Chapter

Prognostication

Roy S. Gardner

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0025

Series: Oxford Textbooks

Prognostication

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Recent advances in medical therapy, notably angiotensin converting enzyme (ACE) inhibitors, β -adrenoreceptor antagonists, and aldosterone antagonists, as well as device therapy have improved that prognosis such that even in patients with chronic heart failure (CHF) who are in New York Heart Association (NYHA) class IV, the annual mortality can be as low as 9.7%. Nevertheless, many patients do not respond to medical therapy and remain symptomatically very limited with a poor prognosis. It is for such patients that cardiac transplantation and ventricular assist devices are options. However, identifying such patients is one of the great challenges of HF management.

The 1-year mortality following cardiac transplantation is approximately 19%. The selection of candidates for cardiac transplantation is therefore heavily involved with identifying those patients whose annual mortality from HF exceeds this rate and who might therefore benefit prognostically from a transplant. There are over 300 prognostic markers described in patients with HF, the most significant of which are shown in Table 25.1. Many studies have been carried out looking at clinical, haemodynamic, and neurohormonal variables to assist with risk stratification, although it is important to look at such data in the context of the latest disease-modifying therapy. The traditional markers, including left ventricular ejection fraction (LVEF) and the peak oxygen uptake (pVo2), consistently offer useful prognostic information, although scoring systems involving a combination of markers have also been developed. More recently, neurohormones have been shown to demonstrate the greatest prognostic potential in identifying patients at the greatest risk of an adverse outcome.

Chapter.  11127 words.  Illustrated.

Subjects: Cardiovascular Medicine

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