Elsevier

American Heart Journal

Volume 155, Issue 2, February 2008, Pages 324-331
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Life expectancy after an index hospitalization for patients with heart failure: A population-based study,☆☆

https://doi.org/10.1016/j.ahj.2007.08.036Get rights and content

Background

An understanding of the life expectancy of patients with heart failure (HF) may assist in difficult treatment decisions such as placement of an implantable cardioverter-defibrillator or initiation of end-of-life care. However, previous studies have focused on predicting shorter-term mortality and limited data currently exist to predict expected survival among hospitalized patients with HF.

Methods

We studied 9943 patients who were newly hospitalized with HF between 1999 and 2001 in Ontario, Canada. Median survival was calculated using survival analysis and stratified by baseline characteristics and the EFFECT HF risk score. These analyses were repeated for the 1467 patients who had left ventricular ejection fraction of ≤30%.

Results

The average age of our HF cohort was 75.8 years and 50.4% of the patients were female. After a median follow-up of 6 years, hospitalized patients with HF had a 5-year mortality rate of 68.7% and a median survival of 2.4 years. Mortality varied substantially across risk groups such that median survival was only 8 months for patients in the high-risk group and only 3 months in the very high risk group. Similarly, among patients with depressed left ventricular ejection fraction, median survival was only 6 and 3 months in the high- and very high risk groups, respectively.

Conclusions

Prognostic estimations using median survival may improve the ability of physicians to identify subgroups of patients with HF who have limited life expectancy. This information may assist in communicating prognostic information and guiding difficult treatment decisions among hospitalized patients with HF.

Section snippets

The EFFECT project

The EFFECT project is an ongoing initiative to improve the quality of care of patients with cardiovascular disease in Ontario, Canada, and has been described in detail elsewhere.16, 17 Briefly, patients admitted to acute care hospitals with a primary diagnosis of HF from April 1999 to March 2001 were identified in the Canadian Institute for Health Information hospital discharge abstract database using the International Classification of Diseases, Ninth Revision, Clinical Modification code 428.

Characteristics of patients with HF in EFFECT

Baseline characteristics and medication use at hospital discharge are shown in Table I. Our study sample included 9943 hospitalized patients with HF followed for a median of 6 years. The mean age of the overall cohort was 75.8 years and 50.4% of the patients were female (Table I). The area under the receiver operating characteristic curve for the EFFECT HF risk score was 0.76 for 30-day mortality, 0.74 for 1-year mortality, and 0.77 for 5-year mortality, indicating good discriminative ability

Discussion

Many patients with HF in clinical practice are elderly with multiple comorbidities and therefore also face many competing risks of death. In an attempt to provide a better understanding of prognosis and to assist in treatment decisions, we examined the life expectancy of patients after their index hospitalization for HF. We found the life expectancy of patients with HF after hospitalization to be much shorter than that of the general population. For instance, we estimated the median life

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    The EFFECT study was supported by a grant issued to the Canadian Cardiovascular Outcomes Research Team (CCORT) from the Canadian Institutes of Health Research and the Heart and Stroke Foundation. Dr Ko is supported by a clinician scientist award from the Heart and Stroke Foundation of Ontario. Dr Alter is supported by a career investigator award from the Heart and Stroke Foundation of Ontario. Dr Lee is supported by a clinician scientist award from the Canadian Institutes of Health Research. Dr Tu is supported by a Canadian Research Chair in Health Service Research and a Career Investigator Award from the Heart and Stroke Foundation of Ontario.

    ☆☆

    Role of the sponsors: The results and conclusions of this study are those of the authors and should not be attributed to any of the sponsoring agencies.

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