Clinical factors useful to identify heart failure patients with high risk of death

November 18, 2003

CHICAGO - Factors identifiable at the time of hospitalization can predict the risk of death for heart failure patients, according to an article in the November 19 issue of The Journal of the American Medical Association (JAMA).

Heart failure is a condition with a poor prognosis: 1-year death rates in population-based studies have been reported to be 35 percent to 40 percent, according to background information in the article. Although heart failure is a common, serious condition treated by both generalist and specialist physicians, few methods exist to help quantatitively estimate patient prognosis. Knowledge of predictors of death could be used to generate predictive models that could aid clinicians' decision making, in particular by identifying patients who are at high or low risk of death, and could be useful for clinicians to improve communication with and care of hospitalized patients.

Douglas S. Lee, M.D., of the University of Toronto, Ontario, and colleagues conducted a study to develop a method to predict the risk of death at both 30 days and 1 year in heart failure patients based on information routinely available to clinicians at the time of admission to the hospital, such as demographic features, vital signs, and other patient conditions. The study included 4,031 patients presenting with heart failure at multiple hospitals in Ontario, Canada, who had been identified as part of the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study.

The researchers found that predictors of death at both 30 days and 1 year included older age, lower systolic blood pressure, higher respiratory rate, higher blood urea nitrogen levels, and hyponatremia (low sodium level in the blood). Other conditions associated with death included presence of cerebrovascular disease (43 percent increased risk of death at 30-days), chronic obstructive pulmonary disease (66 percent increased risk of death), hepatic cirrhosis (more that three times increased risk of death), dementia (2.5 times increased risk of death), and cancer (nearly two times increased risk of death).

A risk index stratified the risk of death and identified low- and high-risk individuals. Patients with very low risk scores (60 or less) had a death rate of 0.4 percent at 30 days and 7.8 percent at 1 year. Patients with very high risk scores (greater than 150) had a mortality rate of 59.0 percent at 30 days and 78.8 percent at 1 year. Patients with higher 1-year risk scores had reduced survival at all times up to 1 year.

"The risk index provides estimates of risk that may assist clinicians in counseling patients and families and guides clinical decision making," the researchers conclude.
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(JAMA. 2003;290:2581-2587. Available post-embargo at JAMA.com)

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