Etiology-specific assessment of predictors of long-term survival in chronic systolic heart failure

Background: We sought to identify prognostic factors of long-term mortality, specific for the underlying etiology of chronic systolic heart failure (CHF). Methods and results: Between 1995 and 2009 baseline characteristics, treatment and follow-up data from 2318 CHF-patients due to ischemic (ICM; 1100 patients) or dilated cardiomyopathy (DCM; 1218 patients) were prospectively compared. To calculate hazard ratios with 95%-confidence intervals cox regression was used. We respectively established etiology-specific multivariable models of independent prognostic factors. During the follow-up period of up to 14.8 years (mean = 53.1 +/- 43.5 months; 10,264 patient-years) 991 deaths (42.8%) occurred. In the ICM-cohort, 5-year-survivalwas 53.4% (95% CI: 49.9-56.7%), whereas in DCM-patients itwas higher (68.1% (95% CI: 65.1-71.0%)). Age, ejection fraction, or hyponatremiawere independent predictors formortality in both cohorts, whereas diabetes, COPD, atrial fibrillation and a heart rate of >= 80/min carried independent predictive power only in ICM-patients. Conclusion: This study demonstrates the disparity of prognostic value of clinically derived risk factors between the two main causes of CHF. The effects of covariables in DCM-patients were lower, suggesting a less modifiable disease through risk factors considering mortality risk. An etiology-specific prognosticmodel may improve accuracy of survival estimations in CHF. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.