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Differential clinical prognostic classifications in dilated and ischemic advanced heart failure: the EPICAL study
F Alla1, S Briançon, Y Juillière
1Department of Epidemiology and Cardiology, University Hospital, Nancy, France. f.alla@chu-nancy.fr
Background:
The clinical management of severe congestive heart failure (CHF) should be graded according to the prognosis of each individual patient. Our objective was to elaborate a prognostic rating system for severe CHF.
Methods:
The EPICAL program (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) identified patients with severe CHF defined by hospitalization accompanied by class III/IV dyspnea, edema, or hypertension; an ejection fraction /=60%. Baseline variables were tested in Cox multivariate models.
Results:
Patients with ischemic heart disease (n = 219) had a lower 1-year survival rate (57.6%) than patients with dilated cardiomyopathy (n = 182) (69. 1%). Multivariate analysis identified 5 prognostic factors for ischemic CHF and 7 for CHF caused by dilated cardiomyopathy. These variables were used to classify patients within prognostic subgroups of good (>75%), intermediate, or poor (
Conclusion:
A score for prognostic prediction was further derived from readily available data to help physicians improve decision making and to assist in clinical trials as a stratification tool.