Heart failure is a condition with a poor prognosis: 1-year death rates in population-based studies have been reported to be 35 percent to 40 percent, according to background information in the article. Although heart failure is a common, serious condition treated by both generalist and specialist physicians, few methods exist to help quantatitively estimate patient prognosis. Knowledge of predictors of death could be used to generate predictive models that could aid clinicians' decision making, in particular by identifying patients who are at high or low risk of death, and could be useful for clinicians to improve communication with and care of hospitalized patients.

Douglas S. Lee, M.D., of the University of Toronto, Ontario, and colleagues conducted a study to develop a method to predict the risk of death at both 30 days and 1 year in heart failure patients based on information routinely available to clinicians at the time of admission to the hospital, such as demographic features, vital signs, and other patient conditions. The study included 4,031 patients presenting with heart failure at multiple hospitals in Ontario, Canada, who had been identified as part of the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study.

The researchers found that predictors of death at both 30 days and 1 year included older age, lower systolic blood pressure, higher respiratory rate, higher blood urea nitrogen levels, and hyponatremia (low sodium level in the blood). Other conditions associated with death included presence of cerebrovascular disease (43 percent increased risk of death at 30-days), chronic obstructive pulmonary disease (66 percent increased risk of death), hepatic cirrhosis (more that three times inc
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Contact: Julie Argles
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JAMA and Archives Journals
18-Nov-2003