European Heart Journal Advance Access originally published online on April 25, 2007
European Heart Journal 2007 28(9):1128-1134; doi:10.1093/eurheartj/ehm102
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Prognosis of all-cause heart failure and borderline left ventricular systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES)
1 Department of Primary Care and General Practice, Primary Care Clinical Sciences Building, University of Birmingham, Birmingham B15 2TT, UK
2 Department of Cardiology, Selly Oak Hospital, Birmingham, UK
Received 27 May 2006; revised 8 March 2007; accepted 15 March 2007; online publish-ahead-of-print 25 April 2007.
* Corresponding author. Tel: +44 121 414 3858; fax: +44 121 414 3050. E-mail address: f.d.r.hobbs{at}bham.ac.uk
See page 1047 for the editorial comment on this article (doi:10.1093/eurheartj/ehl573)
Aims: Heart failure (HF) is reported to have an essentially malignant prognosis that can be modified by several interventions. Most outcome data on HF are available from randomized controlled treatment trials and longitudinal epidemiological studies. However, for a number of reasons, neither type of study have, to date, provided generalizable data on HF mortality. Furthermore, data on the prognosis of borderline left ventricular systolic dysfunction (LVSD) are even more limited.
Methods and results: ECHOES (Echocardiographic Heart of England Screening Study) screened a total of 6162 patients from a total of 10 161 invited (61% response rate). Patients were randomly selected from four pre-specified cohorts: the general population, diuretic users, those with a prior clinical label of HF, and a population with risk factors for HF, to identify the prevalence of HF and LVSD based on clinical assessment, ECG, and echocardiography. Causes of death during a 5–9 year follow-up period were recorded from routine mortality statistics. The 5-year survival rate of the general population was 93%, compared with 69% of those with LVSD without HF, 62% with HF and no LVSD, and 53% with HF plus LVSD. Survival improved significantly with increasing ejection fraction (EF) (log rank test for trend, 
2 = 534.5, 1, P < 0.0001).
Conclusion: The ECHOES mortality data confirm the poor prognosis of patients suffering prevalent HF across the community with a mortality risk estimate of 9% per year. Borderline systolic dysfunction (EF 40–50%) on echocardiography carries a poor prognosis.
Key Words: Heart failure • LVSD • Mortality • Prognosis • Community • ECHOES
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