Characteristics of Patients Who Die With Heart Failure and a Low Ejection Fraction in the New Millennium

Therapies for heart failure (HF) with a low ejection fraction (EF) have delayed disease progression and prolonged survival, but the implications of these therapies on the end stages of HF have not been examined. Patients seen by the Brigham and Women's cardiomyopathy service with an EF ≤35%, at...

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Bibliographic Details
Published in:Journal of cardiac failure 2006-02, Vol.12 (1), p.47-53
Main Authors: Teuteberg, Jeffrey J., Lewis, Eldrin F., Nohria, Anju, Tsang, Sui W., Fang, James C., Givertz, Michael M., Jarcho, John A., Mudge, Gilbert H., Baughman, Kenneth L., Stevenson, Lynne W.
Format: Article
Language:English
Subjects:
Cardiac Output, Low - complications
Cardiac Output, Low - mortality
Cardiac Output, Low - physiopathology
Death, Sudden, Cardiac - epidemiology
Death, Sudden, Cardiac - etiology
Female
Hospital Mortality
Hospitalization
Humans
Hyponatremia
Hyponatremia - etiology
Incidence
Male
Middle Aged
Outpatients
Renal insufficiency
Renal Insufficiency - etiology
Retrospective Studies
Stroke Volume
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Summary:Therapies for heart failure (HF) with a low ejection fraction (EF) have delayed disease progression and prolonged survival, but the implications of these therapies on the end stages of HF have not been examined. Patients seen by the Brigham and Women's cardiomyopathy service with an EF ≤35%, at least 1 outpatient visit or at least 30 days of follow-up who died between January 1, 2000, and October 20, 2003, were evaluated retrospectively. Of the 160 patients who died since 2000, 80 (50%) were outpatients. In the 6 months before death, 93% of patients had New York Heart Association (NYHA) class III or IV symptoms. The NYHA class, clinical characteristics, medications, and comorbidities differed little between inpatient and outpatient deaths. Renal insufficiency and hyponatremia were worse in the months preceding death than at the time of death (creatinine: 3.2 versus 2.3 mg/dL, P < .0001; sodium: 128 versus 135 mmol/L, P < .0001, respectively). Death was considered sudden in only 21% of patients. Deaths in the current era of HF management occur in patients with long-standing HF characterized by biventricular dysfunction and advanced symptoms. Most deaths are heralded by hyponatremia, acute on chronic renal insufficiency, and frequent hospitalizations.
ISSN:1071-9164
1532-8414
DOI:10.1016/j.cardfail.2005.08.001