In a real-world heart failure cohort, the 5-year survival rate was 59.9%, with NYHA class IV (HR 4.79; 95% CI 1.50-15.34) and obstructive sleep apnea (HR 4.43) emerging as strong mortality predictors.
Cohort (n=150)
A real-world Russian HF cohort demonstrated a 5-year survival rate of 59.9% with high early mortality, underscoring the need for early optimization of guideline-directed medical therapy.
BACKGROUND: Despite advances in therapy, data on long-term survival and temporal mortality patterns in real-world heart failure (HF) populations, particularly during the critical early period after diagnosis or clinical destabilization, remain scarce. This study aimed to analyze long-term survival and identify factors associated with mortality in a prospective Russian real-world HF cohort that is relatively underrepresented in the international registry literature. METHODS: A prospective 5-years registry study consecutively enrolled 150 patients with HF in February-May 2018. Participants underwent comprehensive assessment of clinical state, traditional cardiovascular risk factors (RF), psychosocial RF, quality of life, perception of illness, cognitive function, and treatment characteristics. Survival was analyzed using the Kaplan-Meier method, and mortality trends were assessed over time. The Cox proportional hazard model, with calculation of hazard ratio (HR) and 95% coincidence interval (CI), was used for univariate and multivariate regression analyses. RESULTS: The cohort (median age 69 years, 57% male) was elderly and multimorbid, with high prevalence of coronary artery disease (95%), hypertension (91%), and chronic kidney disease (56%). Guideline-directed medical therapy was suboptimal: while beta-blocker and diuretic use was high (87% and 79%, respectively), utilization of aldosterone antagonists and ARNI was low (40% and 0.7%, respectively). Only 32.7% received multicomponent HF therapy. The overall 5-years (0.02-5.09) survival rate was 59.9%. Approximately half (48%) of patients died in the first year, the remaining deaths occurred in 2-nd, 3-rd and 4-th years (15%, 17%, and 20%, respectively), and deaths were recorded during 5-th and 6-th years of follow-up. Kaplan-Meier survival analysis showed that left ventricular ejection fraction (LV EF) was strongly associated with 5-years survival. In patients with reduced and moderately reduced LV EF 5-years survival was significantly lower than that in those with preserved LV EF (50.0% and 45.7% versus 70.4%, respectively). No significant difference was found only when comparing the survival curves of patients with moderately reduced and reduced LV EF (chi-square = 0.014; p = 0.906). The leading cause of death was decompensation of HF (65.2%), followed by sudden cardiac death (15.2%). Multivariate analysis showed that age (HR 1.03 per 1-year increase; 95% CI 1.01-1.06; p = 0.017), weight loss >4.5 kg in 5 days in response to therapy (HR 3.49; 95% CI 1.82-6.68; p < 0.001), anemia (HR 2.83; 95% CI 1.47-5.46; p = 0.002), obstructive sleep apnea syndrome (HR 4.43; 95% CI 1.91-10.28; p = 0.001), and HF NYHA functional class IV (HR 4.79; 95% CI 1.50-15.34; p = 0.008) were independent predictors of 5-years all-cause mortality in HF patients. CONCLUSION: This study identifies a high early mortality phenotype in a real-world HF population, strongly associated with significant gaps in guideline-directed therapy. The findings underscore the urgent need for early aggressive optimization of treatment, particularly in the high-risk period following diagnosis or destabilization of HF, to improve long-term survival.
Pogosova et al. (Tue,) conducted a cohort in Heart failure (n=150). In a real-world heart failure cohort, the 5-year survival rate was 59.9%, with NYHA class IV (HR 4.79; 95% CI 1.50-15.34) and obstructive sleep apnea (HR 4.43) emerging as strong mortality predictors.