Ten-year prognosis of heart failure in the community: follow-up data from the Echocardiographic Heart of England Screening (ECHOES) study.
Taylor CJ., Roalfe AK., Iles R., Hobbs FDR.
AIMS: This study investigates the 10-year survival in the ECHOES (Echocardiographic Heart of England Screening) study and examines factors associated with prognosis. METHODS AND RESULTS: A prospective study was carried out to investigate 10-year survival in those with heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). The mean age of participants in ECHOES was 64, and 50% were male. Records of all 6162 screened participants were flagged, and deaths up to 25 February 2009 were coded. Causes of death were categorized according to diagnosis on death certificate. Kaplan-Meier curves and log rank tests were used to compare survival times of participants with HF and LVSD in different diagnostic groups. A Cox proportional hazards regression model was used to identify variables associated with risk of death. A total of 2062 of the 6162 (33.5%) participants had died at the census date in February 2009. Of these deaths, 902 (43.7%) were due to cardiovascular disease, including 263 (12.8%) due to HF. Ten-year survival was 75% for participants without HF, 26.7% for those with HF, 37.6% for those with LVSD, and 27.4% for those with HF and LVSD. Multiple-cause HF had a 10-year survival of 11.6%. Multiple variables including diabetes, valvular disease, diuretic use, and a previous label of HF, as well as lifestyle factors such as smoking and obesity, were associated with increased risk of death. CONCLUSIONS: Patients with HF and LVSD have a poor prognosis. However, the mortality rates of all-cause, all-stage HF as measured in the ECHOES cohort are around half those reported for patients diagnosed for the first time with HF during hospital admission.