Preserved systolic ventricular function heart failure patients referred to a division of internal medicine

At least 70% of patients with heart failure (HF) are referred to departments of internal medicine. Some 40-50% have preserved systolic ventricular function (PSVF; LVEF > 0.45). The aim of this study was to evaluate survival and prognostic value of several functional parameters in PSVF-HF patients admitted to a department of internal medicine.

Eighty-two consecutive patients hospitalized between January 1 and December 31, 2001 (44 men and 38 women, mean age 63.7 years) were followed up for a mean period of 37 months. The severity of symptoms at admission was assessed by NYHA classification. Twenty-five patients were in NYHA class I, 43 in II, and 14 in III-IV. All patients underwent chest X-ray, echocardiogram, and a 6-minute walking test.

Seventeen patients (20.7%) died, 16 of cardiovascular causes and 1 of cancer. Survival was not affected by etiology, sex, age, left ventricular ejection fraction (LVEF), LV filling pattern, or pulmonary artery pressure. With univariate analysis, NYHA class at admission was the strongest predictor of death. Distance covered after the 6-minute walking test was also related to survival. The Cox stepwise regression model showed that only NYHA class at admission (p < 0.05) was significantly related to survival.

During a 3-year follow-up, mortality in PSVF-HF patients referred to a department of internal medicine is close to 7% per year. A high NYHA class at admission and decreased functional capacity (i.e., distance walked at 6 min < 350 m) are related to a worse prognosis.