Pattern and predictors of one-year mortality in heart failure: China PEACE Prospective Heart Failure Study

Abstract

Background: Heart failure (HF) is a global public health problem, which causes high mortality. Purpose: To characterize the pattern of 1-year mortality, including the rate and timing of death, and to identify clinical and non-clinical factors predicting 1-year all-cause mortality after hospitalization for HF. Methods: We prospectively enrolled patients who were hospitalized primarily for HF and discharged alive from 52 hospitals across 20 provinces in China between August 2016 and May 2018, and followed them up by face-to-face interview or telephone. Patients' fatal status were ascertained according to investigators' report and national death registration. Cognitive function was measured by Mini-Cog score and health status was measured by Kansas City Cardiomyopathy Questionnaire (KCCQ). We fitted a Cox proportional hazards model accounting for hospital as random effects to identify patient characteristics associated with 1-year all-cause mortality. Results: Among 4899 patients, 4882 (97.7%) completed 1-year follow-up. The median (IQR) age was 67 (57, 75) years and 37.5% were women. The main etiology of HF was ischemic heart disease (53.1%), 66.0% of patients had history of HF before the index hospitalization. Among 813 deaths within one year after discharge, 13.4% and 58.4% occurred within one months and six months, respectively. Systolic blood pressure <100mmHg at admission (hazard ratio [HR] 2.33, 95% CI 1.76-3.08), NYHA class IV (HR 1.37, 95% CI 1.1-1.7), anemia (HR 1.3, 95% CI 1.1- 1.54), hs-cTNT≥18 ng/L (HR 1.84, 95% CI 1.53-2.22), hyponatremia (HR 1.66, 95% CI 1.38-1.98), LVEF<40% (HR 1.25, 95% CI 1.02-1.53), QRS interval≥120mms (HR 1.19, 95% CI 1.02-1.4), Cognitive impairment (HR 1.25, 95% CI 1.07-1.46) and low KCCQ score (HR 1.24 per 25 score decrease, 95% CI 1.11-1.39) were associated with higher risks of 1-year all-cause mortality. In contrast, female (HR 0.83, 0.7-0.99), sleep apnea syndrome (HR 0.55, 95% CI 0.35-0.88) were associated with lower risks of 1-year all-cause mortality. Conclusion: In China, one in six patients hospitalized for HF die within 1-year, with the majority occurring during the first 6 months after hospital discharge. Both clinical and non-clinical factors predict 1-year mortality.