Risk stratification in a Brazilian hospital-based cohort of 1220 outpatients with heart failure: role of Chagas' heart disease

Few studies evaluated prognostic factors of outpatients with heart failure of different etiologies including Chagas' heart disease. We studied 1220 outpatients with heart failure in functional classes III and IV (NYHA) to evaluate prognostic factors. Patients aged 13–72 years (mean 45.5, standa...

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Bibliographic Details
Published in:International journal of cardiology 2005-07, Vol.102 (2), p.239-247
Main Authors: Freitas, Humberto F.G., Chizzola, Paulo R., Paes, Ângela T., Lima, Antonio C.P., Mansur, Alfredo J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Brazil - epidemiology
Cardiac Catheterization
Cardiology. Vascular system
Chagas Cardiomyopathy - complications
Chagas Cardiomyopathy - diagnosis
Chagas Cardiomyopathy - mortality
Chagas' heart disease
Echocardiography, Doppler
Electrocardiography, Ambulatory
Female
Follow-Up Studies
Heart
Heart failure
Heart Failure - diagnosis
Heart Failure - etiology
Heart Failure - mortality
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Hospital Records
Human protozoal diseases
Humans
Infectious diseases
Male
Medical sciences
Middle Aged
Outpatients
Parasitic diseases
Prognosis
Proportional Hazards Models
Protozoal diseases
Radionuclide Ventriculography
Retrospective Studies
Risk Assessment
Risk Factors
Risk stratification
Survival Rate - trends
Trypanosomiasis
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Summary:Few studies evaluated prognostic factors of outpatients with heart failure of different etiologies including Chagas' heart disease. We studied 1220 outpatients with heart failure in functional classes III and IV (NYHA) to evaluate prognostic factors. Patients aged 13–72 years (mean 45.5, standard deviation 11); 952 men (78%) and 268 women (22%) were followed up for 25.6±26 months from 1991 to 2000. Heart failure was attributed to idiopathic dilated cardiomyopathy in 454 (37%) patients. Etiologies were Chagas' heart disease in 242 (20%) patients, ischemic cardiomyopathy in 212 (17%), hypertensive cardiomyopathy in 170 (14%) and others in 142 (12%). Statistical analyses were performed with Kaplan–Meier and Cox proportional hazards methods, following a strategy of noninvasive model as well as in an invasive model to identify the risk of death. Four hundred fifteen (34%) patients died in the follow-up period, 71 (6%) patients underwent heart transplantation and 28 (2%) underwent other surgical interventions. In the noninvasive model, Chagas' heart disease (relative risk compared with other etiologies 2.26 to 2.97), left ventricular end diastolic diameter on echocardiography (relative risk 1.13) and left ventricular ejection fraction on radionuclide angiography (relative risk 0.96) were associated with higher mortality. In the invasive model, Chagas' heart disease (relative risk compared with other etiologies 2.66 to 9.13) was the most important determinant of mortality in association with the cardiac index (relative risk 0.40). In this cohort of patients with heart failure of different etiologies, Chagas' heart disease was the main prognostic factor for mortality.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2004.05.025