Heart 2000;83:505-510 ( May )

Cardiovascular medicine

Survival of patients with a new diagnosis of heart failure: a population based study M R Cowie^a, D A Wood^a, A J S Coats^a, S G Thompson^b, V Suresh^a, P A Poole-Wilson^a, G C Sutton^a

^a Cardiac Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London SW3, UK, ^b Department of Medical Statistics and Evaluation, Imperial College School of Medicine, Hammersmith Hospital, London W12, UK

Correspondence to: Dr Martin Cowie, Department of Medicine and Therapeutics, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK email: m.cowie{at}abdn.ac.uk

Accepted 31 January 2000

OBJECTIVETo describe the survival of a population based cohort of patients with incident (new) heart failure and the clinical features associated with mortality.
DESIGNA population based observational study.
SETTINGPopulation of 151 000 served by 82 general practitioners in west London.
PATIENTSNew cases of heart failure were identified by daily surveillance of acute hospital admissions to the local district general hospital, and by general practitioner referral of all suspected new cases of heart failure to a rapid access clinic.
INTERVENTIONSAll patients with suspected heart failure underwent clinical assessment, and chest radiography, ECG, and echocardiogram were performed. A panel of three cardiologists reviewed all the data and determined whether the definition of heart failure had been met. Patients were subsequently managed by the general practitioner in consultation with the local cardiologist or admitting physician.
MAIN OUTCOME MEASURESDeath, overall and from cardiovascular causes.
RESULTSThere were 90 deaths (83 cardiovascular deaths) in the cohort of 220 patients with incident heart failure over a median follow up of 16 months. Survival was 81% at one month, 75% at three months, 70% at six months, 62% at 12 months, and 57% at 18 months. Lower systolic blood pressure, higher serum creatinine concentration, and greater extent of crackles on auscultation of the lungs were independently predictive of cardiovascular mortality (all p < 0.001).
CONCLUSIONSIn patients with new heart failure, mortality is high in the first few weeks after diagnosis. Simple clinical features can identify a group of patients at especially high risk of death.


Keywords: heart failure; prognosis; survival; epidemiology

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Survival of patients with a first hospital admission for heart failure

Kate MacIntyre

Online, 9 May 2000 [Full text]