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Short-term mortality in end-stage heart failure patients
Jose Maria Verdú-Rotellar1, Esther Calero2, Rosa Abellana3
1Gerencia Atención Primaria de Barcelona, Institut Català de la Salut, Barcelona, Spain; Primary Health Care University Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain; School of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain.
Insights
Factors like male gender, older age, and low BMI increase short-term mortality in advanced heart failure (HF). Low blood pressure, poor kidney function, cancer, and high diuretic doses predict long-term mortality in HF patients.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- Advanced heart failure (HF) presents significant challenges in patient management and prognosis.
- Identifying key mortality predictors is crucial for optimizing care in end-stage HF patients.
Purpose of the Study:
- To analyze the primary factors influencing short-term and long-term mortality in patients with advanced heart failure (HF).
- To identify easily measurable variables that can aid in clinical decision-making for advanced HF stages.
Main Methods:
- A multicenter cohort study involving 1148 patients with advanced HF (NYHA IV).
- Patients were followed for one year, with mortality assessed at 1, 3, 6, and 12 months using multivariate logistic regression.
Main Results:
- Male gender, advanced age, and decreased body mass index (BMI < 20kg/m²) were associated with higher short-term mortality.
- Low systolic blood pressure, reduced glomerular filtration, malignancy, and higher loop diuretic doses correlated with increased medium- and long-term mortality.
- Low BMI was a significant risk factor across the entire follow-up period.
Conclusions:
- Short-term mortality in advanced HF is significantly influenced by demographic factors and BMI.
- Long-term survival is impacted by comorbidities like reduced kidney function and malignancy, alongside treatment intensity.
- These findings provide valuable, measurable indicators to guide clinical strategies for patients in the most advanced stages of heart failure.
Objectives:
This study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF).
Setting:
Patients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain).
Participants:
Patients with Advanced HF.
Design:
Multicenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV.
Main Measurements:
The primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months.
Results:
Mean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20kg/m2 (three months OR 3.06, 95% CI: 1.58-5.92; six months OR 4.42, 95% CI: 2.08-9.38; and 12 months OR 3.68, 95% CI: 1.76-7.69).
Conclusions:
We may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease.
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