Prognostic assessment of end-stage cardiac failure

Heart failure is not a disease, but rather a complex clinical syndrome that is growing in incidence and carries a very high morbidity and mortality. Although the incidence in the general adult population in the Western world is between 1% and 2%, the frequency increases rapidly in the elderly affecting more than 10% of the individuals over the age of 75 years. The treatment of patients with end-stage chronic heart failure (CHF) is difficult. The two major goals in the treatment of heart failure are to increase the duration (slow its progression) and quality of life (relief of symptoms). Understanding the severity of the syndrome of heart failure in terms of its prognosis can be particularly important in planning long-term management and in counselling the patient. The introduction of aggressive interventional therapies such as active haemodynamic support with ventricular assist devices, or heart transplantation emphasizes the importance of quantitating the risk of death in order to properly select patients for these more aggressive treatments. In large-scale trials it has been possible to identify markers that serve as significant predictors of mortality. Of these, the detection and quantification of neurohumoral activation have gained the most recent attention. Here, we discuss some of the prognostic tools in current use for heart failure patients and their applicability to patients with advanced heart failure.