Objective: To determinate the prognostic value of etiology in patients with chronic systolic heart failure (CSHF).
Methods: Data of in-hospital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei province. All patients were followed up through telephone calls. Univariate and multivariate Cox proportional hazards analyses were then used to explore the differences in the all-cause mortality, heart failure (HF) mortality and sudden cardiac death (SCD) among patients caused by different etiologies. Kaplan-Meier curve were then constructed and Univariate and multivariate Cox regression analyses were used to select demographic and clinical variables in predicting the all-cause mortality, HF mortality and SCD in CSHF patients. Multivariate logistic models and ROC curve were developed with or without the confirmed etiology to assess the incremental additive information related to different etiologies.
Results: (1) Over the median 3 (2 - 4) years follow-up program, 6453 (38.69%) patients died, including 5505 (33.00%) due to HF prognosis and 717 (4.30%) died of SCD. All-cause mortality rates accounted for 34.50%, 54.30%, 41.48% and 15.76%, with HF mortality rates as 30.11%, 44.95%, 36.25% and 13.10%. SCDs accounted 8.46%, 8.45%, 9.84% and 1.05% in patients with CHD, DCM, HHD and RHD, respectively. (2) Compared with RHD patients, the adjusted HRs for all-cause mortality were 1.554 (1.240 to 1.947; P < 0.001), 1.405 (1.119 to 1.764; P = 0.003) and 1.315 (1.147 to 1.467; P = 0.005) while the adjusted HRs and 95%CIs for HF mortality were 1.458 (1.213 - 1.751; P < 0.001), 1.763 (1.448 - 2.147; P < 0.001) and 1.281 (1.067 - 1.537; P = 0.008), in patients with CHD, DCM and HHD, respectively. There were no significant differences in CHD (HR 3.345; 95%CI, 1.291 to 8.666; P = 0.013) or HHD (HR 2.062; 95%CI, 0.794 to 5.352; P = 0.137), while only DCM (HR 4.764; 95%CI, 1.799 to 12.618; P = 0.002) remained significant in SCD despite of the multivariate adjustment. (3) Etiology increased the sensitivity and specificity of predicting models for all-cause mortality (AUC 0.839, 95%CI, 0.832 to 0.845 vs. 0.776, 95%CI, 0.768 to 0.784) and HF mortality (AUC 0.814, 95%CI, 0.806 to 0.822 vs. 0.796, 95%CI, 0.788 to 0.804) but not with SCD (AUC 0.777, 95%CI, 0.749 to 0.809 vs. 0.747, 95%CI, 0.727 to 0.766).
Conclusion: CSHF due to CHD, DCM and HHD carried a worse prognosis than that of RHD. Different etiologies provided significant incremental prognostic information beyond readily available clinical variables for all-cause mortality and HF mortality.