Life expectancy after an index hospitalization for patients with heart failure: A population-based study - 09/08/11

Doi : 10.1016/j.ahj.2007.08.036

Dennis T. Ko, MD, MSc ^a,^b,^⁎ , David A. Alter, MD, PhD ^b,^c, Peter C. Austin, PhD ^b, John J. You, MD, MSc ^b, Douglas S. Lee, MD, PhD ^b,^d, Feng Qiu, MSc ^b, Therese A. Stukel, PhD ^b,^e, Jack V. Tu, MD, PhD ^a,^b,^f
^a Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
^b Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
^c Division of Cardiology and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
^d Division of Cardiology, University Health Network, Toronto, Ontario, Canada
^e Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH
^f Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

^⁎Reprint requests: Dennis T. Ko, MD, MSc, Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5.

Résumé

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.

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Plan

Characteristics of patients with HF in EFFECT

Mortality and life expectancy of patients with HF according to patient characteristics

Mortality rates and life expectancy of all patients with HF according to the EFFECT HF risk score

Mortality and life expectancy of patients with HF with depressed LVEF

Discussion

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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.

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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.