Survival of patients with a new diagnosis of heart failure: a population based study

Objective-To describe the survival of a population based cohort of patients with incident (new) heart failure and the clinical features associated wit h mortality. Design-A population based observational study. Setting-Population of 151 000 served by 82 general practitioners in west Lo ndon. Patients-New cases of heart failure were identified by daily surveillance o f acute hospital admissions to the local district general hospital, and by general practitioner referral of all suspected new cases of heart failure t o a rapid access clinic. Interventions-All patients with suspected heart failure underwent clinical assessment, and chess radiography, EGG, and echocardiogram were performed. A panel of three cardiologists reviewed all the data and determined whether the definition of heart failure had been met. Patients were subsequently m anaged by the general practitioner in consultation with the local cardiolog ist or admitting physician. Main outcome measures-Death, overall and from cardiovascular causes. Results-There were 90 deaths (83 cardiovascular deaths) in the cohort. of 2 20 patients with incident heart failure over a median follow up of 16 month s. Survival was 81% at one month, 75% at three months, 70% at six months, 6 2% at 12 months, and 57% at 18 months. Lower systolic blood pressure, highe r serum creatinine concentration, and greater extent of crackles on auscult ation of the lungs were independently predictive of cardiovascular mortalit y (all p < 0.001). Conclusions-In patients with new heart failure, mortality is high in the fi rst few weeks after diagnosis. Simple clinical features can identify a grou p of patients at especially high risk of death.