Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Chrome congestive heart failure
Description and survival of 190 consecutive patients with a diagnosis of chronic congestive heart failure based on clinical signs and symptoms
*Department of Cardiology, Hvidovre Hospital University of Copenhagen
Department of Clinical Physiology, Hvidovre Hospital University of Copenhagen
Department of Radiology, Hvidovre Hospital University of Copenhagen
UNI-C Arhus, Danish Computing Centre for Research and Education Denmark
Received 25 September 1992; revised 22 July 1993; .
Correspondence: Bente Kühn Madsen, Department of Cardiology 253, Hvidovre Hospital, Kettegérd Alle, DK-2650 Hvidovre, Denmark
Abstract
The prognosis, and clinical findings related to prognosis, were examined in a consecutive series of 190 patients under 76 years of age (mean 64 years) with congestive heart failure (CHF). The aetiology of CHF was ischaemic heart disease in 66%, hypertension in 11% and cardiomyopathy in 23%. The 2-year mortality was 32%. Median left ventricular ejection fraction (LVEF) was 0·30, range 0·06 to 0·74. Eight per cent were in New York Heart Association (NYHA) class I, 46% in II, 44% in III and 2% in IV.
Multivariate analysis, excluding exercise test variables, revealed seven variables with independent, significant prognostic information, (hazard ratios for death in brackets): In (natural logarithm) (LVEF) (3·19), NYHA class III+IV (2·72), plasma urea>7·6 mmol. 1–1 (2·22), serum creatinine >121 µmol. 1–1 (2·05), serum sodium <137 mmol. 1–1 (2·03), pulmonary congestion on X- ray (1·86), and age >65 years (1·86). Multivariate analysis, including exercise testing, showed the following variables to contain independent, significant prognostic information: increase in heart rate during maximal exercise 
35 min–1 (3·5), In(LVEF) (3·7), serum creatinine >121 µmol. 1–1 (2·9), maximal exercise time 4 min (2·3), serum sodium 137 mmol. 1–1 (2·5), ischaemic heart disease (2·0) and plasma urea >7·6 mmol. 1–1 (19).
In conclusion, patients with CHF have a high risk of death despite intensive medical treatment. LVEF is a strong predictor of mortality. Both NYHA class and exercise variables have strong independent prognostic information as regards mortality in combination with LVEF, but are mutually exclusive.
Key Words: Ejection fraction • exercise • congestive heart failure • functional class • prognosis
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