Differential clinical prognostic classifications in dilated and ischemic advanced heart failure: The EPICAL study

Background The clinical management of severe congestive heart failure (CHF) should be graded according to the prognosis of each individual patient. Ou r objective was to elaborate a prognostic rating system For severe CHF. Methods The EPICAL program (Epidemiologie de I'Insuffisance Cardiaque Avanc ee en Lorraine) identified patients with severe CHF defined by hospitalizat ion accompanied by class III/IV dyspnea, edema, or hypertension; an ejectio n fraction less than or equal to 30% or a cardiothoracic index greater than or equal to 60%. Baseline variables were tested in Cox multivariate models . Results Patients with ischemic heart disease (n = 219) had a lower 1-year s urvival rate (57.6%) than patients with dilated cardiomyopathy (n = 182) (6 9.1%). Multivariate analysis identified 5 prognostic factors for ischemic C HF and 7 for CHF caused by dilated cardiomyopathy. These variables were use d to classify patients within prognostic subgroups of good (>75%), intermed iate, or poor(less than or equal to 25%) 1-year survival. Conclusion A score for prognostic prediction was further derived from readi ly available data ia help physicians improve decision making and to assist in clinical trials as a stratification tool.