Establishing prognosis in heart failure: a multimarker approach

As a leading cause of death worldwide, predicting the progression of heart failure is important from the perspectives of facilitating patient and physician understanding of disease course and of determining the appropriate timing of the increasing number of medications and invasive interventions available to the advanced heart failure patient. Many features of a patient's history, laboratory findings, and imaging evaluation correlate with prognosis. This article begins with a review of individual markers that contribute to the risk of adverse events. These individual variables can be combined into multivariate models of outcome, most commonly expressed as life expectancy or probability of death within a certain time period. A representative sample of the better-validated models in the heart failure patient is then summarized and compared. The value in applying these predictors to several specific points in medical decision making is highlighted.