PROGNOSTIC ASSESSMENT OF END-STAGE CARDIAC-FAILURE

Heart failure is not a disease, but rather a complex clinical syndrome that is growing in incidence and carries a very high morbidity and mo rtality. Although the incidence in the general adult population in the Western world is between 1% and 2%, the frequency increases rapidly i n the elderly affecting more than 10% of the individuals over the age of 75 years. The treatment of patients with end-stage chronic heart fa ilure (CHF) is difficult. The two major goals in the treatment of hear t failure are to increase the duration (slow its progression) and qual ity of life (relief of symptoms). Understanding the severity of the sy ndrome of heart failure in terms of its prognosis can be particularly important in planning long-term management and in counseling the patie nt. The introduction of aggressive interventional therapies such as ac tive haemodynamic support with ventricular assist devices, or heart tr ansplantation emphasizes the importance of quantitating the risk of de ath in order to properly select patients for these more aggressive tre atments, In large-scale trials it has been possible to identify marker s that serve as significant predictors of mortality. Of these, the det ection and quantification of neurohumoral activation have gained the m ost recent attention. Here, we discuss some of the prognostic tools in current use for heart failure patients and their applicability to pat ients with advanced heart failure.