Differential clinical prognostic classifications in dilated and ischemic advanced heart failure:: The EPICAL study

Background The clinical management of severe congestive heart failure (CHF) should be graded according to the prognosis of each individual patient. Our objective was to elaborate a prognostic rating system For severe CHF. Methods The EPICAL program (Epidemiologie de I'Insuffisance Cardiaque Avancee en Lorraine) identified patients with severe CHF defined by hospitalization accompanied by class III/IV dyspnea, edema, or hypertension; an ejection fraction less than or equal to 30% or a cardiothoracic index greater than or equal to 60%. Baseline variables were tested in Cox multivariate models. Results Patients with ischemic heart disease (n = 219) had a lower 1-year survival rate (57.6%) than patients with dilated cardiomyopathy (n = 182) (69.1%). Multivariate analysis identified 5 prognostic factors for ischemic CHF and 7 for CHF caused by dilated cardiomyopathy. These variables were used to classify patients within prognostic subgroups of good (>75%), intermediate, or poor(less than or equal to 25%) 1-year survival. Conclusion A score for prognostic prediction was further derived from readily available data ia help physicians improve decision making and to assist in clinical trials as a stratification tool.