Skip Navigation

European Heart Journal 2002 23(23):1861-1866; doi:10.1053/euhj.2002.3282
Copyright © 2002 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (31)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Muntwyler, J.
Right arrow Articles by Follath, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Muntwyler, J.
Right arrow Articles by Follath, F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

One-year mortality among unselected outpatients with heart failure

J. Muntwylera,f1, G. Abetelb, C. Grunera and F. Follatha

a Department of Internal Medicine, University Hospital, Zürich, Switzerland
b Medical Office, Orbe, Switzerland

revised April 16, 2002; accepted April 17, 2002

Abstract

Objective To estimate 1-year mortality and prognostic factors in unselected outpatients with heart failure, and to compare the observed mortality with the estimates of the primary care physicians.

Methods and Results Four hundred and eleven consecutive patients with heart failure New York Heart Association (NYHA) class II–IV (mean population age 75 years, 56% males) were enrolled in 71 primary care offices throughout Switzerland. During a mean follow-up period of 1·4 years, 68 patients had died. One-year total mortality was 12·6% compared to 4·3% in the underlying Swiss population (standardized mortality ratio 3·0). Among patients with heart failure NYHA II, III and IV, mortality was 7·1%, 15·0% and 28·0%, respectively. In multivariate Cox regression, statistically significant (P<0·05) predictors of mortality were NYHA class (NYHA III: risk ratio [RR]=1·6; NYHA IV: RR=2·2), recent hospital stay for heart disease (RR=2·3), creatinine>120µmol.l–1 (RR=1·8) systolic blood pressure<100mmHg (RR=2·4), heart rate>100min–1 (RR=2·7), age (per 10 years, RR=1·6) and female gender (RR=0·49). Among patients with reduced left ventricular ejection fraction, 1-year mortality was 14·3%, and predictors were similar except that female gender was no longer associated with reduced mortality. Primary care physicians significantly overestimated 1-year mortality (estimated mortality 25·9% vs observed mortality 12·6%,P =0·001).

Conclusions Unselected outpatients with heart failure have a poor prognosis, particularly those with advanced heart failure and a recent hospital stay for heart disease. Primary care physicians are aware of the high mortality of this growing patient population. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved

Key Words: Heart failure, prognosis, mortality, cohort study.

f1 Correspondence: Dr Jörg Muntwyler, Department of Internal Medicine, Room C-Hor 47, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland.

References

  1. Reitsma JB, Dalstra JA, Bonsel GJ. Cardiovascular disease in the Netherlands, 1975 to 1995: decline in mortality, but increasing numbers of patients with chronic conditions. Heart. 1999;82:52–56[Abstract/Free Full Text]
  2. Bonneux L, Looman CW, Barendregt JJ, Van der Maas PJ. Regression analysis of recent changes in cardiovascular morbidity and mortality in The Netherlands. BMJ. 1997;314:789–792[Abstract/Free Full Text]
  3. Cowie MR, Mosterd A, Wood DA. The epidemiology of heart failure. Eur Heart J. 1997;18:208–225[Free Full Text]
  4. McMurray JJ, Petrie MC, Murdoch DR, Davie AP. Clinical epidemiology of heart failure: public and private health burden. Eur Heart J. 1998;19:9–16
  5. Zannad F, Braincon S, Juilliere Y. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Epidemiologie de l'Insuffisance Cardiaque Avancee en Lorraine. J Am Coll Cardiol. 1999;33:734–742[Abstract/Free Full Text]
  6. Brophy JM, Deslauriers G, Rouleau JL. Long-term prognosis of patients presenting to the emergency room with decompensated congestive heart failure. Can J Cardiol. 1994;10:543–547[ISI][Medline]
  7. Lowe JM, Candlish PM, Henry DA, Wlodarcyk JH, Heller RF, Fletcher PJ. Management and outcomes of congestive heart failure: a prospective study of hospitalised patients. Med J Aust. 1998;168:115–118[ISI][Medline]
  8. Lucas C, Johnson W, Hamilton MA. Freedom from congestion predicts good survival despite previous class IV symptoms of heart failure. Am Heart J. 2000;140:840–847[CrossRef][ISI][Medline]
  9. MacIntyre K, Capewell S, Stewart S. Evidence of improving prognosis in heart failure: trends in case fatality in 66547 patients hospitalized between 1986 and 1995. Circulation. 2000;102:1126–1131[Abstract/Free Full Text]
  10. Stewart S, MacIntyre K, Hole DJ, Capewell S, McMurray JJ. More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail. 2001;3:315–322[CrossRef][ISI][Medline]
  11. Jaagosild P, Dawson NV, Thomas C. Outcomes of acute exacerbation of severe congestive heart failure: quality of life, resource use, and survival. SUPPORT Investigators. The Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatments. Arch Intern Med. 1998;158:1081–1089[Abstract/Free Full Text]
  12. McAlister FA, Teo KK, Taher M. Insights into the contemporary epidemiology and outpatient management of congestive heart failure. Am Heart J. 1999;138:87–94[CrossRef][ISI][Medline]
  13. Nolan J, Batin PD, Andrews R. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation. 1998;98:1510–1516[Abstract/Free Full Text]
  14. Campana C, Gavazzi A, Berzuini C. Predictors of prognosis in patients awaiting heart transplantation. J Heart Lung Transplant. 1993;12:756–765[ISI][Medline]
  15. Oechslin E, Brunner-LaRocca HP, Solt G. Prognosis of medically treated patients referred for cardiac transplantation. Int J Cardiol. 1998;64:75–81[CrossRef][ISI][Medline]
  16. Lancet. 1999;353:2001–2007[CrossRef][ISI][Medline]
  17. Lancet. 1999;353:9–13[CrossRef][ISI][Medline]
  18. N Engl J Med. 1997;336:525–533[Abstract/Free Full Text]
  19. Kupari M, Lindroos M, Iivanainen AM, Heikkila J, Tilvis R. Congestive heart failure in old age: prevalence, mechanisms and 4-year prognosis in the Helsinki Ageing Study. J Intern Med. 1997;241:387–394[CrossRef][ISI][Medline]
  20. Eriksson H, Wilhelmsen L, Caidahl K, Svardsudd K. Epidemiology and prognosis of heart failure. Z Kardiol. 1991;80:1–6[ISI][Medline]
  21. Mosterd A, Cost B, Hoes AW. The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J. 2001;22:1318–1327[Abstract/Free Full Text]
  22. Muntwyler J, Follath F. [Medical treatment of heart failure: an analysis of actual treatment practices in outpatients in Switzerland. Schweiz Med Wochenschr. 2000;130:1192–1198[ISI][Medline]
  23. Eur J Heart Fail. 1999;1:139–144[CrossRef][ISI][Medline]
  24. Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J. 2001;22:1527–1560[Free Full Text]
  25. Mosterd A, Deckers JW, Hoes AW. Classification of heart failure in population based research: an assessment of six heart failure scores. Eur J Epidemiol. 1997;13:491–502[CrossRef][ISI][Medline]
  26. Swiss Federal Statistical Office, Mortality tables 1999/2000, 2001
  27. Cowie MR, Wood DA, Coats AJ. Incidence and aetiology of heart failure; a population-based study. Eur Heart J. 1999;20:421–428[Abstract/Free Full Text]
  28. Senni M, Tribouilloy CM, Rodeheffer RJ. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998;98:2282–2289[Abstract/Free Full Text]
  29. Cowie MR, Wood DA, Coats AJ. Survival of patients with a new diagnosis of heart failure: a population based study. Heart. 2000;83:505–510[Abstract/Free Full Text]
  30. Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190–1195[Abstract/Free Full Text]
  31. Stewart S, Marley JE, Horowitz JD. Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study. Lancet. 1999;354:1077–1083[CrossRef][ISI][Medline]
  32. Mosterd A, Reitsma JB, Grobbee DE. Angiotensin converting enzyme inhibition and hospitalisation rates for heart failure in the Netherlands, 1980 to 1999: the end of an epidemic? Heart. 2002;87:75–76[Free Full Text]
  33. Polanczyk CA, Rohde LE, Philbin EA, Di Salvo TG. A new casemix adjustment index for hospital mortality among patients with congestive heart failure. Med Care. 1998;36:1489–1499[CrossRef][ISI][Medline]
  34. Pernenkil R, Vinson JM, Shah AS, Beckham V, Wittenberg C, Rich MW. Course and prognosis in patients > or=70 years of age with congestive heart failure and normal versus abnormal left ventricular ejection fraction. Am J Cardiol. 1997;79:216–219[CrossRef][ISI][Medline]
  35. Senni M, Tribouilloy CM, Rodeheffer RJ. Congestive heart failure in the community: trends in incidence and survival in a 10-year period. Arch Intern Med. 1999;159:29–34[Abstract/Free Full Text]
  36. Simon T, Mary-Krause M, Funck-Brentano C, Jaillon P. Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Circulation. 2001;103:375–380[Abstract/Free Full Text]
  37. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993;88:107–115[Abstract/Free Full Text]
  38. Adams KF Jr., Sueta CA, Gheorghiade M. Gender differences in survival in advanced heart failure. Insights from the FIRST study. Circulation. 1999;99:1816–1821[Abstract/Free Full Text]
  39. Fonarow GC, French WJ, Parsons LS, Sun H, Malmgren JA. Use of lipid-lowering medications at discharge in patients with acute myocardial infarction. Circulation. 2001;103:38–44[Abstract/Free Full Text]
  40. Brown AM, Cleland JG. Influence of concomitant disease on patterns of hospitalization in patients with heart failure discharged from Scottish hospitals in 1995. Eur Heart J. 1998;19:1063–1069[Abstract/Free Full Text]
  41. Hobbs FD. Primary care physicians: champions of or an impediment to optimal care of the patient with heart failure? Eur J Heart Fail. 1999;1:11–15[CrossRef][ISI][Medline]
  42. Witte K, Thackray S, Clark AL, Cooklin M, Cleland JG. Clinical trials update: IMPROVEMENT-HF, COPERNICUS, MUSTIC, ASPECT-II, APRICOT and HEART. Eur J Heart Fail. 2000;2:455–460[CrossRef][ISI][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur Heart JHome page
I. Squire
Assessing prognosis in heart failure: you can see a lot if you look, but more if you look again ... ... ...
Eur. Heart J., April 2, 2008; 29(8): 959 - 960.
[Full Text] [PDF]

Home page
 JRSMHome page
D. Munday, J. Dale, and S. Murray
Choice and place of death: individual preferences, uncertainty, and the availability of care
J R Soc Med, May 1, 2007; 100(5): 211 - 215.
[Full Text] [PDF]

Home page
 HeartHome page
C. Raphael, C. Briscoe, J. Davies, Z. Ian Whinnett, C. Manisty, R. Sutton, J. Mayet, and D. P Francis
Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure
Heart, April 1, 2007; 93(4): 476 - 482.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
B. C. Huynh, A. Rovner, and M. W. Rich
Long-term Survival in Elderly Patients Hospitalized for Heart Failure: 14-Year Follow-up From a Prospective Randomized Trial.
Arch Intern Med, September 25, 2006; 166(17): 1892 - 1898.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
M. Tonelli, N. Wiebe, B. Culleton, A. House, C. Rabbat, M. Fok, F. McAlister, and A. X. Garg
Chronic Kidney Disease and Mortality Risk: A Systematic Review
J. Am. Soc. Nephrol., July 1, 2006; 17(7): 2034 - 2047.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
P. Ammann, C. Sticherling, D. Kalusche, J. Eckstein, A. Bernheim, B. Schaer, and S. Osswald
An Electrocardiogram-Based Algorithm To Detect Loss of Left Ventricular Capture during Cardiac Resynchronization Therapy
Ann Intern Med, June 21, 2005; 142(12_Part_1): 968 - 973.
[Abstract] [Full Text] [PDF]

Home page
 HypertensionHome page
K. Kalantar-Zadeh, R. D. Kilpatrick, C. J. McAllister, S. Greenland, and J. D. Kopple
Reverse Epidemiology of Hypertension and Cardiovascular Death in the Hemodialysis Population: The 58th Annual Fall Conference and Scientific Sessions
Hypertension, April 1, 2005; 45(4): 811 - 817.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
M. G. Shlipak, G. L. Smith, S. S. Rathore, B. M. Massie, and H. M. Krumholz
Renal Function, Digoxin Therapy, and Heart Failure Outcomes: Evidence from the Digoxin Intervention Group Trial
J. Am. Soc. Nephrol., August 1, 2004; 15(8): 2195 - 2203.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
K. Kalantar-Zadeh, G. Block, T. Horwich, and G. C. Fonarow
Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure
J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1439 - 1444.
[Abstract] [Full Text] [PDF]

Home page
 Journal of Renin-Angiotensin-Aldosterone SystemHome page
M. Tendera
The epidemiology of heart failure
Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1_suppl): S2 - S6.
[Abstract] [PDF]

Home page
 Journal of Renin-Angiotensin-Aldosterone SystemHome page
T. Murray-Thomas and M. R Cowie
Epidemiology and clinical aspects of congestive heart failure
Journal of Renin-Angiotensin-Aldosterone System, September 1, 2003; 4(3): 131 - 136.
[Abstract] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (31)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Muntwyler, J.
Right arrow Articles by Follath, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Muntwyler, J.
Right arrow Articles by Follath, F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?