Is the prognosis of congestive heart failure patients still so bad?

Czech version

Authors: O. Ludka; L. Galková; M. Šablaturová; J. Jarkovský; L. Dušek; J. Špinar
Published in: Kardiol Rev Int Med 2011, 13(1): 30-36
Category: From Hypertension to Heart Failure

Overview

Background:
According to a Framingham study, more than half of patients with congestive heart failure die within five years of the occurrence of clinical symptoms, and about 17% of patients within a year of clinical manifestation of the disease.

Aim:
To determine the mortality rate of patients with CHF monitored in the outpatient heart failure clinic of University Hospital Brno.

Methods:
Retrospective analysis of data obtained from outpatient records of consecutive patients with CHF.

Patients:
159 patients, 70.4% men, 29.6% women, age 66 (40–84) years, follow up period 32.5 (11.1–61.9) months (8 to 66 months), NYHA class I–II/II/III 26.4/61.6/12%, LV EF 30 (15–45) %, diastolic dysfunction 94.3%, aetiology of CHF – 68.6% ischaemic heart disease, 22.6% dilatative cardiomyopathy, other 8.8%, comorbidities – hypertension 67.9%, myocardial infarction 49.1%, dyslipoproteinaemia 56.6%, diabetes mellitus 34%, stroke + TIA 11.3%, COPD 8.8%, anemia 16.4%, atrial fibrilation 15.1%, GF according to Cockroft formula 66.8 (27.2–125.2) ml/s, GF < 60 ml/s 44.7%, pharmacological treatment: ACE-I 84.3%, ARB 13.2%, BB 95.6%, loop diuretics 60.4%, hydrochlorothiazid 21.7%, spironolacton 52.8%, digitalis 22.6%, statins 61.6%, non-pharmacological treatment: pacemaker 18.9%, CRT-D 5%, CRT-P 7.5%, PCI 30.2%, CABG 10.1%.

Results:
24 patients (15.1%) died during the monitoring period, 18 (11.3%) of them from non-cardiovascular complications. The cumulative survival rate was 96.2% after first year, 90.8% after the second year, 87.6% after the third year and 82.7% after the fourth year of monitoring.

Conclusion:
Mortality in the Framingham study highly exceeds mortality in our sample, which may be explained not only by improvements in both pharmacological and non-pharmacological treatment strategies, but also by slightly different spectra of patients.

Keywords:
chronic heart failure – prognosis – pharmacological treatment – non-pharmacological treatment

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