A multivariate model for predicting mortality in patients with heart failure and systolic dysfunction

Am J Med. 2004 Mar 1;116(5):300-4. doi: 10.1016/j.amjmed.2003.09.035.


Background: Heart failure is a leading cause of morbidity and mortality, but there are no reliable models based on readily available clinical variables to predict outcomes in patients taking angiotensin-converting enzyme (ACE) inhibitors.

Methods: A multivariate statistical model to predict mortality was developed in a random sample (n = 4277 patients [67%]) of the 6422 patients enrolled in the Digitalis Investigation Group trial who had a depressed ejection fraction (<or=45%), were in sinus rhythm, and were taking ACE inhibitors. The model was then validated in the remaining 2145 patients.

Results: Total mortality in the derivation sample was 11.2% (n = 480) at 12 months and 29.9% (n = 1277) at 36 months. Lower ejection fraction, worse renal function, cardiomegaly, worse functional class, signs or symptoms of heart failure, lower blood pressure, and lower body mass index were associated with reduced 12-month survival. This model provided good predictions of mortality in the verification sample. The same variables, along with age and the baseline use of nitrates, were also predictive of 36-month mortality.

Conclusion: Routine clinical variables can be used to predict short- and long-term mortality in patients with heart failure and systolic dysfunction who are treated with ACE inhibitors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Cardiotonic Agents / therapeutic use
  • Digoxin / therapeutic use
  • Female
  • Heart Failure / complications
  • Heart Failure / drug therapy
  • Heart Failure / mortality*
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Multivariate Analysis
  • Proportional Hazards Models
  • Stroke Volume
  • Survival Rate
  • Systole
  • Ventricular Dysfunction, Left / complications*


  • Angiotensin-Converting Enzyme Inhibitors
  • Cardiotonic Agents
  • Digoxin