Death in heart failure: a community perspective.

Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Circulation Heart Failure (Impact Factor: 6.68). 07/2008; 1(2):91-7. DOI: 10.1161/CIRCHEARTFAILURE.107.743146
Source: PubMed

ABSTRACT Mortality in heart failure (HF) remains high but causes of death are incompletely defined. As HF is heterogeneous syndrome categorized according to ejection fraction (EF), the association between EF and causes of death is important, yet elusive.
Community subjects with HF were classified according to preserved (> or =50%) and reduced EF (<50%). Deaths were classified as coronary heart disease (CHD), other cardiovascular and non-cardiovascular. Among 1063 persons with HF, 45% had preserved EF with less cardiovascular risk factors and less coronary disease than those with reduced EF. At 5 years, survival was 45% (95% CI 43%-49%) and 43% of the deaths were non-cardiovascular. The leading cause of death in subjects with preserved EF was non-cardiovascular (49%) vs CHD (43%) for subjects with reduced EF. The proportion of cardiovascular deaths decreased from 69% in 1979-1984 to 40% in 1997-2002 (p=0.007) among subjects with preserved EF contrasting with a modest change among those with reduced EF (77% in to 64%, p=0.08). Advanced age, male sex, diabetes, smoking and kidney disease were associated with an increase risk of all cause and cardiovascular death. After adjustment, preserved EF was associated with a lower risk of cardiovascular death but not all cause death.
Community subjects with HF experience a persistently high mortality and a large proportion of deaths are non-cardiovascular. Subjects with preserved EF have less cardiovascular disease before death, are less likely to experience cardiovascular deaths than those with reduced EF and the proportion of cardiovascular deaths declined over time.

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    ABSTRACT: ABSTRACT Heart failure (HF) is a clinical syndrome, which is becoming a major public health problem in recent decades, due to its increasing prevalence, especially in the developed countries, mostly due to prolonged lifespan of the general population as well as the increased of HF patients. The HF treatment, particularly, new pharmacological and non-pharmacological agents, has markedly improved clinical outcomes of patients with HF including increased life expectancy and improved quality of life. However, despite the facts that mortality in HF patients has decreased, it still remains unacceptably high. This review of summarizes the evidence to date about the mortality of HF patients. Despite the impressive achievements in the pharmacological and non-pharmacological treatment of HF patients which has undeniably improved the survival of these patients, the mortality still remains high particularly among elderly, male and African American patients. Patients with HF and reduced ejection fraction have higher mortality rates, most commonly due to cardiovascular causes, compared with patients with HF and preserved ejection fraction. Key words: heart failure, mortality, race, elderly, gender
    Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 08/2014; DOI:10.5152/akd.2014.5731 · 0.76 Impact Factor
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    ABSTRACT: BACKGROUND: Comorbidities are a major concern in heart failure, leading to adverse outcomes, increased health care utilization, and excess mortality. Nevertheless, the epidemiology of comorbid conditions and differences in their occurrence by type of heart failure and sex are not well documented. METHODS: The prevalence of 16 chronic conditions defined by the US Department of Health and Human Services was obtained among 1382 patients from Olmsted County, Minn. diagnosed with first-ever heart failure between 2000 and 2010. Heat maps displayed the pairwise prevalences of the comorbidities and the observed-to-expected ratios for occurrence of morbidity pairs by type of heart failure (preserved or reduced ejection fraction) and sex. RESULTS: Most heart failure patients had 2 or more additional chronic conditions (86%); the most prevalent were hypertension, hyperlipidemia, and arrhythmias. The co-occurrence of other cardiovascular diseases was common, with higher prevalences of co-occurring cardiovascular diseases in men compared with women. Patients with preserved ejection fraction had one additional condition compared with those with reduced ejection fraction (mean 4.5 vs 3.7). The patterns of co-occurring conditions were similar between preserved and reduced ejection fraction; however, differences in the ratios of observed-to-expected co-occurrence were apparent by type of heart failure and sex. In addition, some psychological and neurological conditions co-occurred more frequently than expected. CONCLUSION: Multimorbidity is common in heart failure, and differences in co-occurrence of conditions exist by type of heart failure and sex, highlighting the need for a better understanding of the clinical consequences of multiple chronic conditions in heart failure patients. (c) 2015 Elsevier Inc. All rights reserved.
    The American Journal of Medicine 09/2014; 128(1). DOI:10.1016/j.amjmed.2014.08.024 · 5.30 Impact Factor
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    ABSTRACT: AimsThe prognostic impact of coronary artery disease (CAD) in heart failure is debated. Whereas causes of death have been well described in patients with cardiomyopathy, little is known about how CAD influences causes of death in heart failure with preserved ejection fraction (HFPEF). We undertook a 10-year study and analysed causes of death in relation with CAD in HFPEF and in heart failure with reduced ejection fraction (HFREF).Methods and ResultsOur prospective analysis included 591 consecutive patients (320 HFPEF and 271 HFREF) hospitalized for the first time for heart failure during 2000 and followed for 10 years. History of CAD was documented in 25% of HFPEF and 39% of HFREF patients (P < 0.001). Overall, CAD was independently predictive of all-cause and cardiovascular death. CAD had powerful prognostic impact in HFREF [adjusted hazard ratio (HR) 1.60 (1.19–2.15) for all-cause death, and adjusted HR 2.01 (1.38–2.92) for cardiovascular death]. In HFPEF, the association between CAD and cardiovascular death was no longer observed after adjustment [adjusted HR 1.01 (0.69–1.50)]. In HFREF, CAD was associated with increased risk of heart failure-related (adjusted HR 2.03 (1.21–3.43)] and myocardial infarction-related fatal events [adjusted HR 3.84 (1.16–12.7)], while HFPEF patients with CAD appeared at greater risk of sudden death [adjusted HR 2.22 (1.05–4.95)].Conclusion The prognostic impact of CAD is different in HFPEF compared with HFREF. Patients with HFPEF and CAD are at high risk of cardiovascular death, especially sudden death.
    European Journal of Heart Failure 08/2014; 16(9). DOI:10.1002/ejhf.142 · 6.58 Impact Factor


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