at the first hospitalization. Survival of patients was assessed using survival analysis methods and expressed using a Kaplan-Meier curve.

Results: One thousand pts were eligible for the analysis. Mean age was 49.0±10.9 years, 86.8% were men, mean NYHA class 2.6±0.7, left ventricular end diastolic diameter 67.7±9.9 mm, left ventricular ejection fraction 24.3±7.7%, and median NT-proBNP 2297 pg/mL. The most frequent underlying causes of HF were dilated cardiomyopathy (57.0% of pts), coronary artery disease (27.5%), and arterial hypertension (7.1%). Most important comorbidities included arterial hypertension (43.0% of pts), atrial fibrillation (24.6%), diabetes mellitus (25.1%), and anaemia 17.2%. At hospital admission, 21.5% of pts received intravenous treatment. Angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker and beta-blocker use was 94.3% and 81.2%, resp. The dosing was relatively low (30-63% of target doses). Cumulative survival was as follows: 1-year 83%, 3-year 63%, 5-year 50%, 7-year 39%, and 10-year 23%.

Conclusion: The paper shows a long-term follow-up of a large and selected cohort of pts from one centre that reflects the course of HF with severe left ventricular systolic dysfunction, barely modified by important comorbidities. The mortality of pts with advanced HF remains still high, with 50% of pts surviving 5 years. Probability of surviving 10 years in the cohort of pts with mean age of 50 years is only 23%.

Keywords: advanced heart failure; survival; treatment; prognosis

Published: June 1, 2012  Show citation