Clinical information routinely available during hospitalization can predict risk of death for patients with heart failure, according to an article in the November 19th issue of the Journal of the American Medical Association.

Heart failure generally has a poor prognosis, with 1-year death rates in population-based studies ranging from 35 to 40 percent. Although heart failure is common, few methods help to quantitatively estimate prognosis. In the current study, Douglas S. Lee, MD, and his Canadian colleagues developed a method to predict risk of death at 30 days and at 1 year with use of information on 4,031 patients who had presented with heart failure and who had been identified as part of a study on effectiveness of cardiac interventions.

The researchers found that predictors of death at both 30 days and 1 year included older age, lower systolic blood pressure, higher respiratory rate, higher blood urea nitrogen level, and hyponatremia. Important comorbidity included cerebrovascular disease (43 percent increased risk), chronic obstructive pulmonary disease (66 percent increased risk), hepatic cirrhosis (more than 3 times increased risk), dementia (2.5 times increased risk), and cancer (nearly 2 times increased risk).

A risk index stratified the risk of death and identified low-risk and high-risk individuals. Patients with very low risk scores (60 or less) had a death rate of 0.4 percent at 30 days and 7.8 percent at 1 year. Patients with very high risk scores (greater than 150) had a mortality rate of 59.0 percent at 30 days and 78.8 percent at 1 year. Patients with higher risk scores had reduced survival at all times up to 1 year.

"The risk index provides estimates of risk that may assist clinicians in counseling patients and families and guides clinical decision making," the researchers concluded.