Calculator “Available prognosis”: Method of evaluation for predicting survival of patients with chronic heart failure and reduced left ventricular ejection fraction

Abstract

Background. A method for predicting one-year survival of patients with heart failure and reduced ejection fraction (HFrEF) is required to choose a management tactics and determine indications for high-tech care at the outpatient stage. Aim. To develop a method for proper prediction of survival of patients with HFrEF in outpatient clinics. Materials and methods. This was a prospective study of 212 patients with functional class II–IV CHF of non-valvular origin and LV EF (Simpson) ≤35% aged 18–70, including 176 (83%) men and 36 (17%) women who had given an informed consent to participate in the study. Study design: hospitalization to a specialized department for treatment of heart failure; best titration of tolerated doses and stabilization of the patient’s condition; evaluation of status; laboratory and instrumental tests; outpatient follow-up by an HF specialist (visits, telephone contacts, therapy adjustment, and admission to a specialized HF department in case of decompensation); 200-item database population; recording the composite endpoint (cardiovascular death, or implantation of a mechanical circulatory assist (MCA) device, or heart transplantation (HT) within 12 months). Results. For 12 months, 135 (64%) patients survived; a MCA device was implanted to 5 (2%) patients; HT was performed for 21 (10%) patients; and a fatal outcome was observed in 51 (24%) patients. Therefore, 77 patients had the composite endpoint. A method for predicting survival was developed using a multiple logistic regression analysis. The developed proper method for survival prediction included the following parameters: age of HFrEF onset; frequency of respiratory movements; systolic blood pressure measured at 3–5 min of ortho-stasis; lymphocyte count, and red cell distribution width. An identified patient with a predicted survival less than one year should be as soon as possible forwarded to a selection panel for considering HT or MCA implantation as a «bridge» to HT. A predicted survival longer than one year is an indication for further outpatient management and considering cardioverter defibrillator implantation. Conclusion. The method for proper outpatient evaluation of survival prognosis for patients with HFrEF allows to predict the one-year survival using routine indexes, such as results of objective examination, case history, and blood count, without additional expenses.