One-year mortality among unselected outpatients with heart failure

Abstract

Objective: To estimate 1-year mortality and prognostic factors in unselected outpatients with heart failure, and to compare the observed mortality with the estimates of the primary care physicians. Methods and Results: Four hundred and eleven consecutive patients with heart failure New York Heart Association (NYHA) class II-IV (mean population age 75 years, 56% males) were enrolled in 71 primary care offices throughout Switzerland. During a mean follow-up period of 1·4 years, 68 patients had died. One-year total mortality was 12·6% compared to 4·3% in the underlying Swiss population (standardized mortality ratio 3·0). Among patients with heart failure NYHA II, III and IV, mortality was 7·1%, 15·0% and 28·0%, respectively. In multivariate Cox regression, statistically significant (P<0·05) predictors of mortality were NYHA class (NYHA III: risk ratio [RR]=1·6; NYHA IV: RR=2·2), recent hospital stay for heart disease (RR=2·3), creatinine>120 μmol. 1-1 (RR=1·8) systolic blood pressure<100 mmHg (RR=2·4), heart rate>100 min-1 (RR=2·7), age (per 10 years, RR=1·6) and female gender (RR=0·49). Among patients with reduced left ventricular ejection fraction, 1-year mortality was 14·3%, and predictors were similar except that female gender was no longer associated with reduced mortality. Primary care physicians significantly overestimated 1-year mortality (estimated mortality 25·9% vs observed mortality 12·6%, P=0·001). Conclusions: Unselected outpatients with heart failure have a poor prognosis, particularly those with advanced heart failure and a recent hospital stay for heart disease. Primary care physicians are aware of the high mortality of this growing patient population. © 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.