Long-Term Survival and Prognostic Markers in 1000 Patients with Advanced Heart Failure. A Single-Center Analysis

Abstract

Purpose Heart transplant candidates are a selected group of patients with advanced heart failure (HF). Prognosis estimation is the key determinant of optimal patient management. The aim of the study was to analyze the descriptive characteristics, long-term survival, and mortality predictors in pts with advanced HF hospitalized at a single centre. Methods and Materials Consecutive patients with HF considered for heart transplantation and hospitalized at the National Cardiovascular Institute Bratislava from January 1, 1998, to January 1, 2010, were retrospectively analyzed. Kaplan-Meier survival analysis was performed. Independent mortality predictors were established using logistic regression analysis. Results One thousand and two pts were eligible for the analysis. The mean age of pts was 49 years, 86.8% were males, NYHA class was 2.6±0.7, and left ventricular ejection fraction was 24.3±7.7%. The etiology of HF consisted predominantly of dilated cardiomyopathy (57%), coronary artery disease (27.5%), and arterial hypertension (7.1%). The most important comorbidities included arterial hypertension (43%), atrial fibrillation (24.6%), diabetes mellitus (25.1%), and anemia (17.2%). Cumulative survival was as follows: 1-year survival 83%, 3-year 63%, 5-year 50%, 7-year 39% and 10-year 23%. HF progression was the cause of death in 55.7% of pts and sudden death in 37.5% of pts. Presence of coronary artery disease, left ventricular diastolic diameter of >79 mm, plasma sodium 2297 pg/mL, intravenous treatment, and furosemide dose at discharge >240 mg/day were independent predictors of 1-year mortality. Conclusions We present a long-term follow-up of a large and selected cohort of pts from a single centre that reflects the course of HF with severe left ventricular systolic dysfunction, barely modified by comorbidities. Mortality of pts with advanced HF still remains high, with 50% of pts surviving 5 years. This cohort represents the pool of potential assist device implant candidates.