Prognosis of left ventricular dysfunction 1998 in a tertiary care nonuniversity hospital

Background: Prognostic data on heart failure rely on epidemiological studie s or large clinical trials. These data are not to transfer easily on everyd ay practice. Objective: To assess the prognosis of left ventricular dysfunction under th e therapeutic conditions of the 1990s. Setting: Nonuniversity tertiary care hospital. Patients and methods: Since January 1995 consecutive and complete registry of all inpatients presenting with a left ventricular dysfunction (EF < 45 % ). No exclusion criteria. Results: n = 512, mean age 64 years, 77 % male, mean NYHA class 2.5, left v entricular EF 31%. Etiology: 58 % coronary heart disease, 28 % dilated card iomyopathy. Medical treatment consisting of 91 % ACE inhibitors, ACE inhibi tor dosage 52 % of the recommended dose, 42 % beta-blockers, 70 % diuretics , and 63 % digitalis. Follow-up completeness 95.5 %. One-year mortality 64/ 489 patients (13.9 %). Determinants of mortality: NYHA III/IV, EF < 30 %, m alignant disease, age > 75 years. Conclusion: In spite of the aforementioned medical treatment and a proporti on of 14.8 % implanted defibrillators in 1998. the one-year mortality of ve ntricular dysfunction is as high as 13.9 %. In everyday practice the progno stic effect of ACE inhibition and beta-blockade is not completely utilized.