| Autor: |
Muñoz MA; Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain.; Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain.; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain., Calero E; Bellvitge University Hospital, Institut Català de la Salut, 08921 Barcelona, Spain., Duran J; Clinica Sant Antoni (Institut Medic i de Rehabilitació), 08038 Barcelona, Spain., Navas E; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain., Alonso S; Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain., Argemí N; Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain., Casademunt M; Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain., Furió P; Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain., Casajuana E; Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain., Torralba N; Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain., Farre N; Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain., Abellana R; Departament de Fonaments Clínics-Bioestadística, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain., Verdú-Rotellar JM; Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain.; Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain.; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain., On Behalf Of Hades Study |
| Abstrakt: |
Background: Information regarding short-term vital prognosis in patients with heart failure at advanced stages of the disease is scarce. Objective: To develop a three-month mortality predictive model for patients with advanced heart failure. Methods: Prospective observational study carried out in primary care and a convalescence community facility. Heart failure patients either New York Heart Association (NYHA) III with at least two HF hospitalizations during the previous six months or NYHA IV with/without previous recent hospitalization were included in the study. Multivariable predictive models using Cox regression were performed. Results: Of 271 patients included, 55 (20.3%) died during the first three months of follow-up. Mean age was 84.2 years (SD 8.3) and 59.8% were women. Predictive model including NT-proBNP had a C-index of 0.78 (95% CI 0.71; 0.85) and identified male gender, low body mass index, high potassium and NT-proBNP levels, and moderate-to-severe dependence for daily living activities (Barthel index < 40) as risk factors of mortality. In the model without NT-proBNP, C index was 0.72 (95% CI 0.64; 0.79) and, in addition to gender, body mass index, low Barthel index, and severe reductions in glomerular filtration rate showed the highest predictive hazard ratios for short-term mortality. Conclusions: In addition to age, male gender, potassium levels, low body mass index, and low glomerular filtration, dependence for activities of daily living add strong power to predict mortality at three months in patients with advanced heart failure. |
