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A Contemporary Population-Based Perspective

Robert J. Goldberg, PhD; Julia Ciampa; Darleen Lessard, MS; Theo E. Meyer, MD, PhD; Frederick A. Spencer, MD

Arch Intern Med. 2007;167(5):490-496.

Background  Heart failure (HF) is a major public health problem that is associated with substantial morbidity, impaired quality of life, and diminished survival. Despite the considerable prevalence of HF in the United States, there are limited published data describing the contemporary long-term prognosis of patients hospitalized with decompensated HF.

Methods  A total of 2445 residents in the Worcester metropolitan area discharged from 11 greater Worcester hospitals after confirmed acute HF during 2000 comprised the study sample. Follow-up of discharged hospital survivors was carried out through 2005.

Results  The mean age of the study population was 76 years, 43.4% were men, and approximately three quarters had been previously diagnosed as having HF. Among discharged hospital patients, 37.3% died during the first year after hospital discharge, while 78.5% died during the 5-year follow-up period. Several subgroups of patients were at significantly increased risk for dying during the first year after hospital discharge. This included older persons (85 years) (adjusted odds ratio [OR], 2.11; 95% confidence interval [CI], 1.35-3.29), patients with a history of chronic obstructive pulmonary disease (OR, 1.39; 95% CI, 1.15-1.69) or HF (OR, 1.26; 95% CI, 1.00-1.59), and patients with elevated serum urea nitrogen levels during hospitalization (OR, 1.02; 95% CI, 1.01-1.03).

Conclusions  The results of our communitywide study demonstrate the poor long-term prognosis of patients surviving hospitalization for decompensated HF. Despite advances in the therapeutic management of these patients, their long-term survival remains guarded. Efforts are needed to improve the long-term survival of patients with this clinical syndrome.

Author Affiliations: Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester (Drs Goldberg and Meyer and Mss Ciampa and Lessard); Department of Community Health, Brown University, Providence, RI (Dr Goldberg); and Department of Medicine, McMaster University, Hamilton, Ontario (Dr Spencer).

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