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How do heart failure patients die?

S Ørn* and K Dickstein

University of Bergen and Cardiology Division, Central Hospital in Rogaland, Stavanger, Norway

* Correspondence: Dr Stein Ørn, University of Bergen and Cardiology Division, Central Hospital in Rogaland, Stavanger, Norway.

Abstract

Approximately 90% of heart failure patients die from cardiovascular causes. Fifty per cent die from progressive heart failure, and the remainder die suddenly from arrhythmias and ischaemic events. Autopsy reveals the presence of an acute ischaemic event in approximately 50% of sudden deaths and in 35% of all deaths among patients with ischaemic heart failure. An accurate description of the cause and mode of death is important if we are to elucidate the mechanisms that are operative in the heart failure population. At present, the most accurate data on mode of death are obtained from large randomized heart failure trials. They indicate that current treatment strategies for heart failure prolong life expectancy, but have relatively little impact on the proportion of heart failure patients who die from cardiovascular causes. The ultimate goal of intervention is to shift the balance toward more deaths from non-cardiovascular causes.

Key Words: Autopsy • cause of death • classification of death • heart failure • mode of death

References

  1. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302[Abstract]
  2. Priori SG, Aliot E, Blomstrom-Lundgvist C, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J. 2001;22:1374–1450[Free Full Text]
  3. Dickstein K, Kjekshus J. Comparison of the effects of losartan and captopril on mortality in patients after acute myocardial infarction: the OPTIMAAL trial design. Optimal Therapy in Myocardial Infarction with the Angiotensin II Antagonist Losartan. Am J Cardiol. 1999;83:477–481[CrossRef][Web of Science][Medline]
  4. Smith CJ, Scott SM, Wagner BM. The necessary role of the autopsy in cardiovascular epidemiology. Hum Pathol. 1999;29:1469–1479
  5. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353:2001–2009[CrossRef][Web of Science][Medline]
  6. CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999;353:9–13[CrossRef][Web of Science][Medline]
  7. Ziesche S, Rector TS, Cohn JN. Interobserver discordance in the classification of mechanisms of death in studies of heart failure. J Card Fail. 1995;1:127–132[CrossRef][Medline]
  8. Digitalis Investigative Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525–533
  9. Packer M, Bristow MR, Cohn IN, et albehalf of the US Carvedilol Heart Failure Study Group. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med. 1996;334:1349–1355[Abstract/Free Full Text]
  10. Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidlity in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 1992;327:669–677[Abstract]
  11. Uretsky BF, Thygesen K, Armstrong PW, et al. Acute coronary findings at autopsy in CHF patients with sudden death. Results from the ATLAS trial. Circulation. 2000;102:611–616[Abstract/Free Full Text]
  12. Pitt B, Zannad F, Remme WJ, et al, behalf of the Randomized Aldactone Evaluation Study Investigators. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709–717[Abstract/Free Full Text]
  13. SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327:685–691[Abstract]
  14. Johnstone D, Limacher M, Rousseau M, et al, The SOLVD investigators. Clinical characteristics of patients in Studies of Left Ventricular Dysfunction (SOLVD). Am J Cardiol. 1992;70:894–900[CrossRef][Web of Science][Medline]
  15. Litwin SE, Katz SE, Litwin CM, et al. Gender differences in postinfarction left ventricular remodelling. Cardiology. 1999;91:173–183[CrossRef][Web of Science][Medline]
  16. Caroll JD, Caroll EP, Feldman T, et al. Sex-associated differences in left ventricular function in aortic stenosis of the elderly. Circulation. 1992;86:1099–1107[Abstract/Free Full Text]
  17. Ho KK, Anderson KM, Kannel WB, et al. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993;88:107–115[Abstract/Free Full Text]
  18. Simon T, Mary-Krause M, Funck-Brentano C, Jaillon P, The CIBIS II investigators. Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Circulation. 2001;103:375–380[Abstract/Free Full Text]
  19. Schocken DD, Arriata M, Laver PE, et al. Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol. 1992;20:301–306[Abstract]
  20. Adams KF, Sueta CA, Gheorgiade M, et al. Gender differences in survival in advanced heart failure: insights from the FIRST study. Circulation. 1999;99:1816–1821[Abstract/Free Full Text]
  21. Waagstein F, Bristow MR, Swedberg K, et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Lancet. 1993;342:1441–1446[CrossRef][Web of Science][Medline]
  22. Cleland JG, Thygesen K, Uretsky BF, et al, behalf of the ATLAS investigators. Cardiovascular critical event pathways for the progression of heart failure; a report from the ATLAS study. Eur Heart J. 2001;22:1601–1612[Abstract/Free Full Text]
  23. Capewell S, Maclntyre K, Stewart S, et al. Age, sex and social trends in out-of-hospital cardiac deaeths in Scotland 1986-95: a retrospective cohort study. Lancet. 2001;358:1213–1217[CrossRef][Web of Science][Medline]
  24. Khand AU, Gemmell I, Rankin AC, Cleland JGF. Clinical events leading to the progression of heart failure: new insights from a national database of hospital discharges. Eur Heart J. 2001;22:153–164[Abstract/Free Full Text]

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This Article
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