PMID- 15820281
OWN - NLM
STAT- MEDLINE
DCOM- 20050831
LR  - 20071115
IS  - 0167-5273 (Print)
IS  - 0167-5273 (Linking)
VI  - 100
IP  - 1
DP  - 2005 Apr 8
TI  - The risk of cardiovascular death in elderly patients with possible heart failure. 
      Results from a 6-year follow-up of a Swedish primary care population.
PG  - 17-27
AB  - Little is known about the prognosis and clinical variables influencing the 
      prognosis among elderly patients in primary health care with mild to moderate 
      heart failure. AIM: To evaluate the risk of cardiovascular mortality in elderly 
      patients with symptoms of heart failure with respect to systolic and diastolic 
      function, and functional impairment. To evaluate prognostic determinants and to 
      risk-stratify the patients. METHODS: A cardiologist examined 510 patients, out of 
      548 invited, attending primary care for symptoms of dyspnoea, fatigue and/or 
      peripheral oedema and assessed New York Heart Association (NYHA) functional 
      class. Examination by Doppler echocardiography was done in 454 patients, 56 
      patients being excluded because of, e.g., atrial fibrillation. Abnormal systolic 
      function was defined as ejection fraction<40%. The diastolic function was 
      evaluated using the mitral inflow and pulmonary venous flow variables. Different 
      clinical and echocardiographic variables were analysed using a Cox regression 
      analysis to identify those most influencing the risk of cardiovascular mortality. 
      CONCLUSION: Abnormal systolic and/or diastolic function was found in 219 patients 
      (48% of the 454 patients who could be echocardiographically completely 
      investigated). The follow-up period was 6 years. Total mortality was 20%, and 
      cardiovascular mortality was 14% (70% of total mortality). Cardiovascular 
      mortality was high in patients with severely impaired functional capacity and 
      ejection fraction<40% at the start of the study. Risk variables identified were 
      male gender, diabetes mellitus, impaired functional capacity and abnormal cardiac 
      function by echocardiography. A prognostic score model using simple clinical 
      variables (gender, NYHA class, cardiac function) was developed to assess the risk 
      of cardiovascular death in order to identify patients with high, moderate or low 
      risk. In a ROC curve analysis, the AUC for clinical variables was only 0.75, 
      whereas the AUC for clinical variables and echocardiography was 0.78, indicating 
      that the additional prognostic information obtained by Doppler echocardiography 
      was rather small.
FAU - Alehagen, U
AU  - Alehagen U
AD  - Department of Cardiology, Heart Center, University Hospital of Linkoping, SE-581 
      85, Linkoping, Sweden. urban.alehagen@ihs.liu.se
FAU - Lindstedt, G
AU  - Lindstedt G
FAU - Levin, L-A
AU  - Levin LA
FAU - Dahlstrom, U
AU  - Dahlstrom U
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Area Under Curve
MH  - Echocardiography, Doppler
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*mortality
MH  - Humans
MH  - Male
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - ROC Curve
MH  - Risk Assessment
MH  - Survival Analysis
MH  - Sweden/epidemiology
EDAT- 2005/04/12 09:00
MHDA- 2005/09/01 09:00
CRDT- 2005/04/12 09:00
PHST- 2003/08/27 00:00 [received]
PHST- 2004/03/05 00:00 [revised]
PHST- 2004/03/05 00:00 [accepted]
PHST- 2005/04/12 09:00 [pubmed]
PHST- 2005/09/01 09:00 [medline]
PHST- 2005/04/12 09:00 [entrez]
AID - S0167527304003109 [pii]
AID - 10.1016/j.ijcard.2004.03.031 [doi]
PST - ppublish
SO  - Int J Cardiol. 2005 Apr 8;100(1):17-27. doi: 10.1016/j.ijcard.2004.03.031.