Background: A method for predicting one-year survival of patients with heart failure and reduced ejection fraction (HFrEF) is required to choose a management tactics and determine indications for high-tech care at the outpatient stage.
Aim: To develop a method for proper prediction of survival of patients with HFrEF in outpatient clinics.
Materials and methods: This was a prospective study of 212 patients with functional class II-IV CHF of non-valvular origin and LV EF (Simpson) ≤35 % aged 18-70, including 176 (83 %) men and 36 (17 %) women who had given an informed consent to participate in the study.
Study design: hospitalization to a specialized department for treatment of heart failure; best titration of tolerated doses and stabilization of the patient's condition; evaluation of status; laboratory and instrumental tests; outpatient follow-up by an HF specialist (visits, telephone contacts, therapy adjustment, and admission to a specialized HF department in case of decompensation); 200‑item database population; recording the composite endpoint (cardiovascular death, or implantation of a mechanical circulatory assist (MCA) device, or heart transplantation (HT) within 12 months).
Results: For 12 months, 135 (64 %) patients survived; a MCA device was implanted to 5 (2 %) patients; HT was performed for 21 (10 %) patients; and a fatal outcome was observed in 51 (24 %) patients. Therefore, 77 patients had the composite endpoint. A method for predicting survival was developed using a multiple logistic regression analysis. The developed proper method for survival prediction included the following parameters: age of HFrEF onset; frequency of respiratory movements; systolic blood pressure measured at 3-5 min of orthostasis; lymphocyte count, and red cell distribution width. An identified patient with a predicted survival less than one year should be as soon as possible forwarded to a selection panel for considering HT or MCA implantation as a «bridge» to HT. A predicted survival longer than one year is an indication for further outpatient management and considering cardioverter defibrillator implantation.
Conclusion: The method for proper outpatient evaluation of survival prognosis for patients with HFrEF allows to predict the one-year survival using routine indexes, such as results of objective examination, case history, and blood count, without additional expenses.
Keywords: prognosis, systolic heart failure, high-tech methods of health care, one-year survival.